Kungani izici ezibekezelayo zihluka phakathi kwalaba babhedlela ababili
Ucwaningo olwanyatheliswa kuyi-Journal of the American Medical Association (JAMA) luye lwathola umehluko omkhulu kubantu abaneziguli ze-ejensi yokunakekelwa ngenzuzo uma kuqhathaniswa nabalingani babo abangenzi inzuzo. Ngokuyinhloko, iziguli ezisezikhungweni ezihlinzekela izihambi zihlala zinezidingo ezincane zokunakekelwa futhi zihlale ezikhungweni zokubeletha isikhathi eside kunalezo ezise-ejensi zokunakekelwa kwezingane ezingenzi inzuzo.
Thola amaqiniso mayelana nokungafani nokufana phakathi kwe-ejensi yokuhlinzeka ngezinzuzo ezingenzi inzuzo nalokhu kuhlaziywa.
AmaHhovisi okuHlola amaHlelo okuHlola
Imikhakha yokunakekelwa kwezinzuzo ezenzelwe inzuzo iye yanda kakhulu ekhulwini lama-21. Inombolo yezinkampani ezenzelwe inzuzo yabuye yaphindaphindwa kabili kusukela ngo-2000 kuya ku-2007 kanti inani lezinhlangano ezingekho ngaphansi kwenzuzo liye lahlala lifanayo.
Nakuba uthembisa ukuthi inani lezinhlaka ze-hospice liyakhula jikelele, liphakamisa ukukhathazeka ukuthi ama-ejensi okubhedlela asezinkampani ezihlomulayo anezinhlawulo eziphakeme kakhulu kunezinsiza ezingekho ezingenzuzo. Ucwaningo lwe-JAMA lubuke ukuhlukana kwesibalo sesiguli kanye nemikhuba yenhlangano engenzi inzuzo kanye ne-non-profit ukuqonda kangcono ukuthi kungani ukungafani kwenzuzo kwakukhulu kakhulu.
I-Medicare Hospice Ukubuyisela imali
I-Medicare yokubuyisela imali ikhokha iziguli ezingamaphesenti angama-84 ekunakekeleni abantu esibhedlela. I-Medicare ibuyisela i-ejensi yokugulisa ekunakekeleni abantu esibhedlela ngokulinganisa, okusho ukuthi zonke iziguli zithola inani elifanayo lokubuyisela ngosuku noma ngabe zixilongwa noma ziyakudinga ukunakekelwa ngabanye.
Lolu hlelo lokubuyisela lungase ludale izikhuthazo ze-ejensi yokubhedlela ukuze ukhethe iziguli ezinezidingo ezimbalwa zokunakekelwa nokuhlala isikhathi eside. Ngokwenza kanjalo, izinhlangano zenzelwe ukugcinwa imali ngokuhlinzeka ngokunakekelwa okuncane kakhulu nokwandisa izinzuzo ngokukhetha iziguli ezizohlala isikhathi eside.
Izikhungo Zokunakekelwa Kwezenhlalakahle Zineziguli Eziningi Zokugula
Ukucwaninga kwe-JAMA, abacwaningi basebenzisa idatha kusukela ku-2007 National Home and Hospice Care Survey, ngesampula esimele isizwe sabalinganiselwa abangu-4 705 abaphunywe esibhedlela.
Ukuqhathanisa idatha evela ezikhungweni ezihlinzeka ngezinzuzo kanye nasezikhungweni zokuhlala ezingekho ngaphansi kwenzuzo kwembulani ukuthi kokubili ukuxilongwa kanye nendawo yokunakekelwa kunesimo esithile senzuzo. Uma kuqhathaniswa nama-hospitals angenzi nzuzo, ama-hospitals angenzuzo ayenomzimba ophansi weziguli ezinomdlavuza (amaphesenti angu-48.4 vs. 34,1 amaphesenti) kanye nezibalo eziphakeme zeziguli ezinezinkinga zokucindezeleka (amaphesenti angu-8,4 nangu-17.2%) nezinye izifo (amaphesenti angu-43.2 vs. 48.7% ).
Le datha ibonise ukuthi cishe izingxenye ezimbili kwezintathu zeziguli ezisezikhungweni zokuhlala ezihlomulayo zine-dementia kanye nezinye izifo ezingekho komdlavuza, kuyilapho kuphela isigamu seziguli ezingabanikazi basezikhungweni ezingenalusizo.
Iziguli ze-Cancer zinesikhathi sokuphila esingenakulinganiswa nesikhathi sokwelashwa. Ngesikhathi iziguli zomdlavuza zifaka ukunakekelwa kwe-hospice abaningi baye bakhathala zonke ezinye izifo futhi baseduze nokufa . Iziguli zomdlavuza we-End-stage nazo zivame ukudinga ukunakekelwa okubizayo ngokuphathwa kanzima kanye nokuphathwa kwezimpawu.
