Amaphesenti angama-340% ama-ER odokotela angamaphesenti angama-110% ama-internists angewona ama-ER
Ucwaningo lwangoMeyi 2017 lwanyatheliswa ku- JAMA Internal Medicine lubonisa ukuthi amanani aphezulu ajwayelekile eminyangweni yaseMelika ephuthumayo-iningi elibhekene neziguli ezincane, ezimbalwa.
Ngokuvamile, izinsizakalo ezihlinzekwa odokotela bezokwelapha eziphuthumayo zaphawulwa ngamaphesenti angama-340 uma kuqhathaniswa nomkhawulo wamaphesenti angu-110 wezinsizakalo ezinikezwe ngabangaphandle ngaphandle kwegumbi lokuphuthumayo.
Sibutsetelo
Izinkokhelo ezikhokhelwa izinsizakalo ezifanayo ziyahlukahluka kakhulu emnyangweni wezimo eziphuthumayo kuya emnyangweni ophuthumayo Ngaphezu kwalokho, kuhlale kubiza kakhulu ukuthola ukwelashwa kwesimo somnyango ophuthumayo kunokuba uthole ukwelashwa ehhovisi likadokotela noma isikhungo sokunakekelwa okuphuthumayo.
Abantu abaningi abathola izikweletu eziphezulu kakhulu ezibhedlela yibo abangakwazi ukuzikhokhela: abancinci abangenawo umshuwalense. Izikweletu zezokwelapha eziphezulu zingaholela ekuhlaleni okuphansi futhi kuyisizathu esiholela ekutheni abantu bemeze ukuyeka imali.
Ukwesaba ukuthi izibhedlela eziningi zinikeza futhi ukudikibala abantu ekufuneni ukunakekelwa okudingekile. Laba bantu baqeda ekugcineni babethulela emnyangweni ophuthumayo ngemibandela yokuhlukumezeka hhayi nje kuphela ukuthatha umonakalo omkhulu emkhakheni wokuphila kodwa futhi ugcina ukubiza okungaphezulu.
Indlela Amanani Asebenza ngayo
Izibhedlela zisebenzisa ama-chargeemasters, okuyizinhlu zamasevisi nezindleko zabo, ukuhlanganisa ibhilidi yesiguli. Noma kunjalo, intengo yangempela yezinsizakalo ihlukahluka kuye ngokuthi uhlobo lomshuwalense onjani isiguli nesimo senethiwekhi.
Iziguli ezise-inethiwekhi kanye ne-insurers zazo zikhokha kancane; kanti, iziguli ezingaphandle kwe-network futhi ezingenayo umshwalense zikhokhisa izindleko ezigcwele esibhedlela, okungaba yiziphindaphindwa eziningi zokwelashwa kukaMedare. Izibhedlela ezibizayo kakhulu zingakhokhisa ngaphezu kwamaphesenti angaphezu kuka-900 kunalokho okukhokhelwa yiMedricare.
Ukuphenya i-ER Intengo
Kulo cwaningo lokuhlaziywa kwentengo, abacwaningi bahlaziya amarekhodi okukhokha avela odokotela abangu-12,337 odokotela abaphuthumayo abasebenza ezibhedlela ezingaba ngu-2,707 kulo lonke elase-United States. Ngokufanayo, bahlola amarekhodi angama-57 607 odokotela bangaphakathi odokotela abahlinzeka ngezibhedlela ezingu-3,669.
