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National Approaches Health Insurance - The Patient's Experience

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Health care systems exist to serve the patient. Thus, an understanding of the patient's experience is crucial when attempting to compare and evaluate different systems. Rates of health care coverage, degrees of patient choice, amounts of hospital utilization, and types of long-term care vary from country to country, providing patients with vastly different experiences across health care systems.

Coverage. Different types of health care coverage can drastically affect the amount of health care individuals receive. Virtually the entire populations of Australia, Canada, France, Japan, Korea, Sweden, and the United Kingdom have public health care coverage. In contrast, only 45 percent of the population in the United States and 74.5 percent of the population in the Netherlands are covered under public systems. In countries in which large proportions of the population have no coverage, the poor and other at-risk groups may not receive adequate health care. However, it is important to note that even in systems offering universal health coverage, not all patients will necessarily have equal access to care. Patients' experiences may, in fact, vary with factors like income or geographic location. For example, while the Swedish system used to be relatively equitable, rising co-payments have recently increased the gap in services between rich and poor. Because medical resources in France are concentrated in urban areas, residents in rural locations may not have access to the same medical services available in cities.

Health care systems also differ in their coverage of pharmaceutical goods. Elderly individuals are by far the largest consumers of pharmaceuticals, and are thus most affected when drugs are not covered by their health insurance. In Australia, Japan, Korea, Sweden, and the United Kingdom, all people are covered for approved pharmaceuticals. The French public insurance system covers pharmaceuticals at varying rates, with higher rates of reimbursement for drugs considered more essential to patients' health. In Canada, less than half the population receives assistance for pharmaceuticals through the national public system. Most Canadian provinces and territories, however, have developed supplementary programs to help provide pharmaceuticals to the elderly population. In the United States, only 12 percent of the population has public pharmaceutical coverage.

Patient choice. Systems vary in the degree of choice they allow patients. Individuals may have more power to decide how, where, and from whom they receive medical care in some systems than in others. In France, Japan, and Korea, patients are not restricted to any particular set of doctors. Publicly insured individuals in Germany, Sweden, and the Netherlands can choose their doctor from among those affiliated with their sickness fund, or within a specified geographic area. Once patients have chosen a doctor, they can generally change their doctor at will, except in Germany, where they have to complete a three-month period with their current doctor before moving to a new one. In the United States, patients in the managed-care system are typically restricted to a list of medical providers, and some can only change their doctor during specified enrollment periods.

Individuals in the United States managed-care system usually must visit their primary care doctor before seeking care with a specialist. In this way, the primary care doctor serves as a gatekeeper, having complete discretion over patient referrals to specialists. Similarly, in the Netherlands, publicly insured patients can only visit specialists after receiving vouchers from their primary doctor.

In practice, patients' ability to choose a doctor may depend on their level and type of insurance coverage, their income, or the location of their residence. For example, though patients in Canada may typically choose their primary care doctor, the availability of such doctors tends to vary by region. In France, lower-income people are more likely to receive care from general practitioners, while higher-income people tend to receive care from specialists.

Inpatient care. The number and length of hospital stays can also vary greatly between countries. France has the highest hospital admission rate of the countries considered here. Patients in France are frequently checked into the hospital for short stays to undergo procedures that would take place in an outpatient setting in most other systems. Hospital stays are almost completely reimbursed under the French system.

Meanwhile, in Japan and the Netherlands, the average length of stay in hospitals is high—over thirty days in each country. This is mainly due to the incorporation of long-term care patients in their measure of hospital stays. In comparison, individuals in hospitals in Sweden spend only 6.6 days as inpatients. In Canada, average stays are 8.2 days; while in the United States they are 71 days.

Elderly patients. An elderly patient's experience may differ from that of a younger individual in the same health care system. Even in countries that offer universal coverage, certain groups of patients may receive less care. Elderly persons may be especially affected by this health care rationing. In the United Kingdom, for example, a survey found that the oldest segment of the population rarely received certain health services, including heart transplants, bypass operations, and admission to intensive therapy units.

