Iithintelo ezithintela utshintsho kwizonyango ezincinane zonyango

Icandelo lezoshishino lihlala litshintshana ngezizathu ezininzi. Okona kutshanje, ukuphuculwa komgangatho kuye kwaba yindlela kunye nezindlela ezincinci zonyango zijongene nokuphunyezwa kwezicwangciso ezinzima ukuphucula umgangatho wokunyamekela izigulane. Uphuculo oluthile olwenziwe ngonyango luquka ukunciphisa amaxesha okulinda , ukuphucula iindlela zokulandelelana kwezigulane, ukuphucula izikhalazo zesigulane, ukuphucula amaxwebhu eekliniki kunye nokucwangcisa iinkqubo.

Ukuze kuphunyezwe utshintsho kwinkqubo encinci yezokwelapha, kubalulekile ukuchonga nokuqonda imiqobo kunye nemingeni ephazamisa utshintsho. Kukho izithintelo zangaphakathi nezangaphandle ezithintela utshintsho kwiindlela zonyango ezincinane.

Imiqobo yangaphakathi iquka:

• Abasebenzi abangafuni ukutshintsha
• Ukungabi nokhuthazo kwamalungu omsebenzi
• Ukungabi nolwalamano phakathi kwamalungu asebenzayo
• Ukungabi nendawo efanelekileyo
• Imizabalazo yamandla

Imiqobo yangaphandle iquka:

• Khuphiswano
• Ukuhlaziywa kwentlawulo
• Ukubandakanyeka komonde

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Ukunyanzelwa kwabasebenzi ukutshintsha

Ukumelana nokutshintsha kuphezulu kwiluhlu lwezithintelo zokuphumeza utshintsho kuyo nayiphi na imeko. Kwindlela yokwelapha apho kubaluleke khona, kubalulekile ukuqikelela imithombo yokuchasana nokuphuhlisa izicwangciso zokusebenza kuzo. Ezinye zezona zizathu eziqhelekileyo abasebenzi abanokumelana nokutshintsha ziquka:

1. Ukwesaba okungaziwa. Abantu banamathele ngokuzenzekelayo okanye baqonde utshintsho njengamava amaninzi. Oku kuyinyani ngakumbi ukuba abanalo isilumkiso esaneleyo okanye abangayiqondi ukuba kuya kuthinta njani umsebenzi wabo.
2. Ukwesaba ukulahlekelwa yimisebenzi yabo. Abantu bavame ukubona utshintsho njengengozi kwimisebenzi yabo. Basenokujonga ukuphumeza iinkqubo ezintsha njengoluhlengahlengiso kwaye bacinge ukuba unyango lusebenza kakuhle, isikhundla sabo siya kupheliswa.
3. Ukungabi nethemba. Ukuba amalungu omsebenzi angathembi ukulawulwa, ababanako ukulandela ngokulula imigaqo-nkqubo nemigaqo emitsha. Ukuba ulawulo lulahlekelwe yithemba okanye aluzange lufumane ukuthembela kwamalungu omsebenzi, banokumelana nokutshintsha.
4. Ulungelelaniso lwesiqhelo. Abanye abantu abanaso isizathu sokumelana nokutshintsha ngaphandle kokuba bakhetha indlela yabo yangoku. Emva kokusebenza kwindawo enye, kwindawo efanayo, iminyaka emininzi, ilula nje ukunamathela kwizinto eziqhelekileyo. Aba bantu abakuvuyo ukufunda izinto ezintsha kwaye banokuthi bangabamalungu amanqabileyo.
5. Ixesha elibi. Zonke iinyathelo kwishintsho okanye ukuphunyezwa kufuneka zenziwe ngexesha elifanelekileyo. Ukuba akunjalo, amalungu asebenzayo aya kulwa naluphi na utshintsho olwenziwe luya kuhlanganyelwa.

