UMthetho woNonophelo ojongene noThutho onokuThuthukiswa unokuPhucula iPhulo loPhepha
UMthetho woNonophelo ojongene noNgcono unokujolise ekuphuculeni ukhuseleko lokugcina isigulane, kodwa yintoni na amava asitshoyo ngoku? Makhe sijonge ngezizathu zokulungiswa kwempilo ekunciphiseni iimpazamo zezokwelapha, kunye nengcamango engezantsi kutshintsho. Ngeli xesha siyazi ukuba iimpazamo zezobugqirha zikwinqanaba eliphakamileyo elingamkelekanga, kwaye into ethile idinga ukutshintsha. Kwakhona, nokuba, ukuba utshintsho olufunekayo luninzi kakhulu kunemithetho embalwa, okanye emininzi, iyakwenza.
Kodwa yiphi indlela impilo eguquke ngayo yatshintsha, kwaye ingaqhubeka njani ukutshintsha inani lezonyango zonyango eMelika?
I ziphoso zonyango
Izibalo ziyaziwa ngokugqithisileyo kumayeza, oogqirha, abaphathi bezibhedlele, kunye nezigulane ezininzi: iziphene zonyango ezikhuselweyo zibulala kunye / okanye zenzakalisa kakhulu amawaka amawaka aseMerika ngamnye unyaka omnye.
Ulungelelwano phakathi kweephene zonyango kunye nokufa kwafika ekuphambili kolwazi loluntu ngokunjalo, xa i-2016 ifundwa kwiYunivesithi kaJohn Hopkin yagqiba ukuba iimpazamo zezokwelapha zazijongene neepesenti ezili-10 zokufa. Ukubeka le ndlela ngendlela ecacileyo, okanye eyingozi kakhulu, iimpazamo zezokwelapha zibonakala ziyesisombululo sesithathu sokubangela ukufa.
Nangona kubekho impikiswano ebalulekileyo malunga nenani elichanekileyo, kunye nokuba zininzi zale ngozi ezikhuselweyo, siyazi ukuba iimpazamo zonyango ziyingxaki enkulu eMelika. Nangona kubekho ingxoxo eninzi kwimibandela emininzi, kwaye nangona iimpazamo zezokwelapha zibonakala ziyancipha nangaphambi kokusayinwa kweMpilo yoNonophelo ongenakunciphisa, kukho ukunciphisa ukufa ngenxa yeziphene zonyango, ubuncinane ngexesha eliphakathi kuka-2010 no-2014.
Ukuguqulwa kwezeMpilo njengendlela yokunciphisa iziphoso zonyango
Nangona ugxininiso oluphambili lweMpilo yoNonophelo olungabonakaliyo (umthetho wokulungiswa kwempilo) wasayinwa ngumthetho ngo-Matshi 2010 kukubonelela ukufikelela kwi-inshurensi yempilo efikelelekayo kubo bonke abemi baseMerika, umthetho unemiqathango yamalungiselelo anokuphucula ukhuseleko lomguli.
Ukhuselo lwezonyango lulingana neendleko zonyango lwezempilo ezantsi
Ukuqaphela ukugcina imali enokuthi ingeniswe ngokunciphisa iimpazamo zezonyango ezisekelwe esibhedlele, i-Medicare ichaze inani "leemeko ezinokukhusela" eziqhelekileyo ngexesha lokuhlala esibhedlele. Ukuba ikhona ngexesha lokulaliswa esibhedlele, isibhedlele ayikwazanga ukuhlawulwa kwiinkonzo ezinikwe.
Le mithetho yaqalisa ukusebenza ngo-2008 phambi kokuhamba kweNqanaba loNonophelo olunganakuncedo. Ngaphandle kokungalindelekanga, iinkampani ezininzi ze-inshurensi zempilo yecala yangasese, kuquka i-Aetna kunye ne-Blue Cross / Blue Shield Association phakathi kwabanye, iphumeze imigaqo-nkqubo efanayo yokungahlawulisi izibhedlele kunye namagqirha enkathalo enxulumene noxinzelelo lwezonyango ezingafaneleki ngokuqhelekileyo ngexesha lokubhedlelelwa esibhedlele.
Injongo yale migaqo-nkqubo kukugcina ubomi kunye nokugcina imali ngokuthi izibhedlele ziqalise iinkqubo ezintsha zokukhusela amaphutha.
