Comparison of Healthcare Systems in the US and Great Britain, Thesis of Cost Accounting

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Task 3 Western Governors University Organizational Systems and Quality Leadership

Task 3 A. Compare the U.S. with another country A1. Identify Country This paper will compare Great Britain’s healthcare system to that of the United States. A2. Compare Access The people of Great Britain receive free health care from the National Health Service (NHS) and this is public coverage. There are about 10.5 percent of people that also carry private coverage to have quicker access to elective health care (The Commonwealth Fund, 2020). In the United States children are either covered under their parent’s private insurance or if they come from a low-income family, they are covered under Medicaid or the Children’s Health Insurance Program (CHIP). The unemployed may receive coverage from Medicare if they are disabled, Medicaid if they are low or no incomeandif they are a veteran from the VA. People who are retired may purchase a supplemental insurance plan and if they are 65 or older, they would be covered under Medicare (The Commonwealth Fund, 2020). A2a. Medication Coverage In Great Britain medications are covered 100 percent for much of the population including: children, low-income individuals or families, pregnant women and people over the age of 60. Other patients have copayments for their prescriptions and participate in cost-sharing (The Commonwealth Fund, 2020). In the United States prescription drugs are covered under most insurance plans. People covered by Medicare need to purchase private or Part D drug plans to help cover the costs of their prescription medications. Insurance companies negotiate prices with drug manufacturers.

Generic medications are typically favored over name brand and there are typically deductibles that apply (The Commonwealth Fund, 2020). A2b. Specialist Referral In Great Britain everyone has the NHS public insurance coverage with some having an additional private insurance coverage. Patients must see their primary general practitioners (GPs)who are also called “gatekeepers”to get a referral for a specialist. If the GP is not able to manage the reason that the patient is seeking a specialist then they will most likely make a referral. Gatekeepers are in place to help the specialist save their time and efforts for patients that are more complex (Greenfield et al., 2016). In Great Britain they provide excellent preventative care and gatekeepers get paid bonuses for keeping their patients healthy (Palfreman et al., 2008). In the United States it depends on the type of insurance plan you have if you need a referral to see a specialist or not. There are Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs). People who have an HMO insurance plan must see their primary care provider first and if they can’t treat the problem then they will make a referral to a specialist in the same network. People who have a PPO insurance plan can see a specialist without seeing their primary care provider and they don’t have to stay in network (Ramsey, 2020). A2c. Pre-existing Conditions The people of Great Britain receive NHS public insurance coverage from birth and this covers pre-existing conditions. There are some private insurance companies that exclude emergency care, general practice, maternity services and mental health (The Commonwealth Fund, 2020).

In the United States marketplace insurance plans cannot reject a person with pre-existing conditions. They also cannot charge people more for having pre-existing conditions. There is an exception to this rule and that applies to “grandfathered” plans. Grandfathered plans are individual health insurance policies that were bought for an individual or their family on or before March 23, 2010. People would need to purchase a different insurance plan to receive coverage for pre-existing conditions (Assistant Secretary for Public Affairs (ASPA), 2017). A3. Financial Implications In Great Britain under NHS, most patients will never pay a medical bill, co-pays or deductibles (Palfreman et al., 2008). Most patients don’t have to pay for prescription medications and patients that do can purchase prepayment certificates. They buy certificates that can be good for up to 12 months and cost around $150 dollars. Patients can receive an unlimited number of prescriptions while the certificate is valid (The Commonwealth Fund, 2020). In the United States people may struggle with paying their insurance premiums just to have coverage and some go uninsured. All of the different insurance companies vary on what they will cover and how high their deductibles are (The Commonwealth Fund, 2020).A diabetic may have to go see their doctor four times a year, get labs drawn and prescriptions. All this adds up quickly with office co-pays, cost of diagnostic tests and prescription co-pays. Back in March 2016, the average cost of a month supply of insulin in the United States was $360 compared to $65 in Great Britain. This may cause people to start rationing their insulin which may cause them to end up in the hospital or worse dead (Prasad, 2019).

References Assistant Secretary for Public Affairs (ASPA). (2017, January 31). Pre-existing Conditions. HHS.gov. Retrieved February 6, 2021, fromhttps://www.hhs.gov/healthcare/about-the aca/pre-existing-conditions/index.html. Greenfield, G., Foley, K., & Majeed, A. (2016, September 23). Rethinking primary care’s gatekeeper role. Retrieved February 6, 2021, from https://www.bmj.com/content/354/bmj.i Palfreman, J. (Producer and Director) & Reid, T.R. (Co-writer). (2008). Sick around the world. [Television series episode]. In Mangini, T, (Director) Frontline. Arlington, VA: PBS. Retrieved from https://www.pbs.org/wgbh/frontline/film/sickaroundtheworld/ Prasad, R. (2019, March 14). The human cost of insulin in America. Retrieved February 6, 2021 from https://www.bbc.com/news/world-us-canada-47491964. Ramsey, D. (2020, April 28). HMO vs PPO: Which is Right for You? daveramsey.com. Retrieved February 6, 2021, fromhttps://www.daveramsey.com/blog/hmo-vs-ppo. The Commonwealth Fund (2020). International Healthcare System Profiles. Retrieved February 6, 2021, from https://international.commonwealthfund.org/