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Ukungabi Nentshukumo YamaLungu eMisebenzi

Amalungu asebenzayo angenayo isisiseko sokuphumeza utshintsho ahlukile kulawo anqabile ukutshintsha. Ukuchasana kukula ukuvuma okanye ukuthobela utshintsho. Ukungabikho kokukhuthazwa kubhekisela ekungafuni komntu ngenxa yokungahambi komnqweno okanye umdla.

Olunye umehluko phakathi kokuchasana nokukhuthazwa kukuba ukuxhatshazwa kunokutshatyalaliswa ngokuthetha nabasebenzi ukuba zeziphi utshintsho zibandakanya, ngubani oya kuba nefuthe ngabo, nokuba njani utshintsho luya kubachaphazela ngaphambi kokuba kukho utshintsho olwenziwa. Ukukhuthaza, ngakolunye uhlangothi, kunzima kakhulu.

Kukho ezimbini iindidi zabagqugquzeli: ukungena ngaphakathi nokugqithisileyo.

Abakhuthazi be-intrinsic baqhutywa yizinto zangaphakathi. Umntu uyazuza ukwaneliseka ngokwenza umsebenzi othile. Eminye imizekelo yabashukumisayo bangaphakathi bayaphumelela, baqaphele, banandipha, okanye baneliseka.

Abagqugquzeli be-Extrinsic baqhutywa yizinto zangaphandle. Ezi zinto ziquka udidi oluthile lolawulo ngokunikezela okanye ukugwema imivuzo, okanye uhlobo oluthile lokujeziswa. Eminye imizekelo yabakhuthazi abasemgangathweni yimali, indumiso, isenzo soleko, ukukhuselwa komsebenzi, okanye inzuzo.

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Ukungabikho koBudlelwane phakathi kwamalungu eMisebenzi

Xa amalungu omsebenzi engenawo ulwalamano, awanakho ukusebenzisana kunye nemveliso. Ukuze uphumelele, ngakumbi ngexesha lokutshintshwa, amalungu asebenzayo kufuneka athembeke, axhaswe kwaye ahlonelane.

Ngaphambi kokuphunyezwa kwenguqu encinane, kunokufuneka ukuba isebenze imisebenzi yokwakha iqela ukuphucula ubudlelwane phakathi kwamalungu omsebenzi. A

Nazi izikhonkco ezilishumi ezenza amalungu angenalo ubudlelwane:

1. Izikhalazo zesineke malunga nomgangatho wenkonzo
2. Ukwenyuka kwemveliso
3. Ukudideka malunga nemisebenzi kunye neemfanelo zomsebenzi
4. Imisebenzi ayenziwanga ngendlela efanelekileyo okanye ngexesha elifanelekileyo
5. Ukungabi nokhuthazo
6. Imisebenzi eqhelekileyo idinga izigqibo ezinzima
7. Impikiswano phakathi kwamalungu asebenzayo
8. Iingcamango ezingekho phantsi kolawulo
9. Izikhalazo zobubele
10. Ukungabikho kwentsebenziswano

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Ukungabi Nendawo Efanelekileyo

Iindlela zonyango zonyango zihlala zingenalo indawo efanelekileyo yokuphumeza utshintsho. Ngokukodwa, utshintsho olwenziwe ekuphuculeni ukuhamba komguli luba nzima ngenxa yezinto ezidlulileyo. Iindleko zokulungiswa okanye ukufudukela kwisikhulu esikhulu asikwazi ukukhetha ngenxa yoxinzelelo lwemali onokubeka kulo msebenzi.

Ukuqhuba uvavanyo lokuhamba kwesigulane kunokukunceda ukuba i-space iyona mcimbi okanye ukuba kukho utshintsho kwinkqubo. Ukuba kuqinisekiswe ukuba indawo iyona mcimbi, kuyona nto inomdla wokwenza utyalo ekwakheni okuya kuphuculisa isigulane ngesigulane kwizigulane zangoku kunye nezizayo.