Iziguli ze-Dementia (kanye nezinye iziguli ezinezifo ezincane ezingalindelekile) zivame ukuhlala isikhathi eside kuneziguli zesifo somdlavuza onakekelwa ngokweqile. Lezi ziguli zinenzuzo kakhulu ngoba zithola i-Medicare esibhedlela ngesilinganiso sokudla nsuku zonke ngezindleko ezingaphandle kwe-pocket.
Indawo Yokunakekelwa Nesikhathi Sokuhlala
Uma kuqhathaniswa nama-hospice angenzi-nzuzo, izikhungo ezihlinzeka ngezinzuzo ezihamba phambili zinezibalo eziphakeme zeziguli ezihlala emakhaya asebekhulile kanye nengxenye ephansi ehlala ekhaya.
Iziguli ezihlala emakhaya asebekhulile zivame ukubiza ama-ejensi wokubhedlela kancane kancane.
Amakhaya asezihlengikazi anakekelwa ukunakekelwa kokunakekelwa kwesikhashana okubhekene nezimo eziningi iziguli zasekhaya ezizodinga ukuvakashelwa esibhedlela. I-ejensi yokunakekelwa kwezinzuzo zentela futhi ijwayele ukwenza umsebenzi omuhle kakhulu wokumaketha emakhaya asezikhungweni ukuze kutholakale "ngaphakathi" nabasebenzi basekhaya labahlengikazi nokwandisa izinga lokudlulisela.
Ucwaningo lwe-JAMA lithole ukuthi uma kuqhathaniswa neziguli ezinomdlavuza, labo abane-dementia noma ezinye izifo zokuhlola babenokuvakashelwa okuncane ngosuku ngosuku lwabahlengikazi nabasebenzi bezenhlalakahle . Lokhu kunengqondo ngoba iziguli zomdlavuza zinezibonakaliso ezinzima kakhulu ezidinga ukuqapha okuqhubekayo.
Ngenxa yokuthi ama-e-hospice ekhokhelwa iziguli zikhokhwa amanani nsuku zonke ngesiguli, izikhungo ezihlinzeka ngezinzuzo ezingenzuzo zingase zizuze ngokwezimali ngokukhetha iziguli ezizodinga ukunakekelwa okuncane.
Isikhathi sokuhlala esibhedlela (LOS) siyinani lezinsuku isiguli sisemtholampilo ngaphambi kokuqedwa noma ukufa. Ngokusho kwabacwaningi, i-LOS yesikhulu (medipoint) i-LOS yayinezinsuku ezine ezinyangeni zokuhlala ezikhungweni ezenzelwe ukuhlomula uma kuqhathaniswa nezikhungo zokuhlala ezingenzi-nzuzo (izinsuku ezingu-20 kuya kwezinsuku ezingu-16, noma amaphesenti angu-26.2 ubude be-LOS).
Uma kuqhathaniswa neziguli ezingabanikazi bezempilo, iziguli ezisezikhungweni zokubeletha ezingenzuzo ziningi amathuba okuhlala isikhathi eside kunezinsuku ezingama-365 (amaphesenti angu-2.8 nangu-6,9%) futhi zingenakwenzeka ukuba zihlale zingaphansi kwezinsuku eziyisikhombisa (amaphesenti angama-34.3 no-28.1 amaphesenti) .
Ukubaluleka kokutholakala kocwaningo
Abacwaningi be-JAMA bathi ukutholakala kokutadisha kunomthelela obalulekile wezinqubomgomo futhi ukuthi abahlengikazi abangenzi inzuzo bahlukumezeke ngokweqile ngokwemigomo yesiguli.
"Ukukhethwa kwesineke kwalolu hlobo kushiya ama-ejensi okugulisa abantu abangenzi inzuzo ngokungafani nokukhathalela iziguli ezibiza kakhulu-labo abanomdlavuza nalabo abafuna ukuqala ukugula esibhedlela isikhathi eside kakhulu ekupheleni kokugula kwabo; ngenxa yalokho, labo abagulayo abakhonza iziguli ezidinga usizo bangase babhekane nezingqinamba ezinzima zezezimali ekuhlinzekeni ukunakekelwa okufanele kuloluhlelo oluhlelekile lokukhokha. "
Lezi zitholakele, futhi kufanele, zivuselele izingxoxo mayelana nokuguqulwa kwenkokhelo ku- Medicare Hospice Benefit . I-Hospice yimboni ekhulayo, ikakhulukazi emkhakheni wezinzuzo, futhi ucwaningo oluningi luyadingeka ukuze kuqondwe ngokugcwele ukulingana phakathi kwesimo senzuzo kanye nokuhlangenwe nakho kwesiguli / ukunakekelwa ekupheleni kokuphila.
> Umthombo:
> Wachterman MW, uMarcantonio ER, Davis RB, McCarthy EP. I-Association of Hospitals Agency Isimo Senzuzo Ngokuthola Isiguli, Indawo Yokunakekela, Nesikhathi Sokuhlala. I-JAMA. 2011; 305 (5): 472-479. i-doi: 10.1001 / jama.2011.70