Umthetho Wokunakekelwa Onganakeki Ungase Uthuthukise Ukuphepha Kwesineke
I-Care Affordable Act igxile ekuthuthukiseni ukuphepha kwesiguli sonke, kodwa yini okwenzekayo manje ositshelayo? Ake sihlole izizathu zokuguqulwa kwezempilo ekunciphiseni amaphutha wezokwelapha, kanye nomcabango wezinguquko. Ngalesi sikhathi siyazi ukuthi amaphutha ezempilo asezingeni eliphakeme elingamukeleki, nokuthi kukhona okudingeka kuguqulwe. Kungenzeka ukuthi, nokuthi ushintsho oludingekayo lukhulu kakhulu kunamithetho ambalwa, noma amaningi, angayifeza.
Kodwa ingabe impilo iguquliwe kanjani, futhi ingaqhubeka kanjani ukushintsha inani lamaphutha ezempilo e-United States?
Iziphambeko Zezokwelapha
Izibalo ziyaziwa kakhulu odokotela, abakwa-pharmist, abaphathi besibhedlela, neziguli eziningi: amaphutha ezempilo avinjelwe abulale futhi / noma abalimala kabi amakhulu ezinkulungwane zamaMelika njalo ngonyaka owodwa.
Ukubambisana phakathi kwamaphutha wezokwelapha nokufa kwavela phambili kolwazi lomphakathi futhi, lapho i-2016 ifundela eYunivesithi kaJohn Hopkin yaphetha ngokuthi amaphutha ezempilo ayebhekene namaphesenti angu-10 okufa. Ukubeka lokhu ngendlela ecacile, noma eyingozi kakhulu, amaphutha wezokwelapha abonakala abe yimbangela yesithathu yokufa.
Ngenkathi sekuye kwaba nokuphikisana okubalulekile mayelana nezinombolo eziqondile, kanye nokuthi zingaki zalezi zifo ezivimbelayo, siyazi ukuthi amaphutha ezempilo yinkinga enkulu e-United States. Ngenkathi sekuye kwaba nokuphikisana okukhulu ezindabeni eziningi, kanti ngenkathi amaphutha ezempilo ebonakala ehla ngisho nangaphambi kokusayina kwe-Care Affordable Act, kuye kwaba ukunciphisa ukufa ngenxa yamaphutha wezokwelapha, okungenani phakathi kuka-2010 no-2014.
Ukuguqulwa Kwezempilo Njengendlela Yokunciphisa Amaphutha Ezempilo
Nakuba ukugxila okuyinhloko kwe- Care Act Act (umthetho wezokuguqulwa kwezempilo) usayinwe ngomthetho ngo-Mashi 2010 kwakuwukuhlinzekela ukufinyelela kumshuwalense wezempilo ongenakuthola kubo bonke abaseMelika, umthetho unamalungiselelo amaningi angathuthukisa ukuphepha kwesiguli.
Ukuphepha KwezeMpilo Kulingana Nezindleko Zokunakekelwa Kwezempilo Emncane
Ukuqaphela ukugcina okungenzeka okungatholakala ngokunciphisa amaphutha ezempilo esekelwe esibhedlela, uMedare uhlonze izimo eziningi "ezivinjelwayo" ezivamile ngesikhathi sokuhlala esibhedlela. Uma bekhona ngesikhathi sokubeletha esibhedlela, isibhedlela asikwazanga ukukhokhela izinsizakalo ezinikeziwe.
Le mithetho yaqala ukusebenza ngo-2008 ngaphambi kokuya koMthetho Wokunakekelwa Onganakekelwayo. Ngaphandle kokungalindelekile, izinkampani eziningi zomshuwalense wezempilo ezizimele, ezihlanganisa i-Aetna kanye neBlue Cross / Blue Shield Association phakathi kwabanye, zaqalisa izinqubomgomo ezifanayo zokungazikhokheli izibhedlela kanye nodokotela ngokunakekelwa okuhlobene nezinkinga zezokwelapha okungafanele zenzeke ngesikhathi sokubeletha.
Umgomo walezi zinqubomgomo ukugcina izimpilo nokugcina imali ngokuthola izibhedlela zenza izinqubo ezintsha zokuvimbela amaphutha.
Ukuphawula kanye Nezikhuthazo Ezintsha Zokuphepha Patimende
Ukwakhiwa kwemithetho yezokuphepha esibhedlela i-Medicare yaqala ukusebenza ngonyaka ka-2008, uMthetho Wokunakekelwa Kwezezimali ongenakuthengiwe usebenzisa izinkokhelo ze-Medicare ezibhedlela ukuze kushukumise ushintsho. Ngokuhamba kwesikhathi, kulindeleke ukuthi izinkampani eziningi zomshuwalense ezizimele zizolandela ukuhola kwe-Medicare; lokhu kufanele kukuthinte kungakhathaliseki uhlelo lwezempilo olukhokhela izikweletu zakho zesibhedlela.
