Ingabe i-Medicaid izokwehlisa ukunciphisa ukwelashwa kwezinketho?
Ukulutha kwe-opioid kuyinkinga ekhulayo e-United States. Kusukela ngo-1999 kuya ku-2015, kungakhathaliseki ukuthi izidakamizwa zemithi noma ezivela e-opioid ezingekho emthethweni njenge-heroin, abantu abangaphezu kwesigamu sezigidi bafa ngokweqile kwe-opioid. I-Centres ye-Medicare ne-Medicaid Services (i-CMS) ibika ukuthi abantu abangu-91 bafa nsuku zonke ngokuhlukunyezwa kwe-opioid, besifaka emgwaqweni kwabafa abangu-32 400 ngo-2017.
I-Medicaid idlala indima enkulu ekwelapheni umlutha. Ngomunye wabantu baseMelika abahlanu abathembele ku-Medicaid ngezidingo zabo zokunakekelwa kwezempilo, yiziphi izinsizakalo ezinikezwayo futhi lezi zinsizakalo zizoqhubeka yini uma iqembu leRiphabhuliki liphumelela ekuqedeni uMthetho Wokunakekelwa Ongabizi , i-Obamacare?
Ukuhlukumeza i-opioid Yonke indawo
Ukuhlukumeza i-opioid akuyona inkinga yesimo kuphela. Kuyinkinga kazwelonke.
Ukufa kwe-Overdose kwenyuka kusukela ogwini kuya ogwini ngo-2014. I-Ohio neCalifornia yahlupheka kakhulu ngokufa okuhlobene no-opioid okungaphezu kuka-2 000 ngamunye, kuyilapho iNew York, Florida, Illinois, Texas, Massachusetts, Pennsylvania, naseMichigan bebebhekene nokufa kwabantu abangaphezu kuka-1 000 .
Njengoba nje ukuhlukunyezwa kwe-opioid akuyona isifunda, i- Medicaid ayinqunyelwe emazweni. I-Medicaid, ngenkathi ilawulwa ngokwezindlela yizizwe, ixhaswa kancane ngamadola ase federal. Uhulumeni wesifunda ubeka izindinganiso ezincane zokuthi ubani ofanelekile ku-Medicaid nokuthi yikuphi ukufakwa okuyisisekelo okumele kufakwe kuloluhlelo.
UMthetho wezeMpilo waseMelika , njengoba wawuthiwa eNdlu Yezindwendwe zase-US, uhlongoze ukukhishwa okukhulu ohlelweni lweMedicaid. Umthethosivivinywa, manje obizwa ngokuthi uMthetho we-Better Care Reconciliation Act, ulindele ivoti eSenate yase-US ngaphambi kokuba kube ngumthetho. Uma sidlulile, umthetho ungashintsha iziphi izinzuzo ezibalulekile zezempilo - kuhlanganise nezinsizakalo zempilo yengqondo kanye nokwelapha izidakamizwa - zihlanganiswa umshwalense wakho wezempilo.
Lokho kufaka phakathi i-Medicaid.
Ukwelapha Umlutha We-opioid
I-Care Affordable Act iyadingeka ukuthi kusho ukuthi iqhaza ekukhuliseni i-Medicaid ye-cover substance ukusetshenziswa kwe-disorder treatment. Kodwa-ke, umthetho wanikela ngokuvumelana nezimo futhi wavumela umbuso ngamunye ukuba unqume ukuthi yiziphi izinsizakalo ezaziyofuna ukuzibuyisela.
Umthetho we-Better Care Reconciliation Act uzoqeda ukwandiswa kweMedicaid futhi umise ukwelashwa okugunyaziwe wokulutha umlutha.
Kunezigaba ezine zokwelapha okumele zicatshangelwe:
- Izinsizakalo eziphuthumayo (kuhlanganise nokwelashwa kweqembu, ukwelashwa ngamanye, nezinsizakalo zokusekela kabusha)
- Izinsizakalo eziphuthumayo kakhulu
- Izinsizakalo zokuhlala neziguli zesikhathi eside
- Ukunakekelwa okukhulu kwesifo sofuba sokuxoshwa kwe-detoxification
Ucwaningo olwenziwe ezempilo lwezempilo luhlolisise ukuxilongwa kokulutha umlutha kusukela ngo-2015 kuya ku-2016. Kuyathakazelisa ukuthi abacwaningi bathola ukuthi ukubhekwa kwakungeyona ephakeme kumazwe ayenokukhulisa iMedicaid .