Another important factor in an elderly patient's experience is long-term care. In the past, older individuals have traditionally received long-term care in hospitals or institutional settings. However, some countries have come to rely increasingly on home care for long-term patients. Table 5 details the share of elderly persons in institutions versus those receiving formal home care. While France, Japan, and the United Kingdom have relatively equal percentages of the elderly population in institutions and receiving formal home care, a greater proportion of the elderly in Australia, Canada, Germany, the Netherlands, Sweden, and the United States receive long-term care in the home. Some countries have passed laws explicitly encouraging this move towards home health care. For example, some localities in Sweden pay family members to provide care in the home. The Netherlands and Germany attempt to provide more flexibility for older adults by offering them an option to receive a lump-sum payment so that they can seek treatment wherever they prefer.

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over 6 years ago

Dear Beloved,

Glory to God in heaven. My name is Mrs Anne Marie Joubert from South Africa. I am married to Mr Abraham Benjamin Joubert, who is a mechanical engineer worked with shell petroleum company for many years before he died in 2004. We were married for eleven years without a child. He died after a brief illness that lasted for only four days.

Before his death we were both born again Christians. Since his death I decided not to re-marry or get a child outside my matrimonial home which the Bible is against. When my late husband was alive he deposited a total sum of $5.6 Million (5.6 Million, six Hundred Thousand U.S.Dollars) National Merchant Bank London.

Presently, this money is still under the safe keeping of the bank. Recently, my Doctor told me that I would not last for the next seven months due to my Spaniel cold problems. Though what disturbs me most is my stroke .Having known my condition, I decided to donate this fund to church or better still a Christian individual that will utilize this money the way I am going to instruct here in. I want a church or God fearing individual that will use this fund on, orphanages and widows propagating the word of God and give help to mankind. The Bible made us to understand that blessed is the hand that givet.

I took this decision because I don't have any child that will inherit this money and my husband relatives are not Christians and I don't want my husband's hard earned money to be misused by unbelievers. I don't want a situation where this money will be used in an ungodly manner. Hence the reason for taking this bold decision.

I am not afraid of death hence I know where I am going. I know that I am going to be in the bosom of the Lord. Exodus 14 VS 14 says that the lord will fight my case and I shall hold my peace. I don't need any telephone communication in this regard because of my health condition and the presence of my husband's relatives around me always. I don't want them to know about this development.

With God all things are possible. As soon as I receive your reply I forward your personal information to the company in Europe so that they will contact you as the legal owner of this fund before transferring the fund to you in your country. I will also issue you a letter of authority that will empower you as the original- beneficiary of this fund. I want you and the church to always pray for me because the lord is my shepherd.

My happiness is that I lived a life of a worthy Christian. Whoever that wants to serve the Lord must serve him in spirit and truth. Please always be prayerful all through your any delay in your reply will give me room in sourcing for a church or Christian individual for this same purpose. Please assure me that you will act accordingly as I stated herein. Hoping to hear from you as soon as possible.by this email address JUBET_AMINA4LOVE@mail.com

Remain blessed in the name of the Lord.
Yours in Christ, Read Hebrews13:15v16 New Living Translation

Mrs Anne Marie Joubert.

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over 6 years ago

Dear Beloved,

Glory to God in heaven. My name is Mrs Anne Marie Joubert from South Africa. I am married to Mr Abraham Benjamin Joubert, who is a mechanical engineer worked with shell petroleum company for many years before he died in 2004. We were married for eleven years without a child. He died after a brief illness that lasted for only four days.

Before his death we were both born again Christians. Since his death I decided not to re-marry or get a child outside my matrimonial home which the Bible is against. When my late husband was alive he deposited a total sum of $5.6 Million (5.6 Million, six Hundred Thousand U.S.Dollars) National Merchant Bank London.

