Organizational Systems and Quality Leadership
Good organization systems and quality leadership are the basic factors that determine effective healthcare delivery in both distinct countries and health care organizations. Leadership is a contributing factor that shapes health care systems across different nations. Besides, leadership, as depicted by Obamacare in the US, significantly influences the payment system of any health care center (Nica, 2015). With respect to payment systems, insurance plans and price control vary within different countries. Therefore, the essence of this exposition is to compare two health care systems that vary in terms of services and leadership. According to Nica (2015), by benchmarking on countries with the best health care system, a government can learn some of the strategies necessary to embrace in achieving an effective system that suits its economy. For this paper, Germany and the United States will be compared in terms of how their payment of health funds and other properties vary.
Comparison of United States Health Care with Germany
Germany is known globally for its efficient health care system, which comfortably accommodates the needs of its citizens. The main reason behind its effectiveness is the payment plans enacted for safeguarding the welfare of its citizens. Germany has two hundred and forty enacted insurance plans, which are aimed at providing flexible and quality care. Such funds are regulated by the Germany government and are not allowed to go beyond a particular limit to protect citizens from the possible exploitation from insurance companies. The sickness fund is mandatory for every citizen in Germany, which differentiates it with that of the US (PubMed Health, 2015). The government shares the cost of paying for these funds by paying half and deducting the remaining half from the employee’s salary.
The health coverage in Germany covers some of the health care services such as dental, vision care, and mental health care services. On the contrary, the healthcare coverage in the US comes from both the private sector and public sector. Unlike in Germany, US health care is considered complicated even though the government strives to fill in the gaps within the system. As such, public insurance is provided through programs such as Medicaid and Medicare. In 2010, the US introduced Obamacare, which was in an insurance plan aimed at covering the health welfare of all Americans (Tate, 2012). It was designed in such a way that Americans who lived in low economic conditions and had their employees not paying for medical coverage were insured by this program. The Obamacare is an example of a healthcare program shared among employers, employees, and government. Obamacare serves as a platform for supplementing the price of good health insurance. One of the differences between this system in the US and Germany is that the Obamacare did not cover all the US citizens appropriately, hence, had a coverage gap (Tate, 2012). In this coverage gap, some community groups that differed with others in terms of color and ethnicity were not included. Such an instance is the Black Americans who were not fully covered by this health care systems.
Some of the categories of people covered under Medicare program in the US include individuals over the age of sixty-five years and people diagnosed with diseases such as renal illness. The Medicare program received funding from governmental funds, premiums, deductibles, and deduction from salaries of employees (Tate, 2012). This health care program is intended at covering low earners, although it has a disadvantage in failure to cover some age brackets such as children. Children’s health care is covered under Children Health Insurance Plan, which receives funding from the United States federal funds.
Comparison of Health Care Access between Germany and US
The choice of physician access and the benefits provided between different categories of people varies between the two nations. As previously stated, Germany has one of the best health care systems as depicted from the health care access services offered to its citizens. The citizens have the choice of going to any physician, hence, the issue of quality health care access is highly upheld due to preferences of treatment from quality approved physicians (Gaynor & Town, 2015). Moreover, all the citizens are covered in their entire lifetime to enjoy health care benefits regardless of their age groups of background status (PubMed Health, 2015). Unlike in Germany, citizens are restricted in the US to the type of health care provider to offer services based on the private insurance network. Based on this type of insurance network, citizens possess a range of enlisted health care services providers who can cater for their health services in case a need arises.
Coverage for Medications in the two Healthcare Systems
According to PubMed Health (2015), the medication prices in Germany are regulated based on the sickness funds. As such, pharmaceutical companies cannot set prices beyond the set price by the government as a way of safeguarding citizens to purchase affordable health care products and services (Gaynor & Town, 2015). On the contrary, prices are set by drug companies in the US; hence, they may at times be uneconomical for the citizens due to lack of a well-stated way of controlling these prices. However, the insurance coverage controls payment of drugs where people who are not insured tend to pay a greater amount of money for the drugs unlike people under the insurance coverage. The US healthcare system provides a Medicare that caters for a percentage of money paid on prescription drugs (Burwell, 2015). For citizens who are not covered under this Medicare plan, no discounts are subjected on the price of bought drugs, hence, such individuals buy them under the standard market rates.
