Healthcare Utilization and Finance
Introduction
It is essential that nurses understand the issues related to healthcare financing, including local, state, and national healthcare policies and initiatives that affect healthcare delivery. As a patient advocate, the professional nurse is in a position to work with patients and families to access available resources to meet their healthcare needs.
Requirements
A 1. Country to Compare
Compare the U.S. healthcare system with the healthcare system of Japan
A2. Access
Compare access between the two healthcare systems for children, people who are unemployed, and people who are retired.Be sure to address all of the populations separately: children, unemployed, retired. Discuss the government or private healthcare plans that cover specifically these 3 groups of citizens for each country. You do not have to include any other groups, but you must respond for children, unemployed, and retired.
A2A.Medication Coverage
Discuss coverage for medications in the two healthcare systems.
A2B. Specialist Referral
Determine the requirements to get a referral to see a specialist in the two healthcare systems.1. Describe the referral process to see a specialist based upon the plan type for each country. 2. Consider: United States – HMO vs PPO 3. Discuss both countries 4. Consider discussion of “Gatekeeperâ€
A2c. Preexisting Conditions
Discuss coverage for preexisting conditions in the two healthcare systems.1. Discuss if pre-existing conditions are covered based upon the plan type for each country. 2. Healthcare.gov, click “see topicsâ€
A3. Financial Implications
Explain two financial implications for patients with regard to the healthcare delivery differences between the two countries (i.e.; how are the patients financially impacted).1. Discuss out-of-pocket expenses, financial risks, or cost savings for the citizens based upon their healthcare system. 2. Compare two implications
B. Acknowledge sources, using in-text citations and references, for content that is quoted, paraphrased, or summarized.
C. Demonstrate professional communication in the content and presentation of your submission.
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