Organizational Systems and Quality Leadership Organizational Systems

Running Head: HEALTHCARE 0
Organizational systems and quality leadership

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A1 – The study and research are based on healthcare systems comparison of the United States
with Switzerland. With the continuous increasing cost of healthcare, access to service has
become major issue. From many times, the United States has tried to make effective change
in healthcare system to enable for every people in America provide them required access to
healthcare services. According to Berland (2012), healthcare is the upholding and
reinstatement of health by the treatment and deterrence of disease, particularly by licensed
and trained professionals.
A2 – In Switzerland and the U.S. healthcare systems, there are various similarities like
compulsory widespread healthcare coverage. Disparate from the U.S., in Switzerland, with
the help of various government and employment programs, the insurance plans are largely
offered whereas Switzerland residents needed to buy their individual private health coverage
policies. For the children’s, it is mandated for parents to buy healthcare policies within 3
months after delivery and each person must have to buy a separate health coverage policy for
themselves (expatica.com, 2020). The time period for new immigrants is also same as
children’s where they have to buy this policy within 3months of entrance to the nation. In
relation with retirees and unemployed residents, the procedure for buying the health
insurance plan is alike to that of the US social programs. However, in Switzerland, there are
no uninsured residents for any purpose.
Considering the U.S., an act was conceded in 2012 with name as the ACA and that
stands for Affordable Care Act. Here, the accountability for healthcare coverage was shared
amid employers, government plans and insurers operating privately (Rosenbaum, 2011). This
act and plan were developed to make the healthcare services accessible to the residents at
reasonable cost. In the country, most of the residents depend on employers for the insurance
coverage and program and this can create the issues for individuals who are not employed as
they cannot possess healthcare services and therefore, have to be live lacking necessary
coverage. Families and individuals can be eligible with various income-built government
plans and programmes if essential terms are fulfilled. In relation with children, there is a limit
of age and exceptional situations in which coverage can happen. For individuals or elder
people whose age are above 65, the coverage is being offered through different government
programme such as Medicare (debt.org, 2020). Although, this program a lot do not include
the complete cost of services and this induce individuals to buy from private service
providers regarding add-on insurance. There is also various distance in coverage for young
people just move up from universities and colleges, vagrant individuals and also for those

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who are not employed. There are not any prescribed limits for the insurance corporations on
what and how much amount they can take for premiums and other costs. Across the insurance
corporations, there is also no standardisation and this leaves to widespread differences while
leading to scattered healthcare services.
A2 (a) – In relation with Swiss, the coverage for medicines is counted with insurances plans
and there are certain exclusions with some particular medicines. Alike to the U.S. general
medicines are inexpensive and will have a lesser co-pay, although the cost is high for the
medicines connected with any name of brand. There are 10 per cent deductions of the cost for
general prescriptions where it is 20 per cent in case of medicines engendered with name of
any brand (Rice et al, 2018). Insurance corporations do not cover the counter medicines and
various branches of Switzerland government assess new medicines effectiveness prior to
approval of coverage.
In relation with the United States healthcare system, the insurance is mainly based on
the coverage that a person has as the insurances plans differ extensively and also there is
much inconsistency considering the prescription medicines cost as of deficiency of
standardization. On the other hand, some of the insurance plans may not provide any sort of
coverage and insurance corporation’s habitually distinct medications through sorting like
medicines for birth control will often be included at no charge to the customer against an
antiemetic medication may have deduction. The sorting of drugs is also possible into name of
brand as well as general and as general medicines are inexpensive, insurance corporations
wish to pay for these irrespective of brand name. In case of old age individuals on Medicare,
there is often requirement of supplemental insurance for drug coverage (medicare.gov, 2020).
This scattered system in the US also becomes topic of debate many times.
A2 (b) – Considering Switzerland, specialists referrals can differ by the plan that a person
selects to buy. There is no need for a referral from a General Consultant or Primary Care
Physician (ehealthinsurance.com, 2020). The typical SHI plan enables access to more
specialist against if a person buys a plan with a lesser premium. Hence, people with lesser
premium may need to get a referral from their General Practitioner.
In relation with the United States, Primary Care Provider referral is generally needed
to get appointments with a specialist. Insurance corporations a lot time needed former
approvals prior a patient went to an expert. These experts or specialists are also needed to be

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within the patient’s supplier link. If a supplier or provider is not in system or network, the
patient could possibly be left with the whole of a cost, or a greater conclusive.
A2 (c) – In both Switzerland and the U.S., health insurance corporations have coverage for
pre-existing conditions whereas, people in the companies must have to offer coverage for
patient irrespective of disease identified before coverage go underway. In addition, if the
patient is having pre-existing sort of any disease, premium or high price cannot be charged by
any insurers in both the nations.
A3 – There is high similarity in relation to financial implication for patient in both nations as
there are legal rules in Swiss to buy health insurance where the premium can be fairly costly.
In addition with the needed yearly premium of insurance, it is also necessary for patient to
pay 10 per cent of the whole cost of services provided. Furthermore, the cost of nursing
homes, dental care is not covered by SHI and above the counter prescriptions. Medicine and
prescriptions, irrespective of insurance coverage lead a 10-20 per cent cost to the patient and
yearly premiums cost along with 10 per cent cost of services have great implications on
patient cash and investments (lenews.ch, 2015).
As stated above, the implications in the United States is also similar although, there is
a sort of difference where US insurance corporations are not bound to any standard unlike in
Swiss where insurance corporations have a certain limit on how much they can charge for
yearly premium and therefore in the US, they can take as high as they need for yearly
premiums. This cost does not contain other charges and deductibles which have a further
financial implication. Ultimately, it leads to great impact on Americans while developing a
disparity as due to these massive costs, many people in America are not taking insurance
leaving them access to necessary healthcare practices.

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References
Berland, R. P. (2012). Introducing Patient Scope of Care: Psychologists, Psychiatrists, and
the Privilege to Prescribe Drugs. . Louis UJ Health L. & Pol'y, 6(1), 425.
debt.org. (2020). Senior Health Care Options and Costs. Retrieved from
https://www.debt.org/medical/senior-options-costs/
expatica.com. (2020). A guide to healthcare in Switzerland. Retrieved from
https://www.expatica.com/ch/healthcare/healthcare-basics/healthcare-in-switzerland-
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lenews.ch. (2015). 15 things you should know about Swiss health insurance. Retrieved from
https://lenews.ch/2015/10/08/15-things-you-should-know-about-swiss-health-
insurance/
medicare.gov. (2020). What's Medicare Supplement Insurance (Medigap)?. Retrieved from
https://www.medicare.gov/supplements-other-insurance/whats-medicare-supplement-
insurance-medigap
Rice, T., Quentin, W., Anell, A., Barnes, A. J., Rosenau, P., Unruh, L. Y., & van Ginneken,
E. (2018). Revisiting out-of-pocket requirements: trends in spending, financial access
barriers, and policy in ten high-income countries. BMC health services research,
18(1), 371.
Rosenbaum S. (2011). The Patient Protection and Affordable Care Act: implications for
public health policy and practice. Public health reports, 126(1), 130–135.