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Ukulwa kwamandla

Kukho iingxaki ezininzi zamandla kwizonyango. Omnye ongumqobo wokuphumeza inguqu umzabalazo phakathi kokunikezela ngononophelo lwekhwalithi ngelixa ukunciphisa iindleko. Ikhwalithi engafanelekanga yokunyamekela kunye nokunyuka kweendleko zonyango kuye kwaba yinkalo yemigudu yokulungiswa kwempilo kwiminyaka emininzi.

Uphando lubonisa ukuba imodeli yokuhlawula i-volume-based based care is responsible for the problems and quality and costs of care. Imizekelo yokuhlawula imiqulu ikhuthaza ababoneleli ukuba baphathe izigulane ezininzi ukuvelisa inzuzo ephezulu ngaphandle kokubaluleka kokuphucula iziphumo eziphezulu okanye ukunciphisa iindleko njengoko iimodeli zokuhlawula ixabiso-mali zikhuthaza ababoneleli ukuba bafezekise amanyathelo athile okusebenza ukwenzela ukuvelisa imali ephezulu.

Kwizonyango zonyango ezama ukuphucula iziphumo zomgangatho kunye nokunciphisa iindleko ziyakwazi ukubambana kombane phakathi kokubonelela ngononophelo lwezigulane nokugcina impilo enempilo. Ngaphandle kokuba iimodeli zokuhlawula zitshintshe ukuxhasa umgangatho wokunyamekela ngelixa uvumela ukuba unyango lufikelele ekuzinzeni ukuzinza imali, mhlawumbi ukuphumeza utshintsho kuya kuqhubeka kuthintelwa.

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Khuphiswano

Ukuncintisana okusemgangathweni kulungile kumashishini, nangona kunjalo, inani elikhulu lezonyango ezizimeleyo zidibanisa iinkqubo zabo ukuze zibe ngumsebenzi ogqithisileyo ogqirha. Ezinye iingcali zibonisa ukuba ukudibanisa izakhono ezahlukeneyo zobugqirha kwisenzo esisodwa kunenzuzo kwizigulane kunye nokusebenza.

Izenzo zonyango ezizimeleyo zinoxanduva olulodwa lokugcina nokuhlaziya izixhobo ezikhoyo, isofthiwe (iteknoloji yolwazi) kunye nezibonelelo. Ezi ndleko zingafaka utyando kwiofisi yezobonyango ngokukhawuleza kwemali. Iimfuno ze-ICD-10, i-HIPAA, ukusetyenziswa okubalulekileyo kunye nokuphunyezwa kwerekhodi yezempilo ye-elektroniki kufuna ababoneleli ngeenkonzo zezempilo ukuba bandise amandla abo kwi-teknoloji yolwazi kunye nemfundo.

Izenzo ezinkulu zikwimeko engcono yezemali ukuzalisekisa olu tshintsho.

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Ukuhlaziywa kweNtlawulo

I-Medicare kunye neMedicaid yokuhlawula i-reimbursement, ekwachongwa njengenguqu yokuhlawula, ngumqobo omkhulu wokutshintsha kwindlela yokwelapha encinci. Ukwelashwa kweMedare kunye neMedicaid kwakha imbuyiselo enkulu yemali kwizinto ezizimeleyo okanye ezizimeleyo. Inzuzo ephantsi yenza kube nzima ukuphumeza utshintsho kuba iinkqubo ezincinci azikwazi ukugcina uncinci ukwenza uphuculo.

Ukongeza, iinkqubo ezonyango inani elikhulu leMedare kunye / okanye izigulane zeMedicaid, ukunciphisa ukubuyiswa kungabangela ukuba bayeke ukumkela izigulane ezintsha zeMedare kunye neMedicaid. Kwabanye, kuthetha ukuthintela isenzo sabo.

