Ukwelashwa kwemithi, i-Physician shortage, ne-Prescription Drug Costs
UMongameli Trump wenza izithembiso eziningi emgwaqeni womkhankaso . Omunye wabo bekumele agcine iMareare- okungukuthi, wathi akayikusika uMedare. Esinye isithembiso kwakungenza uhlelo lukwazi ukubiza izindleko ngaphezulu kwabazuzi. Ngesiphakamiso sesabelomali sika-2019, wenza izinguquko eziningi kuMedaretha okwenzayo futhi angafezi leso sithembiso.
Ukuxhaswa Kwezimali NgeMithi
Ushintsho lokuqala luphikisana ngokuqondile nalokho uMongameli athembise khona.
Isabelomali sonyaka wezimali (FY) sika-2019 sihlongoza u-$ 236 ku-Medicare esinciphisa iminyaka engaphezu kwengu-10.
I-White House ithi abazuzi ngeke babone ukwehla kwezinzuzo zabo. Esikhundleni salokho, bathi ukunciphisa ukuchitha imali kuzovela kwezinye izici zohlelo lwe-Medicare. Okushiwo akukaze kuboniswe kepha kuncishisiwe ukukhokhela izinkokhelo odokotela nezibhedlela.
Ukusetshenziswa Kwezimali Ezidutshulwa Iziqu
I-Association of American Medical Colleges yenza ucwaningo ngo-2017 oluqinisa lokho uhlelo lwezempilo oluye lwamesaba isikhathi eside-ukuntula udokotela. Ngo-2030, leli lizwe kulindeleke ukuba libe mfushane okungenani odokotela abangu-40,800 kuwo wonke ama-specialties.
Ngo-2016, kwakukhona odokotela abangu-953,695 abanecala lokuqhuba e-United States. Kulelo nani, amaphesenti angu-27.1 odokotela ayephakathi kweminyaka engu-56 no-65 ubudala. Omunye amaphesenti angu-13.1 aneminyaka engama-66 nangaphezulu. Phakathi naleso sikhathi, kwakunabangu-19 254 kuphela abaphothula iziqu zezokwelapha ngonyaka.
Ngamaphesenti angaphezu kuka-40 odokotela abafika eminyakeni yobudala bomhlalaphansi kanti bambalwa abangene emsebenzini, ngeke kube khona odokotela abanele ukuhlangabezana nezidingo ezikhulayo zabantu basebekhulile, abangeke bakhulume inani elikhulayo labantu abaqinisekisiwe ngaphansi koMthetho Wokunakekelwa Okunganakekelwa.
Naphezu kwalokhu okungekho emkhakheni wezimali kanye nesidingo, isabelomali se-FY 2019 sikhuthaza imali engamaRandi ayizigidi eziyizinkulungwane ezingu-48 ukuze iphothule imfundo yezokwelapha (GME) eminyakeni engaphezu kwengu-10.
Izimali ze-GME zikhokha ukuqeqeshwa kokuhlala kwezokwelapha . Izikole eziningi zezokwelapha zingakwazi ukuvula nokuqasha abafundi, kodwa ngaphandle kokuqeqeshwa kokuhlala, labo abaphothule iziqu babhekene ne-bottleneck ohlelweni. Ukunciphisa imali yokuhlala yokuhlala kungase kunciphise inani labahlali abaqeqeshwe kunoma yimuphi unyaka owodwa, okuqhubeka nokwehliswa ukwelashwa okudinga ukwelashwa odokotela.
Ama-Akhawunti Wokulondoloza Impilo
UMongameli Trump umkhankaso weMedricare ukuvumela ukusetshenziswa kwe- akhawunti yokulondoloza impilo (HSA) , futhi kubonakala sengathi uhlala ethembekile kuleso sithembiso.
I-HSA i-akhawunti yokulondoloza intela-deductible esetshenziselwa izindleko zezempilo. Abantu bangalondoloza imali ngesisekelo sokukhokhwa kwentela bese behoxisa leyo mali engenayo intela uma nje imali iya ezindlini zokwelapha ezifanelekayo. Kuze kube isiphakamiso sesabelomali se-FY 2019, i-IRS ayizange ivumele abahlomuli beMedare ukuba bahlanganyele kuma-HSA.
Ngo-2018, umuntu angagcina imali engaba ngu-R4,450 ku-HSA nomndeni okungenani u-$ 6,900. Abantu abaneminyaka engaphezu kwengu-55 bangagcina imali engu-R1 000 eyengeziwe ngonyaka uma bebengekho kwi-Medicare. Imali engavunyelwe ukuthi abahlomuli be-Medicare bahlale kungacacile.
Imithi ye-Medicare Part B
Akuyona yonke imithi yokwelashwa elandelwayo kuMedricare Part D. Eminye imithi ibuyiswa ngaphansi kwe- Medicare Part B.
Lezi mithi zihlanganisa, kodwa azikhawulelwanga, izidakamizwa zokungabi namagciwane, izidakamizwa ezilwa nomdlavuza, izidakamizwa eziphikisana nokuhlukunyezwa, izidakamizwa zokuzivikela, izidakamizwa ze-immunosuppressant, i-IV infusions, izifo ze-nebulizer, izifo ze-osteoporosis, izifo zethubhu kanye nemigomo ethile.
