Healthcare Organization Management and Systems

Health care organization management and system is the docket in the health care system that leads and provides directions to the health care organizations that. The health care system management traverses all the divisions, units, or departments that form the organization. Health care organizations are so dynamic and complex. Health organizations nature requires managers to supervise and coordinate employees as well as the provision of leadership. Globally different healthcare organizations have got similarities and differences in the modes of decision making and management of their system. The differences and similarities lie on reimbursement methodologies, rationing, and prioritization of care, medical records technologies, access to health care services. Other comparisons and contrasts in the healthcare system are in diagnostic and therapeutic use and ways of healthcare delivery assessment by the government in relation to health care policy. The paper provides a detailed description of the comparisons and contrasts of the health care systems of Japan to that of the USA.

The medical services reimbursement to any health care provider in Japan is primarily based on fee-for-service basis. Attempts are being made to start pay-for-performance to help improve the value of healthcare service provision. Japan uses many methodologies to contain health care costs. These include regulations on supply-side price; this advocate for reviewing healthcare products costs after two years. Co-payments, here the users of the service pay 30% of the medical price set by the government where 10%  goes to long term care and 70% reimbursed by the insurance.  The Co-payment of 30% caters for all the medical fees, be it prescription drugs, outpatient or inpatient. In extreme situations where the medical price surpasses threshold payment, it is lowered to 1% and the remaining covered by the insurance. The last methodology is Physician’s guidelines on medical treatment.

The USA healthcare system uses two types of reimbursement methodologies different from the Japanese reimbursement method. These are fee- for service and episode for care reimbursement. Fee-for-Service is a method of healthcare payment in the USA where providers are paid for each service rendered. After the provider has calculated the cost of the services provided the claim is transferred to the insurance company that pays for the charges. The types of fee-for-service reimbursements include retrospective payment, managed care and self-pay.  The second methodology for healthcare reimbursement in the US is Episode for Care, where lump-sum reimbursement is made to the healthcare providers for the service provided. The types of Episode for Care treatment include prospective payment, global payment, and capitated payment. Potential payment is based on the calculation of the services provided in advance; global payment combines pays for the services offered by different health facilities on a given episode. The capitated payment is a fixed payment given to the service providers by the insurance company within a given period.  Therefore, the USA uses pay- for -performance while Japan uses free-for service basis of reimbursement. The last difference is that Japan uses supply-side price which reviews prices of healthcare products after two years while the USA only reviews the insurance cover fees. The similarity in health system reimbursement in Japan and the USA is that they both use insurance companies to make their reimbursements.

The access to medical care and services in Japan is provided by two major entities either by national or regional hospitals or private hospitals. In Japan, any patient has universal access to any health care facility however most healthcare facilities charge a high price to those who have not been referred. The hospitals with one doctor specialized in treating a given disease requires same day appointments but not reservations. Several ambulances are in place in most of the Japanese health center centers ready to ferry patients with significant health complications to the hospitals.  The health care system of Japanese does not cover contact lenses but can only do so to children if recommended by physicians. Health insurance covers preventive measures like counseling, health education, and screening while long term insurance covers services of home care. Programs of national insurance cover only the following services as legalized by Japanese laws. Dental operations, vaccines, Obstetrics, Contraception’s, medical treatments that result from fights cosmetic surgery, medical checkups among others. Everyone in Japan including residents and the citizens receives universal health care.

On the contrary, the data from Healthy People Midcourse Review shows that there exists a significant disparity in America in the access of health care based on ethnicity, race, education, age, sex, and family income. The access to care disparities in the USA exists in all levels including dental insurance and health. Disparities also exist in geographical locations.  Shortages of the workforce make several Americans inhabiting rural areas to access health care. The number of ambulances that ferries the sick to the hospitals in the USA is low as compared to the number in Japan. The number of people visiting hospitals for care services is also reduced due to the disparities in access to health care. Japan offers Universal health care to all citizens while the USA only provides it to specific groups of people. The similarities between the health care systems are that they both provide elderly care services. The number of people enrolled in the insurance scheme for health care service provision has gone high in both Japan and the USA. Both the health insurances only cover specific diseases as outlined by the laws of the country for example both the systems do not provide contact lenses unless recommended a physician.

Japan prioritizes and rations its health care by operating the free- for- the service system. The government rations the healthcare fee system by using a fee schedule which revises the fee for healthcare services after every two years with the aim of controlling the prices of the country’s care. The other means the state had prioritized the care system was coined in the year 2000 when the long term care insurance system took over the care of the elderly people.  The government prioritized this to reduce the families the burden of healthcare towards the elderly.  At the age of 65 years, the elderly starts receiving the social care support which mostly done at the care homes.  The scheme also prioritizes on those who have dementia which mostly attacks the aging.