Ukusebenzisa la marekhodi, abacwaningi babalwa "izinga lokukhokhiswa ngokweqile ngokusebenzisa ama-markup ratios, okuyi-ratio yamacala okukhokhiswa emalini evumelekile." Ngokwemithi ebizwa ngokuthi i-Medicare imali engavumelekile "isamba salokho uMnyango okhokhela khona, imali ekhishwayo kanye ne-coinsurance umthamo lowo ozuzayo onesibopho sokukhokha, nanoma iyiphi imali umuntu wesithathu onesibopho sokukhokha. "
Ngaphezu kwalokho, abacwaningi banquma izici ezilandelayo emnyangweni ngamunye ophuthumayo :
- Usayizi
- Indawo
- Isimo senzuzo
- Isimo sokufundisa
- Isimo sendawo yasemadolobheni noma yasemakhaya
- Isimo esibhedlela sokuphepha-net
Ngokusekelwe kolwazi olunikezwe i-United States Census abacwaningi baphinde balinganise lokhu okulandelayo:
- Ubumpofu
- Isimo esingavunyelwe
- Abantu abancane kakhulu
Ukuthola ukungafani kwamanani
Lapho izinsizakalo ezifanayo zenziwa ngudokotela ophuthumayo wezokwelapha noma i-internist, lo mkhawulo wawuphakeme ngokukhululekile ngezinsizakalo ezinikezwa udokotela wezimo eziphuthumayo.
Isibonelo, ukukhokha okuphakathi komuntu we- electrocardiogram kwakuyi $ 95 uma kuchazwa udokotela ophuthumayo; kanti, ukufundwa ngu-internist kubiza u-$ 62.
Ngokusho kwabacwaningi:
Ekucubunguleni zonke izinsizakalo ze-ED, zonke izibhedlela ezihlukahlukene zifaka iziguli eziphakathi kuka- $ 100 (i-markup ratio, i-1.0) kanye ne-$ 12,600 (i-markup ratio, i-12,6), enama-$ 420 (isilinganiso samaraki, 4.2); Ngokuphambene nalokho, inkokhelo yezokwelapha yangaphakathi esibhedlela yayizoba ngu-$ 200 (isilinganiso samarandi, 2.0).
Nakhu okunye okutholakele okunye okuvela ekutadisheni:
- Odokotela abaphuthumayo bagcina bekhokhisa u-$ 4 billion, cishe amaRandi 3.1 billion ngaphezu kweMederalare imali engavumelekile.
- Ukumaketha kwakunkulu kakhulu ekukhuliseni ukuchotshozwa (okungukuthi ukuvalwa kwesilonda).
- Ukuhlolwa kwe-CT kwekhanda kwaba nokuhluka okukhulu kunani phakathi kwezibhedlela ezihlolwe. Ngamanye amazwi, izingcingo ze-CT zekhanda zaziningi kakhulu emanani.
- Iminyango yezimo eziphuthumayo ezithengisa kakhulu ziyingxenye yezibhedlela ezingenzuzo futhi ziseMidwest naseNingizimu-mpumalanga ye-United States. Le minyango ephuthumayo yanikeza izinombolo ezinkulu zamaSpanishi nabantu base-American abangenakuqinisekiswa.
Izwi elivela
Uma umuntu ephathwa ngesevisi ephuthumayo, kaningi engenamathuba amancane, atholakala kuma-vagaries amanani. Ngokusho kwabalobi, "Manje, kunanini ngaphambili, ukuvikela iziguli ezingaqinisekisiwe nezingaphandle kwenethiwekhi ezisuka ezinhlobonhlobo zemithi esibhedlela kufanele zibe yinto ebaluleke kakhulu kunqubomgomo."
Imiphumela yalolu cwaningo igcizelela isidingo sokuveza ngokucacile ukukhokha esibhedlela. Baphinde basekele isidingo sabameli bezwe nezombusazwe ukuvikela iziguli ngokumelene namanani aphakanyisiwe.
> Imithombo:
> I-Medline. I-Electrocardiogram.
> I-Medline. Nini ukusebenzisa ikamelo eliphuthumayo.
> Xu, T, et al. Ushintsho eMnyangweni Wezimo Eziphuthumayo NgokweMithi Yangaphakathi Imithwalo Esindayo Eningizi E-United States. I-JAMA Imithi Yangaphakathi. 2017.