Ukuqonda uMyinge weNgxowa-mali we-Private Health Insurers
Enye yezigxeko eziqhelekileyo ezifakwe kwiinkampani zomshuwalense zempilo yabucala kukuba zizuzisa ngeendleko zabantu abagulayo. Kodwa makhe sijonge ngakumbi kwi-data kwaye sibone apho kusithatha khona. Ingaba iinkampani zomshuwalense zempilo yabucala zenza inzuzo engenangqiqo?
Ziyintoni na eziqhelekileyo kwiNtshuwalense yezeMpilo yangasese
Ngaphambi kokuqwalasela umbuzo malunga neenzuzo, kubalulekile ukujonga indlela oqhelekileyo ukuba ne-inshorensi yezempilo yangasese e-United States.
Ngamanye amagama, bangaphi abantu abanokuchaphazeleka ngalo mbuzo.
Ngokweenkcukacha zeKaiser Family Foundation, malunga nesithathu kwabaseMerika babenomshuwalense wezempilo karhulumente ngo-2016 (ngokugqithiseleyo i-Medicare neMedicaid). Ezinye iipesenti eziyi-9 zazingenakuqinisekiswa, kodwa abanye bafumana i-inshorensi yempilo yabucala ukuba bazithengela ngokwabo kwimarike nganye (iipesenti ezi-7) okanye ukunika ingxelo enikezelwa ngumqeshi (iipesenti ezingama-49). Phantse isiqingatha seMerika sineenkcazo ezinikezelwa ngumqeshi, nangona ama-63 ekhulwini awo aneembopheleleko ezincinci okanye ngokuzenzekelayo ezixhaswa ngemali ngumqeshi (oko kuthetha ukuba umqeshi unayo imali yakhe yokugubungela iindleko zonyango, kunokuba athenge i-coverage evela kwinshurensi yezempilo umphathi).
Kodwa abaninzi abaxhamli beMedareid kunye neMedicaid bafumana uncedo olubonelelwa ngekampani yenkampani yomshuwalense yabucala, nangona bababhalisele kwizicwangciso zonyango lwezempilo.
Iipesenti ezingama-33 ze-Medicare abaxhamli babhaliswa kwiiprogram ze-Medicare Benevantage eziqhutywa ngabashenxhi bezempilo bangebodwa, kwaye ii-39 zinezivumelwano zokunyamekela ngeMedicaid kunye nabathwali bezithuthi ukufihla ezinye okanye zonke ii-Medicaid zabo. Ngaphandle kwabaxhamli be-Original Medicare, i-quarter inezicwangciso ze-Medigap zithengwa kubathwali bomshuwalense benkampani yabucala kwaye le namba iyanda (yanda iipesenti ezi-6 ukusuka ngo-2013 ukuya ku-2015 yedwa).
Xa sibeka zonke ezo zinto, kucacile ukuba inani elikhulu labantu baseMelika banokufumana impilo enikezelwa okanye ephethwe yinkampani ye-inshurensi yempilo. Yaye iinkampani zomshuwalense zonyango zihlala zifumana i-rap embi xa ifikelela kwiindleko zonyango.
Ngaba i-inshurensi inzuzo engenangqiqo?
Amanqaku amaninzi abhalwa ngabantu abazama ukufumana inkxaso ngexesha lokubhalisa okuvulekileyo. Ezinye zazo zibonakala zidibanisa ingeniso ngenzuzo eyenza ukudideka. Kakade ke, abaphathi be-inshurensi yezempilo abanemali engenayo, kubonelelwe ukuba baqokelela iipriyamu ezininzi ze-insureds.
Kodwa kungakhathaliseki ukuba ingaba zininzi iimali zenkcitho ziqokelela kuma-premium, kufuneka ukuba zichithe ezininzi zazo kwiimfuno zonyango kunye nokuphuculwa kwekhwalithi yezempilo. Kwaye nangona ukugxekwa okuqhelekileyo kukuba iinkampani zomshuwalense yezempilo zihlawula i-CEO zazo kakhulu, oko kukubonakalisa ngakumbi ukuba ukukhula kwemivuzo ye-CEO, ngokubanzi, kuye kwagqithisa kakhulu ukukhula kwamaholo kwiminyaka emininzi edlulileyo. Akukho zithuthi ze-inshorensi zempilo ezimele phakathi kweefisi eziyi-100 ezinama-CEO aphezulu ahlawulwayo, nangona kukho iinkampani ezininzi zezobisi.
Ngoko ngelixa i-CEO yomvuzo wesibhozo okanye ezisibhozo ibonakala ingenangqondo kumsebenzi oqhelekileyo, ngokuqinisekileyo iyahambelana nesiqhelo senkampani.
Kwaye i-CEO ye-inshorensi yempilo ayikho phakathi kwee-CEO eziphezulu ezihlawulwe zeenkampani ezinkulu. Inyaniso iyaqhubeka ukuba imivuzo inxalenye yeendleko zokulawula ukuba iinkampani zomshuwalense yezempilo kufuneka zinciphise phantsi komthetho we-Career Affordable Care Act (MLR). Kwaye ke inzuzo.
Ingakanani Impilo yabanini-mali ngabanini-mali?
Ukuba sijonge iindleko eziqhelekileyo zentengiso yoshishino, iinkampani ze-inshorensi zempilo zihle kakhulu ngasezantsi, kunye nomyinge oqhelekileyo wenzuzo wama-3.3 ekhulwini. Ngokombono, amashishini asebhankini kunye neentengiso azuze iipalini eziphakathi kwama-20 eepesenti, kunye nabenzi beziyobisi eziphambili abanomyinge wemigangatho engama-22 ekhulwini.
I-ACA isebenzise izikhokelo ze-MLR ezifuna iinkampani ze-inshorensi zempilo ukuba zichithe ubuninzi bezinto abaziqokelela kuma-premium kwiimfuno zonyango. Ukuzikhawulela ngokuzenzekelayo iindleko zabo zokulawula - kuquka intlawulo yesigqeba kunye nenzuzo-engaphantsi kwama-20 eepesenti yemali ye-premium. Kodwa akukho mfuneko efanayo nezibhedlele, abenzi beefowuni, okanye abenzi beziyobisi.
Ngaphantsi kwiNzuzo yeeNkampani ze-Intshuwalense yabucala: Ukuqiqa okanye ukungaqondakali?
Iindleko zonyango ziyimpembelelo yee-premium zezempilo. Kuyinyani ukuba iinkampani zomshuwalense zonyango zihlawula iimivuzo zazo ze-CEO kwaye zimele zihlale zinenzuzo ukuze zihlale kwishishini. Kodwa iingeniso zabo zithobekile xa zithelekiswa namanye amashishini.
Ukuba unemibuzo eminye emva kokufunda malunga nenzuzo, funda malunga nezixhobo ezifanelekileyo zokufumana ulwazi malunga ne-inshorensi yempilo kunye nomgaqo-nkqubo wezempilo.
> Umthombo:
> Kaiser Family Foundation. Ubungqina bomshuwalense woBonke abemi. Isiqendu 2016. https://www.kff.org/other/state-indicator/total-population/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22% 7D