The differences in prioritizing and rationing of health care are that the Japanese government has prioritized on rationing healthcare fee by reviewing it after every two years which is not in the USA. The other difference is that in the USA those who are poor are provided access to Medicaid restricted by asset and income limits whereas in Japan everyone is given universal medical care. The similarities that Japan Healthcare shares with the USA in prioritizing and rationing health care service is that,  both the countries use long term insurance to take care of the aging population from the age of 65  years. Both the countries have prioritized on taking care of the aged by sharing the pay with the families paying a lower amount as the government pays the most considerable portion. The other similarity is that both the countries have prioritized on co-payment of the health insurance covers to help the deserving citizens receive treatment.

In the healthcare record management, roughly 25% of health care facilities in Japan with more than 400 beds have introduced the technology of Electronic Health Records System (EHRs) in managing the patient’s database.  The EHRs in Japan has helped in the reduction of medical mistakes, costs of data management and enhanced medical care. The adoption of modern technology of EHRs has been so slow in hospitals in Japan because of its expensive nature. Its adoption has become very challenging to hospitals with less than 100-bed capacity.

The USA is also using Electronic Health Records System to manage the health records of most hospitals to avoid health mistakes and to improve medical care which is similar in Japan. The adoption of the new technology has similarly been hectic for both the USA and Japan hospitals. The only difference in EHRs adoption is that the USA has adopted it at a slightly higher Percentage of 10% as compared to the 6% adoption in Japan hospitals.

The diagnostic and therapeutic methods used in Japan include administering or injecting medicine to inhibit or cure a disease. They also use preventive and physical therapy methods against diseases such as the use of fluoride to prevent tooth decay. The methods for diagnosis used by Japan include measuring the internal organ’s shape. They also detect diseases by measuring the external and internal conditions of the patient.

The similarity is that USA health care systems employ all these kinds of therapeutic and diagnostic methods used in Japan.  There only exist very few differences due to the expansive nature of US technology. The differences in therapeutic and diagnostic methods that are used by the US include performing procedures below the dermis, administering substances not only through injection but also by inhalation and applying the recommended energy in the diagnosis and therapy.

The government of Japan assesses the health care delivery according to health policy by the use of Diagnosis Procedure Combination (DPC).  This is a payment system that gives information to the government about healthcare costs; performance and the length a patient stayed in the hospital. The device helps in the improvement of the standards of healthcare and transparency. It helps the government to assess the treatment information, the practitioner’s delivery and the disparities existing between hospitals. The device payment mode involves flat-rate fee payment to providers per day for the inpatient stay. The information is compared against the health policy for action where necessary.

The differences in the government assessment of healthcare delivery between the two countries are on the technology used for assessment. While Japan uses, DPC America uses Diagnosis Related Groups (DRG) and Prospective Payment System (PPS) to do the assessment.  The other difference is that these devices of government assessment in the USA can accommodate different rates while DPC used in Japan only takes flat-rates. The similarity is that these technologies are all payment modes that help the governments of the USA and Japan to assess the health care system transparency and standards of service delivery.

The pros of the Japanese health care system

The 30% co-payment is a cheap method of payment for health services as it reduces the hospital expenses to families.

The Japanese universal health care creates equal access to healthcare, improved public health, has stopped medical bankruptcies, boosted the economy and encouraged entrepreneurship.

The flat rate system of payment by use of DPC has increase transparency in hospitals.

The aging insurance coverage has led healthy elderly people while reducing the family expenses.

The Use of EMR has enabled easy referrals by physicians, enable physicians to provide better medical care based on the latest technologies and have also prevented medical accidents.

Cons of the Japanese healthcare system

The process of physicians and drug pay cut threatens poor quality care and creation in treatment shortages.

Universal health care has led to long wait times, increased government debts and has also lead to medical abuse cases.

Due to the cheapness of cost of hospitals, even those with minor illnesses visit hospitals hence creating congestion in hospitals.

The pros of the USA health care system

The USA has got some of the best technologies and medical research systems in the world for healthcare services.

The working classes whose insurances are paid by employers enjoy improved current health care in the USA.

The long term insurance coverage has led the longevity of stay of the elderly and reduction of family expenses in health.


Cons of the Japanese healthcare system

The current Americans health system makes people especially the poor to spend a lot of money on the payment of healthcare services.

The other disadvantage is that most of the American citizens are underinsured or not insured.

The government has invested much of its GDP on the healthcare system making the economy of the USA to be unstable.

The current healthcare system has led to discrimination of other races, ethnic groups, and other sexes from being treated in given hospitals.


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