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Ukuguquka komonde

Ngaphandle kokubandakanyeka kwesigulane, kunzima ukuphumeza utshintsho. Indlela elula kwaye ephumelelayo yokuqinisekisa ukuba izigulane zakho zifumana ulwazi olubalulekileyo ekunyamekeleni kwabo kukunika izibonelelo. Izibonelelo ezi-5 ezifunekayo kwizigulane ezintsha ziquka:

1. Ukutyelela kokuqala
   • Umyalezo owamkelekileyo umonde
   • Isingeniso kwindlela yokwelapha
   • I-bio emfutshane yonyango ngamnye
   • Oko bakufanele balindele ukuvavanywa kwabo kuqala
   • Iinkcukacha zoqhakamshelwano
   • Iiyure zokusebenza
   • Iinkonzo ezinikezelweyo
   • Ezinye indawo
2. Uluhlu lwezinto eziza kuzisa kutyelelo ngalunye
   • Ulwazi lweNtshuso
   • ID Photo
   • Iqela elixanduva / uLwazi
   • Ulwazi loLuntu
   • Iintlawulo
   • Ulwazi lwezonyango
   • Oonxibelelwano olukhawulezayo
   • Ulwazi lweNkcazo
   • I zikhokelo
   • Ukugunyazwa kwangaphambili / ukuhanjiswa
3. Umgaqo wokuhlawula
   • Ukuhlawula i-Co-pays, i-deductibles, kunye ne-inshurensi yemali-yintsebenziswano iyafuneka phambi kokuba iinkonzo zihanjelwe ukutyelela nganye
   • Izigulane ezizimeleyo zijongene nokuhlawula imali yonke
   • Iifom zokwamukela iintlawulo ezifana nokuhlolwa komntu siqu, amakhadi enkredithi kunye namakhadi e-debit
   • Imirhumo yexesha elihlawulwayo imali ehlawulwayo ayihlawulwanga ngexesha elithile
   • Imirhumo yokuqeshwa kwabangenayo ayikhansekanga okanye ichithwe ngaphambili
   • Uhlu lweenkampani zomshuwalense
   • Izigulane kufuneka zinikezele ubungqina bomshuwalense ngaphambi kokuba unyango okanye uthathwa njengomvuzo wokuzihlawula
4. Isaziso semisebenzi yobumfihlo
   • Indlela umniki-benzisi oza kusebenzisa ngayo kwaye achaze i-PHI
   • Amagulane amalungelo anxulumene nePHI yawo
   • Ingxelo ekwazisa isigulane semithetho efuna umboneleli ukuba agcine ubumfihlo be-PHI yabo
   • Ngaba izigulane ziyakwazi ukudibanisa ngolwazi olungaphezulu malunga nomgaqo-nkqubo we-ngasese
5. Inzululwazi yokwaneliseka isigulane
   • Ingaba isigulane sathethiwe ngentlonelo xa sithengela ukuqeshwa?
   • Ingaba isigulana sasibuliswa ngumntu owamkeleyo ngokuthobeka kunye nentlonipho?
   • Kwakudala ixesha elingakanani isigulane silinde ukubona ugqirha?
   • Ngaba umongikazi nodokotela uchaza iinkcukacha zeenkonzo ezinikezelwa isiguli?
   • Ngaba umongikazi nogqirha baphendula yonke imibuzo yomguli?
   • Ingaba isiguli sifike ngenkonzo yamakhasimende kakhulu?
   • Ngaba igumbi lokuhlola lalicocekile, likhululekile kwaye lilungiswe?
   • Ingaba indawo yokulinda iphephile, ihlambulukile kwaye ivulekile?

Olu alukho uluhlu lonke olubandakanya kodwa nje ezimbalwa iindlela zokugcina izigulane ezibandakanyekileyo kwaye ziyazi ukuba kubaluleke kangakanani ukubandakanyeka kwabo kukunyamekela kwabo.

_Iingxelo

_{Arar, uNedal H., et al. "Ukuphunyezwa koPhuculo loPhuculo lweMigangatho ePhakamileyo, okuQinisekisa kwiNyango yezoNyango eziPheleleyo." Ubunqanaba lokunyamekela kweprayimari 19.5 (2011): 289-300. CINAHL ngeTekisi epheleleyo.}

_{Forbes. Umagazini weForbes, nd}