Organizational Systems and Quality Leadership
A1. Country to Compare
A comparison of the healthcare systems in the United States to those in Great Britain.
In the United States, we require all citizens to carry health insurance or pay a fine on their income taxes. Citizens whom are unemployed or are considered low-income may qualify for Medicaid. The government funds Medicaid and provides health insurance at low cost or no cost. Childrens Health Insurance Program (CHIP) is also available for low- or no-income families. For individuals over the age of 65 (retired) Medicare is available. The government funds Medicare and has two different plans to choose from traditional and Medicare Advantage. With traditional Medicare you pay a deductible before Medicare will pay the claim from the provider. It also requires the individual to pay a monthly premium. Medicare Part A covers skilled nursing facilities, hospice, and inpatient hospital stays. Part B includes routine doctors visits, vaccinations, and medical supplies. Medicare Advantage is similar to traditional insurance like an HMO or PPO. Medicare Advantage includes Part A and Part B. With both Medicare and Medicaid, the individual still may have a co-pay, which is a set amount provided by the provider for the services rendered (Commonwealth fund). Great Britain healthcare is free. England has the National Health Service (NHS) which allows individuals to seek emergency and preventative care. The funding for insurance comes from taxes. As long as the citizen is born in England, they have access to free healthcare regardless if they are employed or not. There is no monthly premium or co-pays. Primary care is delivered by a general practitioner or gate keeper (Commonwealth Fund).
A2A. Coverage of Medications
In the United States your health insurance provider generally covers a portion of your cost of medications. The portion you are left to pay is the co-pay. Low-income households whos insurance is Medicaid their prescriptions may be free depending on their income; or they may have a co-pay. Citizens who have Medicare have to buy into another insurance through Medicare which is Medicare Part D. Medicare Part D requires a monthly premium, and it still requires members to pay a co-pay to the pharmacy. However, in England if a patient is admitted to the hospital it covers all prescription medications. If the individual is needing outpatient medications, they are then subject to co-payments. Children whom are under the age of 15 or children whom are 16-18 and are in school full time are exempt from co-pays. Also, people whom are 60 or older, low-income, pregnant or have cancer their medicati...