Izifunda eziyishumi nesishiyagalombili kanye nesifunda saseColumbia zihlanganisa zonke izinsizakalo, kanti izifunda ezingu-26 zihlanganisa okungenani isevisi eyodwa ezingeni ngalinye zokwelapha. Izifunda eziyisishiyagalolunye azange zinikeze ukuhlinzekwa kwe-Medicaid nganoma yikuphi ukunakekelwa kokusetshenziswa kabi kwezidakamizwa emazingeni amabili noma ngaphezulu okwelashwa.
Noma kunjalo, ukunikeza lezi zinsizakalo kwakungasho ukuthi kulula ukufinyelela.
Cishe isigamu samazwe afuna uhlobo lwenqubo yokugunyazwa ngaphambi kokugunyazwa ngaphambi kokuba bakhokhele ukunakekelwa okukhulu kweziguli. Izifunda eziyisishiyagalolunye zanezela inqwaba yokuthi kungakanani okuzosetshenziselwa izinsizakalo zokuvuselela izidakamizwa.
Ukwelapha Ukuhlukunyezwa Kwama-opioid Nemithi
Imithi eyinhloko yokwelapha izidakamizwa ze-opioid yi-buprenorphine (igama lomkhiqizo we-Suboxone), i-methadone, ne-naltrexone (amagama wegama lomdabu, i-Revia, ne-Vivitrol). Imithi ngayinye ibophezela kuma-receptors opioid ebuchosheni ukufaka umphumela wayo:
- I-Buprenorphine: I- Buprenorphine ijwayele ukukhethwa njengomuthi ngoba ihlala isikhathi eside kunomzimba. It kuvimbela umphumela omphoric opiates ngokuvamile ukuqala, futhi une isigamu-ukuphila kusuka amahora 24 kuya 42.
- I-Methadone: I- Methadone iyi-opiate yokwenziwa eyenza ukunciphisa izifiso. Nokho, njengamanye ama-opioid, angabangela ukuthembela ngokomzimba. I-Methadone isetshenziswa kaningi njengelashwa lokunakekelwa futhi ingasuswa isikhathi eside. Ukuphila kwengxenye yayo kuguquguqukayo, kusukela emahoreni angu-8 kuya kwangu-59.
- I-Naltrexone: I- Naltrexone ihlose ukunciphisa izifiso ze-opioid futhi kwezinye izimo zisetshenziselwa ukuphuza ukulutha utshwala. Ukuphila kwengxenye kungamahora angu-4 kuya kwangu-13.
Ucwaningo lwezeMpilo lubonise ukuthi zonke izifundazwe kanye nesifunda saseColumbia zimboze i-buprenorphine, kanti izifunda ezingamashumi amane nesishiyagalombili zihlanganiswe naltrexone. Ukusetshenziswa kwe-methadone, noma kunjalo, kwakungavumelani kakhulu. Izifunda ezingu-32 kuphela zihlanganisa ukufakwa kwe-methadone ezinhlelo zabo ze-Medicaid.
Ngokufana nokululekwa kanye nezinsizakalo zokugula, ukugunyazwa kwangaphambi kwesikhathi kudlale indima ekukhuleni ngemithi. Iningi lamazwe lidinga ukugunyazwa ngaphambi kwe-buprenorphine ngenkathi ingxenye yesithathu yazo idinga ama-copay.
Kuyaphazamisa uma ucabanga ngakho. Abantu abafuna usizo lwe-opioid umlutha banqatshelwe ukufinyelela okusheshayo kokwelashwa uma beyidinga kakhulu. Ukunciphisa ekwelapheni yiyona nto eyobenza babuyele emuva.
Ukuxhaswa Kwezimali kuxhumene neMedicaid
Ukulindela i-Medicaid ukulungisa ubhubhane kazwelonke akuyona into engokoqobo, hhayi uma imali ehlelwa ohlelweni isulwa. Ngeshwa, yilokho okungase kwenzeke.