The drugs prices vary in the United States where generic drugs are offered at the most affordable price rate (Burwell, 2015). The mid-level drugs follow, and the top level drugs which are covered by most insurance companies are the most expensive. They include prescriptions drugs such as analgesics, antihypertensive, and antibiotics. Depending on insurance cover, a specific amount is paid to cover each level of drugs per month as chosen by the payer.
Requirements to get a Referral to see a Specialist in the Two Healthcare Systems
The effectiveness of the health care system in Germany is further depicted in the lack of need for a referral to see a professional. To see a specialist, one only needs to make an appointment, and the necessity of possessing a referral is eliminated (PubMed Health, 2015). In the US, having such a privilege as portrayed in Germany leads to paying off more funds. As such, individuals ought to be covered under US Preferred Provider Organization plan (PPO) to have the freedom of seeing specialists without a referral (Tate, 2012). However, people under this plan pay more finances to do away with the need for paying for a referral in case of a need for seeing a specialist. People covered by the Health Maintenance Organization plans (HMO) have to pay for a referral before seeing a specialist. Moreover, this is disadvantageous because people covered by this plan are only capable of seeing specialists with HMO network provider (Tate, 2012). Therefore, the programs in the US are not only cumbersome regarding payment for services, which are free in Germany, but are also limiting since the plan an individual is covered under dictates the type of specialists these individuals can see.
Coverage for Preexisting Conditions in the two Healthcare Systems
The private insurance companies in Germany cover most of the preexisting conditions (PubMed Health, 2015). As part of the basic coverage, the statutory insurance in Germany covers the pre-existing health care conditions. However, the private insurance is offered at a higher rate hence may negatively affect the pre-existing conditions. On the other hand, Obamacare in the US covers for all the pre-existing conditions at no cost (Tate, 2012).
Financial Implications for the Patient about the Healthcare Delivery Differences
In Germany, every person is given the same health care without discrimination based on age, gender or ethnicity. This health care is offered regardless of the payment made for insurance. The health care is Germany is more affordable as compared to that in the US because there are no deductibles from the employees’ payroll (PubMed Health, 2015). The public funds are used in Germany for managing payment of sicknesses. As such, the charges are kept at a standard rate by the government hence they are economical making it easy for every citizen to easily access good health care. On the contrary, the health care services in the US are set by the health care providers with no limit established to regulate a standardized pay. According to Gaynor and Town (2015), citizens may run bankrupt while paying for health care services because high prices are set for quality health care service. To benefit from quality health care, citizens have to spend beyond their regular budget.
Due to financial pressure in the US, citizens are at times forced to take unrecommendable dosage. Instances of citizens not affording to purchase the right dosage of prescription drugs may lead to under dose that obviously affects the treatment process. On the other hand, patients may lack the needed care in nursing facilities dues to an exhausted Medicaid pay. As such, citizens are expected pay for such Medicaid plan once it is exhausted which becomes costly (Burwell, 2015). In essence, the health care payment plan in Germany is more considerate of the needs and preferences of citizens unlike that of the US. Prices in Germany are standardized to suit the economy of the nation and the average budget of citizens (PubMed Health, 2015). Although there are many improvements in US health care system, much is still needed to be done to match efficient systems of a country such as Germany.
Conclusion
Based on the comparison of the health care systems in both Germany and United States, it is evident that leadership shapes the health care delivery system. The funds plans enacted in Germany shape the effectiveness of the services offered in the nation. Such plans are implemented through good governance by leaders. Although United States has a health care system which cannot be compared with that of Germany, its previous leaders such as Obama have contributed in shaping of the healthcare system. Obamacare has so far helped in shaping the healthcare delivery system of US by standardizing the health care service prices. With good governance the health care system of US can be improved to meet the evolving financial needs of United States. Setting of standardized prices by emulating Germany can help minimize the prices charged on prescription drugs and health care services in United States.
References
Burwell, S. M. (2015). Setting value-based payment goals—HHS efforts to improve US health care. N Engl J Med, 372(10), 897-899.
Gaynor, M., Ho, K., & Town, R. J. (2015). The industrial organization of health-care markets. Journal of Economic Literature, 53(2), 235-284.
PubMed Health, (2015). Health care in Germany: Health insurance in Germany National Library of Medicine PubMed Health. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0078017/
Nica, E. (2015). Moral leadership in health care organizations. American Journal of Medical Research, 2(2), 118-118.
Tate, N. J. (2012). ObamaCare Survival Guide: The Affordable Care Act and What it Means for You and Your Healthcare. West Palm Beach, FL: Humanix Books.
