Kutheni iimpawu zesigulane zihluke phakathi kwababhedlele ababili
Uphando olushicilelwe kwiNcwadi ye-American Medical Association (JAMA) lufumene ukungafani okona kubantu abanesigxina kwi-arhente zokunakekelwa ngenzuzo ngokumalunga nabalingane babo abangenzi nzuzo. Ngokubalulekileyo, izigulane ezithengela abantu abafumana inkxaso-mboleko zihlala zineemfuno ezincinci zokunyamekela kwaye zihlala kwizibhedlele ezide kunezo zikarhulumente ezingenakuncedo.
Fumana iinyani kwiintlukwano kunye nokufana phakathi kwee-arhente zokunakekelwa ngenzuzo nangenzuzo.
I-Agro-Growing of Benefit Hospice Agencies
Icandelo lokubhedlele ukunyamekela inzuzo lande kakhulu kwikhulu lama-21. Inani lentlawulo yenzeniso-nzuzo liphindwe kabili ukususela ngowama-2000 ukuya ku-2007 ngelixa inani lee-arhente zokubhedlele ezingenzi nzuzo liye lahlala lifanayo.
Nangona liqinisekisa ukuba i-arhente ye-hospice iyanda ngokubanzi, iphakamisa iinkxalabo ukuba i-arhente yokubhedlele i-benefit-benefit inexabiso eliphezulu kakhulu kunezibhedlele ezingenzi nzuzo. Ucwaningo lwe-JAMA lubhekise ukungafani kwendawo yesigulane kunye nezenzo zengeniso-nzuzo kunye neenarhente ezingenanzuzo ukuqonda kakuhle ukuba kutheni ukungafani kwintlawulo kwakukhulu.
I-Medicare Hospice Imbuyiselo
Ukuhlawula i-Medicare kuhlawula iipesenti ezingama-84 zezigulane kwiinkathalo zonyango. I-Medicare ibuyisela i-arhente ye-hospice kwiinkathalo zokubhedlele kwi - rate -diem rate, oku kuthetha ukuba isigulane sithola umlinganiselo ofanayo wokuhlawulelwa ngosuku nangona i-diagnostic okanye ukunyamekela ngabanye.
Le nkqubo yokubuyisela inokuthi idale izikhuthazo kwii-arhente zokubhedlele ukukhetha izigulane ezineemfuno zokunakekelwa ezimbalwa kunye nokuhlala isikhathi eside. Ngokwenza njalo, ii-arhente zenzelwe inzuzo zingagcina imali ngokubonelela ngononophelo olunzulu kunye nokwandisa inzuzo ngokukhetha izigulane eziza kuhlala zide.
I-Hospitals eziNcedo-nzuzo zinemiphumo engakumbi yezigulane
Ukufundwa kwe-JAMA, abaphandi basebenzise idatha esuka kwi-Survey Home 2007 kunye ne-Hospice Care Survey.
Ukuqhathaniswa kwedatha ukusuka kwizibhedlele zokufumana izibonelelo kunye nabangenasiphelo esibhedlele kubonisa ukuba ukuxilongwa kunye nendawo yokunyamekelwa kwendawo ehluke kwiimeko zengeniso. Xa kuthelekiswa nabangenakunceda abantu basebekhulile, izibhedlele ezifumana inzuzo zineengxaki eziphantsi kwezilwelwe zomhlaza (ama-48.4 ekhulwini kunye nama-34.1 ekhulwini) kunye namazinga aphezulu yezigulane ezineengqondo (8.4 ekhulwini kunye neepesenti ezingama-17,2) kunye nezinye izifo (iipesenti ezingama-43.2 no-48.7 iphesenti ).
Idatha ibonise ukuba malunga neyesibini kwisithathu sezigulane kwizibhedlele zokufumana inzuzo zineengxaki zokugula ngengqondo kunye nezinye izifo ezingekho komhlaza, kanti kuphela isigamu sezigulane ezingabaniki-nkonzo ezikhungathelweyo zifumane izi zifo.
Izigulane zentsholongwane zinexesha elinokuqikelelwa lokuphila kunye nenkqubo yokonyango. Ngethuba ixesha isigulane somdlavuza singena ekunyamekelweni kolondolozo lwama-hospice, ezininzi ziye zaphela zonke ezinye unyango kwaye zisondele ekufeni . Izigulane zesigqirha sokuphela kwesigqirha nazo zifuna ukunyamekelwa ngokunyamekela ngeentlungu ezinkulu kunye nolawulo lwezonyango.