Uma uMthetho Wokunakekelwa Kokunakekelwa Okungcono ube ngumthetho, ukwandiswa kwezidakamizwa njengoba siyazi ngaphansi koMthetho Wokunakekelwa Okunganakusiza kuzophela. Izimfuneko zokufaka ukwelashwa kwezidakamizwa njengengxenye yohlelo lwe-Medicaid nazo zizophela.
Ngisho nokusho ukuthi akuzange kubambe iqhaza ekwandiseni i-Medicaid kungathinteka. Lokhu kungenxa yokuthi izimali zendabuko ezinhlelweni zeMedicaid nazo zizoshintsha. Esikhundleni sikahulumeni wesifundazwe esifana nalokho umbuso ngamunye uchitha amadola ka dollar, uMthetho we-Better Care Reconciliation Act unganciphisa ukukhokhelwa kwezimali kumakhokhi ngamunye . Lokhu kusho ukuthi umbuso ngamunye uzothola inani elingu-dollar elinqunyelwe kuhulumeni ngokususelwa kwinani labantu ngabakwaMedicaid kuleso simo.
Ngokusho kweHhovisi le-Congressional Budget, lolu shintsho lwemali luzokwehlisa u-$ 772 billion ukusuka eMedicaid ngo-2026.
Lokhu kuzobeka umthwalo obalulekile emazweni ukuthola ezinye izimali uma izimali zabo zombuso sezivele zikhawulelwe. Kulindeleke ukuthi izifunda eziningi zizodinga ukusika izinsizakalo zokuxilongwa ukuze zihlale ziqhubeka. Ngokudabukisayo, izinsizakalo zezempilo yengqondo kanye nokwelapha umlutha kungenzeka kube ngowokuqala.
Izwi kusuka
Akukho mbuzo ukuthi uMthetho Wokunakekelwa Kokunakekelwa KwezeMpilo unganciphisa ukufinyelela kwezinsizakalo zempilo yengqondo. Akunandaba ukuthi useMedicaid, uhlelo lwezempilo yangasese, noma umshuwalense oxhaswe ngumqashi. Izinguquko kulokho okumele kulandelwe lezi zinhlelo, okungukuthi, izinguquko ezinzuzweni zezempilo ezibalulekile, kuzothinta ukuthi yiziphi izinsizakalo ozothola futhi kuzokwenza kube nzima kulabo abanenkinga yokuthola umlutha ukuthola usizo abadingayo.
> Imithombo:
> Grogam CM, Andrews C, Abraham A, et al. Amaphuzu avelele emiphakathini Ukungqubuzana kokuxilongwa kwemithi yokusetshenziswa kwezidakamizwa nokusetshenziswa kwemithi ye-Opioid Disorder Medication. Ezempilo Aff. December 2016. 35 (12): 2289-2296. i-doi: 10.1377 / hlthaff.2016.0623
> HR 1628 . Ihhovisi le-Senate lase-US. https://www.budget.senate.gov/imo/media/doc/SENATEHEALTHCARE.pdf. Ishicilelwe ngo-June 22, 2017.
> HR 1628, uMthetho Wokunakekelwa Kokunakekelwa Okungcono Wonyaka ka-2017. Ihhovisi Lokubanjelwa Kwezezimali. https://www.cbo.gov/publication/52849. Ishicilelwe ngo-June 26, 2017.
> Ukuvimbela Ukulimala Nokulawulwa Kokulimala: Ukugqithiswa kwama-opioid - Ukuqonda Ukushaywa Kwesifo. Amasevisi Ewebhusayithi Yokulawula Nokuvimbela Izifo. https://www.cdc.gov/drugoverdose/epidemic/index.html. Kubuyekezwe ngo-Juni 21, 2016.
> Rodriguez CH. Ukuxilongwa Kwe-Medicaid For Treatment Addiction Kubukeka Ngokuphawulekayo. I-Kaiser Health News iwebhusayithi. http://khn.org/news/medicaid-coverage-for-addiction-treatment-varies-dramatically/. Kushicilelwe ngo-December 6, 2016.