Ngaphansi kwe-Medicare Part B, eziningi zalezi zidakamizwa zibuyiselwa uma zihlinzekwa futhi ziphathiswe ehhovisi legqirha noma emnyangweni wezonyango ezibhedlela. Ngenxa yezindleko ezengeziwe zokuhleleka, ukugcina nokuphatha le mithi yokusetshenziswa kwesiguli, lezi zindawo ziye zavunyelwa ukukhokhisa abahlomuli beMedare ngaphezu kwamaphesenti angu-6 ngaphezu kwentengo yokuthengisa yomuthi ngamunye.
Isiphakamiso sesabelomali se-FY 2019 sihlose ukuqeda ukubhekwa kweNgxenye B yemithi nokuguqula lezo zindleko zemithi kwiNgxenye D. Ngokuhambisa isigaba B seNgxenye D, abahlinzeki beMedare ngeke besakwazi ukuphatha imithi ehhovisi. Esikhundleni salokho, isiguli sasizogcwalisa imithi yesidakamizwa bese siyiyisa kudokotela wayo ukuze iqondise. Lokhu kuzosusa noma yisiphi isikhuthazo sezomnotho umhlinzeki angase anakho ekumeni imithi ephakeme kakhulu. Ngesikhathi esifanayo, kuba yinto engathandeki kakhulu ukuba isiguli singene ngezinyathelo ezingeziwe.
Ukunciphisa Izindleko Zezidakamizwa Zokweqile
Ukunciphisa izindleko zemithi yokwelapha bekulokhu kubaluleke kakhulu, kanti isabelomali se-FY 2019 sigcizelela ukwenza lokho. Iphepha elimhlophe nguMkhandlu Wezobuchwepheshe Zezomnotho liveza izindlela ezimbalwa, nakuba kungakacaci ukuthi yiziphi lezi zindlela zokuphatha ezizoziphishekela.
Iphepha elimhlophe lidambisa kakhulu ukuhlelwa kwentengo kahulumeni . I-GOP ihlala ingumakholwa oqinile emakethe yamahhala. Futhi ayisekeli ukungenisa izidakamizwa ezingabizi ngaphansi kwamanye amazwe. Umgomo ukuthuthukisa amabhizinisi aseMelika.
Enye indlela yokwenza kube lula ku-FDA ukusheshisa izicelo zezidakamizwa zemithi ejwayelekile noma imishanguzo engumuthi ongenayo i-generic evumelekile. Ngokwalokho, lokhu kuzokwandisa ukuncintisana emakethe futhi kunciphise izindleko.
Enye indlela ukuthuthukisa ubuhlobo phakathi kweziguli kanye nomkhakha wezempilo. Abashuwalense bangadingeka ukwabelana izaphulelo ezivela ezinkampanini zokwelapha neziguli. Izithibelo zingase ziphakanyiswe ukuze abahlomuli be-Medicare bangasebenzisa izaphulelo zemithi.
Indlela esekelwa nguMongameli Trump izoqeda ukwabelana ngezindleko , okusho ukukhokhwa kwemali kanye nokudonswa kwemali, kubantu abinezindleko zemithi ephezulu yokugulisa izidakamizwa ku-$ 8,418 noma ngaphezulu ngonyaka. Ngeshwa, ukulinganisa lezo zindleko, izindleko ezingaphandle kwamapokhesi ziyokhuphuka kubazuzi abangahlangabezane nalolo mngcele.
Izwi elivela
Isiphakamiso sesabelomali se-FY 2019, uma sesidlulile, sasizokwazi ukuhlinzekela kanye nokwelashwa kwe-Medicare. Yize kungasiza ekunciphiseni izindleko zemithi yesidakamizwa kwabanye abantu abadala (okwandisa abanye) futhi bavumele ukuba basebenzise ama-akhawunti wokulondoloza impilo, futhi kuzokwehlisa uhlelo lwemali ye-Medicare ngokubanzi futhi lube nzima kakhulu ukwelashwa odokotela kakade.
> Imithombo:
> Ukubuyekezwa kuka-2017: Ukuncintisana Kokuhlinzekwa Nezokwelapha Nezidingo - Amaprojekti kusukela ngo-2015 kuya ku-2030. I-Association of American Medical Colleges. https://aamc-black.global.ssl.fastly.net/production/media/filer_public/c9/db/c9dbe9de-aabf-457f-aee7-1d3d554ff281/aamc_projections_update_2017_final_-_june_12.pdf. Ishicilelwe ngo-February 28, 2017.
> IsiHlomelo sonyaka-mali ka-2019. Ihhovisi Lokuphathwa Nebhajethi. https://www.whitehouse.gov/wp-content/uploads/2018/02/Addendum-to-the-FY-2019-Budget.pdf. Kukhishwe ngo-February 12, 2018.
> Unyaka Wezimali 2019: Isibijethi SeMelika. Ihhovisi Lokuphathwa Nebhajethi. https://www.whitehouse.gov/wp-content/uploads/2018/02/budget-fy2019.pdf. Kukhishwe ngo-February 12, 2018.
> Ukuguqulwa Kwezindleko ze-Biopharmaceutical ekhaya nakwamanye amazwe. UMkhandlu Wezincomo Zomnotho. https://www.whitehouse.gov/wp-content/uploads/2017/11/CEA-Rx-White-Paper-Final2.pdf. Ishicilelwe ngo-February 2018.
> Young A, Chaudhry HJ, Xiaomei Pei X, Arnhart K, Dugan M, Snyder GB. Ukubalwa Kwabaningi Abahlinzekwe Ilayisensi E-United States 2016 . J Med Regul. 2017; 103 (2): 2-21.http: //www.fsmb.org/globalassets/advocacy/publications/2016census.pdf.