Izigulane ezichaphazelekayo (kunye nezinye izigulane ezinezifo ezingalindelekanga kangako) zihlala zihlala ixesha elide kunezigulane zomhlaza ezinezinyango ezincinci. Ezi zi gulane zinenzuzo kakhulu kuba zifumana i-Medicare esibhedlele nganye ngezinga lokutya kwi-dayday ngeendleko ezingaphantsi kwee-pocket.
Indawo yoKhathalelo kunye nobude bokuhlala
Xa kuthelekiswa nabangama-hospitri abangenzi nzuzo, izibonelelo eziphathekayo zokufumana izibonelelo zineenqanaba eliphezulu lezigulane ezihlala emakhaya asebekhulile kunye nomlinganiselo ophantsi ohlala ekhaya.
Izigulane ezihlala emakhaya asebekhulile zihlala zibiza i-arhente yokubhedlele imali encinci ngexesha elide.
Amakhaya anesihlengikazi anokunyamekela ngononophelo olusondeleyo-olona olujongene neemeko ezininzi apho izigulane zasekhaya zifuna ukutyelela abantu. I-arhente zokunakekelwa kweenzuzo zenzalo ziye zenza umsebenzi omhle wokuthengisa kumakhaya asebekhulile ukuze kufikelelwe "kwi" kunye nabasebenzi basekhaya abahlengikazi kunye nokwandisa amazinga okuhanjiswa.
Ucwaningo lwe-JAMA lufumene ukuba xa kuthelekiswa nezigulane ezineengculaza, abo abaneengqondo zokugula okanye ezinye izifo bafumana ukutyelela ambalwa ngosuku ngabahlengikazi nabasebenzi bezentlalo . Oku kunengqiqo kuba izigulane zomhlaza zineempawu ezinzima kakhulu ezifuna ukubeka iliso rhoqo.
Ngenxa yokuba ii-arhente zokubhedlele zihlawulelwa iirhafu zemihla ngemihla ngesigulane, izibhedlele zokufumana inzuzo ziza kuncedisa ngemali ngokukhetha izigulane eziza kubakho ukutyelela abancinci.
Ubude bexesha lokuhlala (LOS) yimihla yeentsuku isigulane sinoxanduva lokubhedlele ngaphambi kokukhulelwa okanye ukufa. Ngokomphandi, i-LOS (medipoint) LOS yayininzi iintsuku ezi-ezine kwiindawo zokulalisa izibonelelo ezingenakunceda xa ziqhathaniswa nabangama-hospitali abangenzi-nzuzo (iintsuku ezingama-20 kunye neentsuku ezili-16, okanye i-26.2 ekhulwini i-LOS).
Xa kuthelekiswa nezigulane ezingama-hospitali ezingenzi-nzuzo, izigulane kwizibhedlele zokufumana inzuzo zenzeka ukuba zihlale ixesha elide kuneentsuku ezingama-365 (iipesenti ezi-2.8 kunye nama-6.9 ekhulwini) kwaye zazingenakwenzeka ukuba zihlale zingaphantsi kweentsuku ezisixhenxe (ama-34.3 ekhulwini kunye nama-28.1 ekhulwini) .
Impembelo yoPhando
Abaphengululi be-JAMA bathi ukufunyaniswa kweziphumo kubalulekile kwimpembelelo yomgaqo-nkqubo kwaye ababelethwe ngabangama-hospitali abangenzi nzuzo banokungalungi ngokucacileyo ngokwemiqathango yesigulane sabantu.
Ukhetho olukhethiweyo lwalolu hlobo lushiya i-arhente yokubhedlele ngokungenzi nzuzo ngaphandle kokunyamekela izigulane ezibiza kakhulu-abo abanomhlaza kunye nalabo bafuna ukuqala ukubeleka emva kwexesha lokugula; ngenxa yoko, abo bahlala esibhedlele abakhonza izigulane ezifunekayo banokujamelana nemingcipheko yemali enzima ekuboneleleni ngoncedo olufanelekileyo kule nkqubo yokuhlawula nganye.
Ezi ziphumo, kwaye zifanele, zenze ingxoxo malunga nokuhlaziywa kwentlawulo kwi- Medicare Hospital Benefit . I-Hospice yinkampani ekhulayo, ngokukodwa kwicandelo lenzelwe inzuzo, kwaye uphando olongezelelweyo lufunekayo ukuze kuqondwe ngokupheleleyo ukulungelelaniswa phakathi kwesimo senzuzo kunye namava abagulane / abanakekeli ekupheleni kobomi.
> Umthombo:
> Wachterman MW, Marcantonio ER, Davis RB, McCarthy EP. Umbutho we-Arhente ye-Hospice I-Incit Status Status With diagnosis diagnosis, Indawo yoNonophelo, kunye nobude bokuhlala. JAMA. 2011; 305 (5): 472-479. i-doi: 10.1001 / jama.2011.70