Ukungabonakali kunye neNtshutshiso Entsha yoKhuseleko lweMonde
Ukwakha kwiiprogram ze-Medicare zokhuseleko lwezibhedlele ezenziwa ngo-2008, uMthetho ojongene noKhathalelo ongenakuncedo usebenzisa iintlawulo zeMedare kwiibhedlele ukukhuthaza utshintsho. Kwixesha elidlulileyo, kulindeleke ukuba iinkampani ezininzi ze-inshorensi yabucala ziza kulandela ukukhokelwa kweMedare; Oku kukuchaphazela kungakhathaliseki isicwangciso sezempilo esihlawula izibhengezo zezibhedlele.
Amalungiselelo alandelayo kumthetho wokulungiswa kwempilo abeka isiseko sokutshintsha okufunekayo:
- Izibhedlele ezineziphumo ezingcono ezinxulumene nokunyamekelwa kwezibetho kunye nokuhlaselwa kwentliziyo, kunye nokukhuselwa kwezifo ziya kufumana iintlawulo eziphezulu.
- Izibhedlele kunye namazinga aphezulu okufunda ngokungafezeki kwintliziyo kunye nemilinganiselo ephakamileyo yezimo ezifumene esibhedlele ezifana nezifo, izilonda zokulala, kunye nokuwa ziya kuhlawulwa ngeentlawulo ezincitshisiwe.
- I-Medicare iya kulandela ireyithi yeephene zesibhedlele kwaye (2014) iya kunciphisa intlawulo nge-1 ekhulwini kwizibhedlele ezinezinga eliphezulu kakhulu lemiqathango yokukhusela isigulane.
Ukuqinisekisa ukuba uyazi malunga nale miqathango yokukhusela kunye nokwabelana ngendlela izibhedlele ziphucula ngayo, uMthetho ojongene noNonophelo ongenakunqwenelekayo ufuna iMagarela ukuba:
- Shicilela irekhodi yesiphene yesibhedlele nganye yesibhedlele.
- Yakha iziPhulo eziPhuhliweyo zeziPhando zoPhando eziza kuncomela unyango olululo.
- Ukuseka iZiko loPhuculo loPhuculo kunye noKhuseleko lweMonde ukuphucula uphando ekukhuseleni isigulane.
Njengenxalenye yokuguqulwa kwezempilo, urhulumente wephondo uvumelekile ukubonelela ngezigidi ezingama-75 ngonyaka ukuze kuphuculwe amanyathelo omgangatho kunye nokhuseleko.
Njani Izibhedlele Zithelekisa Ngokubhekiselele KuKhuseleko Lonyango
I-Medicare, ngokubambisana nezibhedlele ezininzi kulo lonke ilizwe, lenze i-Hospital Compare. Esi sixhobo se-intanethi sinokukunceda ufumane ulwazi malunga nokuba izibhedlele zasekuhlaleni zikhathalele njani izigulane ezineemeko ezithile zonyango okanye iinkqubo zokugqirha, kunye neziphumo ezivela kuhlolisiso lwezigulane malunga nomgangatho wokunyamekela owamkelayo ngexesha lokuhlala esibhedlele. Le ngcaciso inokukunceda uqhathanise umgangatho wezibhedlele zonyango unika kwaye ikuncede wenze isigqibo malunga nokuba kuya kuba yintoni efanelekileyo kuwe ukuba ufuna ukunakekelwa esibhedlele.
Ezinye zeemeko zonyango ziqhathaniswa ziquka ukuhlaselwa kwintliziyo, ukungaphumeleli kwentliziyo, isifo esingapheliyo samaphaphu, isifo se-pneumonia, isifo sikashukela kubantu abadala kunye nentlungu yesifuba. Ezinye zeenkqubo zokugonywa ziquka ukuhlinzwa kwentliziyo, ukuvuthwa kwe-pacemaker, ukuhlinzwa okwenziwe nge-gallbladder, ukuhlinzwa kwe-hernia, ukuhlinzwa ngethambo, ukuguqulwa komva kunye nentamo enkulu yokutshintshwa, ukuhlinzwa, kunye nokuhlinzwa okwenziwa ngabasetyhini.
Ezinye izilumkiso malunga neSibhedlele
Ulwazi malunga neSibhedlele Qhathanisa i-website evela kwizibhedlele ezivumile ukungenisa ulwazi lwekhwalithi kwi-Hospital Comparing to make public. Isibhedlele sakho asiyi kubalwa. Kwaye, ukuba unonophelo lokunyamekela (HMO okanye i-PPO), isibhedlele ofuna ukuyisebenzisa singabi kwisiseko somncedisi wezempilo. Nangona kunjalo, kufuneka ukwazi ukulandelela nayiphi na impazamo yecala yezokwelapha.