Izinhlinzeko ezilandelayo emthethweni wokuguqula impilo zibeka isisekelo sokushintsha okudingekayo:
- Izibhedlela nemiphumela engcono ehlobene nokunakekelwa kwemivimbo kanye nokuhlaselwa kwenhliziyo, nokuvinjelwa kwezifo kuyothola izinkokhelo eziphakeme.
- Izibhedlela ezinamazinga aphezulu okufunda ngokuhluleka kwenhliziyo kanye namazinga aphezulu yezimo ezitholakale esibhedlela ezifana nezifo, izilonda zombhede, nokuwa kuzokwaziswa ngokukhokha okuncishisiwe.
- I-Medicare izolandelela izinga lesiphambeko esibhedlela futhi (2014) izokwehlisa inkokhelo ngamaphesenti angu-1 ezibhedlela ezinezinga eliphakeme kakhulu lezinkinga zokuphepha kwesiguli.
Ukuze uqiniseke ukuthi uyazi ngalezi zindlela zokuphepha futhi wabelane ngokuthi izibhedlela zithuthukisa kanjani, uMnyango Wokunakekelwa Ongenakudingeka udinga uMnyango wezokwelapha:
- Shicilela iphutha lezokwelapha ngayinye esibhedlela.
- Dala iziPhumo eziPhezulu eziPhezulu eziPhuthumayo ezizogqugquzela ukwelashwa okuphumelelayo kakhulu.
- Sungula Isikhungo Sokuthuthukiswa Kwezinga kanye Nokuphepha KwezeMpilo ukucwaninga ukuthuthukiswa kokuphepha kwesiguli.
Njengengxenye yokuguqulwa kwezempilo, uhulumeni wesifundazwe wavuma ukuhlinzeka ngemali eyizigidi ezingu-75 ngonyaka ukuze kuthuthukiswe izinyathelo nezindlela zokuphepha.
Indlela Izibhedlela Eziqhathanisa Ngayo Nokuphepha Kokubekezela
I-Medicare, ngokubambisana nezibhedlela eziningi emhlabeni wonke, yenze i-Hospital iqhathanise. Ithuluzi le-intanethi lingakusiza ukuthola ulwazi lokuthi izibhedlela emphakathini wakho zizinakekela kanjani iziguli ezinezimo ezithile zezokwelapha noma izinqubo zokuhlinza, kanye nemiphumela evela ekuhloleni kweziguli mayelana nekhwalithi yokunakekelwa abayitholile ngesikhathi sokuhlala esibhedlela. Lolu lwazi lungakusiza uqhathanise ikhwalithi yezibhedlela zokunakekelwa linikeza futhi likusize wenze isinqumo mayelana nokuthi yini ezoba ngcono kuwe uma udinga ukunakekelwa esibhedlela.
Ezinye zezimo zezokwelapha ziqhathaniswa zihlanganisa ukuhlasela kwenhliziyo, ukwehluleka kwenhliziyo, isifo samaphaphu esingapheli, isibhamu, isifo sikashukela kubantu abadala, nobuhlungu besifuba. Ezinye zezinqubo zokuhlinza zihlanganisa ukuhlinzekwa kwe-heart, ukuhlinzwa kwe-pacemaker, ukuhlinzwa kwe-gallbladder, ukuhlinzwa kwe-hernia, ukuhlinzeka ngamathumbu, ukuhlinzwa emuva nangensipho okukhulu ukushintshwa okuhlangene, ukuhlinzeka ngesisu, nokuhlinza abesifazane.
Ezinye Izixwayiso Ngezibhedlela Qhathanisa
Ukwaziswa esibhedlela Ukuqhathanisa iwebhusayithi kubangelwa izibhedlela ezivumelene ukuhambisa ulwazi lwekhwalithi ye-Hospital kufanelana nokwenza umphakathi. Isibhedlela sakho angeke sibalwe. Futhi, uma usuhlelo lwezokunakekelwa oluphathisiwe (i-HMO noma i-PPO), isibhedlela ofuna ukuyisebenzisa kungenzeka singabi kwinethiwekhi yomhlinzeki wezempilo yakho. Noma kunjalo, kufanele ukwazi ukulandelela noma yiliphi irekhodi lezokwelapha esibhedlela.
