Sick Around the World

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1A. What is the purpose of a gatekeeper?
The purpose of a gatekeeper is to provide guidance and inform patients of their health. A person must first go to a gatekeeper before seeking help from a specialist. The doctor examines the person as a whole instead of single parts of the body. If the general practitioner sees a specific problem with the patient they then will be recommended to a specialist. In GREAT BRITAIN gatekeepers hold down costs for the National Health System (NHS). 1B. What does Great Britain think about the use of a gatekeeper?

GREAT BRITAIN thinks of gatekeepers as being a “medical home”. If there is something wrong, i.e. physically or mentally, they seek the guidance of gatekeepers, just as one can access a concerned family member. As mentioned in “Sick Around the World”, people sometimes even go to gatekeepers just to talk. 1C. Does the US use one? How?

The UNITED STATES has different views when it comes to the term, gatekeeper. When referring to healthcare, gatekeepers are used in the same sense as GREAT BRITAIN. A person can choose whether they go to a general practitioner or specialist depending on the type of insurance they hold. Preferred Provider Organizations (PPO) are the only plans not using gatekeepers. Great Britain refers to their gatekeepers as a medical home whereas in the United States we do not. 1D. How about Germany, and Switzerland? Do they use what can be considered a traditional form of gatekeeper?

GERMANY uses a gatekeeper but it is not mandatory for everyone to visit one before seeing a specialist. With this view they are similar to the United States. If a patient wants they can go straight to a specialist. The only negative aspect of this decision is that the patient may have to pay a higher co-pay if skipping to see a gatekeeper doctor. SWITZERLAND does not have gatekeepers. If the Swiss do decide to see a gatekeeper first their insurance company may give them a discount. Some insurance plans may even require them to see a gatekeeper. Germany and Switzerland both do not use what can be considered a traditional form of gatekeeper. 1E. What about Japan and Taiwan. What is their philosophy about gatekeepers?

JAPAN and TAIWAN do not have gatekeepers. They can go to any specialist. Even though there are no gatekeepers, checks on patients are still conducted. If a citizen of Taiwan makes more than twenty visits to the doctor in the span of one month they will receive a visit from the healthcare ministry to find out why. It was mentioned in the video “Sick Around the World” that Japan and Taiwan like being their own keepers. 2A. Does medical bankruptcy exist elsewhere? If not, why? Be specific about each country.

Bankruptcy does not exist elsewhere. In GREAT BRITAIN the health system is funded through taxes and the administrative costs are low. There are no co-pays for most services and the young and elderly are exempt from all drug co-pays. Due to the collection of taxes there are no bills or claims to review, leaving no possible way for citizens to become bankrupt.

JAPAN has a social insurance system where citizens are required to have health insurance through work or a non-profit community based plan. The people who cannot afford the premiums are covered by public assistance. Copayments for Japan are 30 percent of the cost of a procedure but their total amount paid per month is adjusted according to the person’s income.

In GERMANY premiums are pinned to a patient’s income and copayments are 15 dollars every three months, from which some patients are exempt, like those with preexisting conditions or the elderly. Germans follow a social insurance model but can buy their insurance from more than 200 private nonprofit “sickness funds”, who then bargain with doctors as a group regarding costs. Public assistance is also offered to those who cannot afford to pay their premiums.

TAWAIIN uses a “National Health Insurance” model where all citizens must have health insurance...
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