Iingcamango zokuQala kwiMiphumo yoNonophelo loThathaka
Ngokugxininiswa ngokugqithiseleyo ekuphuculeni ikhwalithi kunye nokucaca "i-kroti kunye nokunamathela" kwindlela yokubuyiselwa kwebhedlele, mhlawumbi ukunyamekelwa kwezibhedlele kuya kutshintshwa ngcono kwixesha elide. Nangona kunjalo, nazo zonke ezinye iinguqu kwiinkqubo zempilo ezilindelekileyo ukusuka ekubuyiselweni kwempilo, iimfuno (zombini iimali kunye nenani elikhulayo lezigulana ezifuna iinkonzo) kwizibhedlele kunye namagqirha, ngokukodwa oogqirha bokunakekelwa kweprayimari, kungenzeka ukuba abalulekile, .
UMthetho woNonophelo ojongene noNcedo kunye neZiphuso zeZonyango, ngo-2010-2014
Okwamanje sinomnye ulwazi malunga nemiphumo enokwenzeka ye-Care Affordable Act kwiiphene zonyango. Ngokwe-Arhente yoPhando lwezeMpilo kunye noPhuculo, kwakukho ukunciphisa kweepesenti ezingama-17 kwizimo ezifumene esibhedlele phakathi ko-2010 no-2014. Oku kuguqulela kuma-87,000 okufa kwabantu abancinci, kunye nokulondolozwa kwama-dollar angama-19.8. Nangona ukunciphisa iiphoso kubonakala kunqanyulwa, kwaye nangona ezinye iimeko eziphakanyiswe yi-ACA, ngeendlela ezininzi oku kuguqulwa kwexesha elide kwinqanaba leempembelelo zonyango.
Imida ekuqondeni iinguqu kwiiNkohlakalo zonyango
Kukho ukunciphisa ukwazi ukuba kuncinci ukunciphisa iimpazamo zonyango kunokubhekiswa kuMthetho woNonophelo ongenakuncedo. Thetha ngeendlela zokunciphisa iimpazamo zezokwelapha zangaphambi kokusungulwa koMthetho, kwaye kuphawulwe ukuba ukunciphisa amaphutha kwaqala ngaphambi kokuba kuphunyezwe ngo-2010.
Kuzo Iimpazamo Zonyango Ezincinci Ngokuba Unomonde Ophefumlelweyo
Kungakhathaliseki ukuba yimpembelelo yintoni i-ACA kunye ne-Obamacare vs Trumpcare inokukhuseleka kwesigulane kwiminyaka ezayo, ezi zinguqu alaneleyo ukufezekisa ukunciphisa esikufunayo ukuze sibone kwiiphene zonyango. Ngeendlela ezininzi, ithuba elihle lokukhusela iimpazamo zonyango kukuba ube nesigulane esinamandla kwaye uthathe ixesha lokuphonononga iindlela zokunciphisa umngcipheko wakho. Thatha ixesha lokufunda indlela yokunciphisa umngcipheko wakho wezonyango . Ukwenza oko kungathatha ixesha elincinci kwaye usindise ubomi. Thatha ixesha lokuhlaziya iirekhodi zakho zonyango malunga neephene. Buza imibuzo eninzi uze uqinisekise ukuba uyayiqonda ingozi kunye neenzuzo zaliphi na amayeza okanye inkqubo ogqirha ugqirha ngayo.
Ngaphantsi kweeNkohlakalo zeZonyango kunye neNguqulelo yezeMpilo
Enye yeenjongo zeMpilo yoNonophelo ongenakuncedo yayikukunciphisa inani lezonyango zonyango, iimpazamo ezinokuthi zijongene neepesenti ezili-10 zokufa kweli lizwe. Ukususela kwixesha lika-2010 no-2014, kubonakala ngathi liphumelele, nangona kukho imiba eninzi ephakanyisiwe. Umgca weli xesha, kukuba abantu banokukwenza into namhlanje ukunciphisa ingozi yabo, kungakhathaliseki ukuba utshintsho kwizinga likazwelonke. Ukuba nesigulane esilumkileyo nesinegunya ngenye yezilwanyana ezikhuselekileyo malunga nezi mpazamo ezihlala zixhaphake namhlanje.
> Imithombo:
> I-Arhente yoPhando lwezeMpilo kunye neMigangatho. Ukulondoloza ubomi kunye nokulondoloza imali: Isibhedlele esifanelekileyo Isimo sokuhlaziya. Iinkcukacha zeTyhutyha ezivela kwiiNzame zoLuntu zokuKhathalela ngoKhuseleko, ngo-2010-2014. https://www.ahrq.gov/professionals/quality-patient-safety/pfp/interimhacrate2014.html?utm_source=HHSPressRelease65&utm_medium=HHSPressRelease&utm_term=HAC&utm_content=65&utm_campaign=CUSP4CAUTI2015