Ukucabanga Okuqala Ngomthelela Womthetho Wokunakekelwa Onganakekelwayo
Ngokugxininiswa okuqinile ekuthuthukiseni ikhwalithi kanye nokucaca "kwesanqante nokunamathela" ekubuyiselweni esibhedlela, kungenzeka ukuthi ukunakekela esibhedlela kuzoshintsha kangcono esikhathini eside. Kodwa-ke, ngazo zonke ezinye izinguquko ohlelweni lwezempilo olulindeleke ekuguqulweni kwezempilo, izidingo (kokubili zezezimali kanye nezinombolo ezikhudlwana zeziguli ezidinga usizo) ezibhedlela kanye nodokotela, ikakhulukazi odokotela bokunakekelwa okuyinhloko, kungenzeka ukuthi zibalulekile, uma kungenasidingo .
Umthetho Wokunakekelwa Ongathintekiyo kanye Neziphambeko Zezokwelapha, ngo-2010-2014
Manje sesinolwazi oluthile ngemiphumela engenzeka ye-Care Affordable Act on amaphutha ezempilo. Ngokusho kwe-Agency for Healthcare Research and Quality, kwaba nokunciphisa amaphesenti angu-17 kwezimo ezitholwa esibhedlela phakathi kuka-2010 no-2014. Lokhu kuhumusha ukufa kwabangu-87,000, kanye nokulondolozwa kwamaRandi ayizigidi ezingu-19,8. Ngenkathi ukunciphisa amaphutha kubonakala sengathi kuyalinganisa, futhi naphezu kwezinye iziphakamiso eziphakanyiswe yi-ACA, ngezindlela eziningi lokhu kuguqulwa kwesikhathi eside kusengaphambili ekuqondeni amaphutha wezokwelapha.
Ukulinganiselwa Ekuqondeni Izinguquko Eziphuthweni Zezokwelapha
Kukhona ukulinganiselwa kokwazi ukuthi ukunciphisa amaphutha wezokwelapha kungabhekwa kanjani kuMthetho Wokunakekelwa Ongenakusiza. Khuluma ngezindlela zokunciphisa amaphutha wezokwelapha ngaphambi kokusungulwa koMthetho, futhi kuphawulwe nokuthi ukunciphisa amaphutha kwaqala ngaphambi kokuba kuqalwe ngo-2010.
Kuzo Iziphambeko Ezimbalwa Zokwelapha Ngokuba Nomguli Ophethwe amandla
Kungakhathaliseki ukuthi i-ACA ne-Obamacare vs i-Trumpcare ibe nomthelela kanjani ekubhekaneni nesiguli eminyakeni ezayo, lezi zinguquko azanele ukufeza ukunciphisa esikudingayo ukuze sibone emaphutha wezokwelapha. Ngezindlela eziningi, ithuba lakho elihle lokugwema amaphutha ezempilo ukuthi ube nesiguli esinikezwe amandla futhi uthathe isikhathi sokubuyekeza izindlela zokunciphisa ingozi yakho. Thatha isikhathi sokufunda ukuthi unganciphisa kanjani amathuba okuphuza imithi . Ukwenza kanjalo kungathatha isikhathi esincane futhi usindise ukuphila. Thatha isikhathi sokubuyekeza amarekhodi akho wezokwelapha amaphutha. Buza imibuzo eminingi futhi uqiniseke ukuthi uyaqonda izingozi nezinzuzo kwanoma yimiphi imithi noma inqubo udokotela wakho uyancoma.
Ngezansi Eziphuthweni Zezokwelapha Nezinguquko Zezempilo
Enye yemigomo yoMthetho Wokunakekelwa Okungenakusiza ukunciphisa inani leziphambeko zezokwelapha, amaphutha angase abe nesibopho samaphesenti ayishumi okufa kuleli zwe. Kusukela ngo-2010 no-2014, kubonakala sengathi iphumelele, nakuba kunezinkinga eziningi eziye zaphakanyiswa kanye. Okubalulekile ngalesi sikhathi, ukuthi abantu bangenza okuthile namhlanje ukunciphisa ingozi yabo, kungakhathaliseki ukuthi izinguquko ezingeni likazwelonke. Ukuba nesiguli esihlakaniphile futhi esinamandla kungenye yezivikelo zakho ezingcono kakhulu ngalezi ziphambeko ezihlala zivame kakhulu namuhla.
> Imithombo:
> I-Agency for Researchcare and Quality Quality. Ukulondoloza Ukuphila Nokulondoloza Imali: Isimo Sezimo Ezidingekayo Ukuvuselelwa. Imininingwane Yesikhashana Evela Emzamweni Kazwelonke Yokunakekelwa Kakhulu, 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