Presently, this money is still under the safe keeping of the bank. Recently, my Doctor told me that I would not last for the next seven months due to my Spaniel cold problems. Though what disturbs me most is my stroke .Having known my condition, I decided to donate this fund to church or better still a Christian individual that will utilize this money the way I am going to instruct here in. I want a church or God fearing individual that will use this fund on, orphanages and widows propagating the word of God and give help to mankind. The Bible made us to understand that blessed is the hand that givet.

I took this decision because I don't have any child that will inherit this money and my husband relatives are not Christians and I don't want my husband's hard earned money to be misused by unbelievers. I don't want a situation where this money will be used in an ungodly manner. Hence the reason for taking this bold decision.

I am not afraid of death hence I know where I am going. I know that I am going to be in the bosom of the Lord. Exodus 14 VS 14 says that the lord will fight my case and I shall hold my peace. I don't need any telephone communication in this regard because of my health condition and the presence of my husband's relatives around me always. I don't want them to know about this development.

With God all things are possible. As soon as I receive your reply I forward your personal information to the company in Europe so that they will contact you as the legal owner of this fund before transferring the fund to you in your country. I will also issue you a letter of authority that will empower you as the original- beneficiary of this fund. I want you and the church to always pray for me because the lord is my shepherd.

My happiness is that I lived a life of a worthy Christian. Whoever that wants to serve the Lord must serve him in spirit and truth. Please always be prayerful all through your any delay in your reply will give me room in sourcing for a church or Christian individual for this same purpose. Please assure me that you will act accordingly as I stated herein. Hoping to hear from you as soon as possible.by this email address JUBET_AMINA4LOVE@mail.com

Remain blessed in the name of the Lord.
Yours in Christ, Read Hebrews13:15v16 New Living Translation

Mrs Anne Marie Joubert.

Vote down Vote up

over 6 years ago

Dear Beloved,

Glory to God in heaven. My name is Mrs Anne Marie Joubert from South Africa. I am married to Mr Abraham Benjamin Joubert, who is a mechanical engineer worked with shell petroleum company for many years before he died in 2004. We were married for eleven years without a child. He died after a brief illness that lasted for only four days.

Before his death we were both born again Christians. Since his death I decided not to re-marry or get a child outside my matrimonial home which the Bible is against. When my late husband was alive he deposited a total sum of $5.6 Million (5.6 Million, six Hundred Thousand U.S.Dollars) National Merchant Bank London.

Presently, this money is still under the safe keeping of the bank. Recently, my Doctor told me that I would not last for the next seven months due to my Spaniel cold problems. Though what disturbs me most is my stroke .Having known my condition, I decided to donate this fund to church or better still a Christian individual that will utilize this money the way I am going to instruct here in. I want a church or God fearing individual that will use this fund on, orphanages and widows propagating the word of God and give help to mankind. The Bible made us to understand that blessed is the hand that givet.

I took this decision because I don't have any child that will inherit this money and my husband relatives are not Christians and I don't want my husband's hard earned money to be misused by unbelievers. I don't want a situation where this money will be used in an ungodly manner. Hence the reason for taking this bold decision.

I am not afraid of death hence I know where I am going. I know that I am going to be in the bosom of the Lord. Exodus 14 VS 14 says that the lord will fight my case and I shall hold my peace. I don't need any telephone communication in this regard because of my health condition and the presence of my husband's relatives around me always. I don't want them to know about this development.

With God all things are possible. As soon as I receive your reply I forward your personal information to the company in Europe so that they will contact you as the legal owner of this fund before transferring the fund to you in your country. I will also issue you a letter of authority that will empower you as the original- beneficiary of this fund. I want you and the church to always pray for me because the lord is my shepherd.

My happiness is that I lived a life of a worthy Christian. Whoever that wants to serve the Lord must serve him in spirit and truth. Please always be prayerful all through your any delay in your reply will give me room in sourcing for a church or Christian individual for this same purpose. Please assure me that you will act accordingly as I stated herein. Hoping to hear from you as soon as possible.by this email address JUBET_AMINA4LOVE@mail.com

Remain blessed in the name of the Lord.
Yours in Christ, Read Hebrews13:15v16 New Living Translation

Mrs Anne Marie Joubert.