Imbonini yezempilo itshintsha njalo ngezizathu eziningi. Iningi lwakamuva, ukuthuthukiswa kwekhwalithi kuye kwaba yindlela yokuziphatha kanye nezinqubo ezincane zezokwelapha ezibhekene nokusetshenziswa kwezinqubo eziyinkimbinkimbi zokuthuthukisa ikhwalithi yokunakekelwa kweziguli. Ukuthuthukiswa okuncane okungenziwa ukuthi ukwelashwa kungabandakanya ukunciphisa izikhathi zokulinda , ukuthuthukisa imikhuba yokulandelwa kweziguli, ukuthuthukisa izikhalazo zesiguli, ukuthuthukisa amaphepha omtholampilo kanye nezinqubo zokumisa.
Ukuze kusetshenziswe ushintsho emtholampilo omncane, kubalulekile ukukhomba nokuqonda izithiyo nezinselele ezivimbela ushintsho. Kukhona kokubili izithiyo zangaphakathi nezingaphandle ezivimbela ushintsho ezinkambisweni ezincane zezokwelapha.
Izithiyo zangaphakathi zifaka:
- Abasebenzi abakwazi ukushintsha
- Ukungabi nesisusa samalungu omkhuba
- Ukungabi nobuhlobo phakathi kwamalungu omkhuba
- Ukungabi nesikhala esanele
- Izinkinga zamandla
Izithiyo zangaphandle zifaka:
- Ukuncintisana
- Ukuguqulwa kwentela
- Ukubandakanyeka kwesineke
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Ukuphikiswa kwabasebenzi ukushintshaUkuphikiswa ukushintsha kuphezulu kuhlu lwezingqinamba ekusebenziseni ushintsho kunoma iyiphi imvelo. Emkhakheni wezokwelapha lapho kubambisana khona kubalulekile, kubalulekile ukubikezela imithombo yokumelana nokuthuthukisa amasu okusebenza kuwo. Ezinye zezizathu ezivame kakhulu abasebenzi abangase balwe ukushintsha zihlanganisa:
- Ukwesaba okungaziwa. Abantu bavame ukuzihlanganisa ngokuzenzekelayo noma ukubona ushintsho njengesipiliyoni esibi. Lokhu kuyiqiniso ikakhulukazi uma bengenayo isixwayiso esanele noma bengayiqondi ukuthi kuzosithinta kanjani umsebenzi wabo.
- Ukwesaba ukulahlekelwa imisebenzi yabo. Abantu bavame ukubona ukuthi ushintsho luyisongo emisebenzini yabo. Bangase babheke ukufeza izinqubo ezintsha njengokuhlelwa kabusha futhi bacabange ukuthi ngabe ukwelashwa kusebenza kahle kangakanani, isikhundla sabo sizoqedwa.
- Ukungabi nethemba. Uma amalungu omkhuba engathembeki ukuphathwa, akakwazi ukulandela kalula izinqubomgomo nezinqubo ezintsha. Uma ukuphathwa noma ukulahlekelwa ukwethembela noma ukungatholi ukuthembela kwamalungu omkhuba, kungase kube ukumelana nokushintsha.
- Okuthandayo isimiso. Abanye abantu abanaso isizathu sokumelana nokushintsha abanye ngaphandle kokukhetha isimiso sabo samanje. Ngemuva kokusebenza endaweni efanayo, endaweni efanayo, iminyaka eminingi, kulula nje ukunamathela kumuntu owaziwayo. Laba bantu abathokozi ukufunda izinto ezintsha futhi kungenzeka ukuthi bangamalungu omkhuba kakhulu.
- Isikhathi esibi. Zonke izinyathelo ekushintsheni noma ukuqaliswa kufanele zenziwe ngesikhathi esifanele. Uma kungenjalo, amalungu omkhuba ngokuqinisekile ngeke amelane nanoma yiziphi izinguquko ezethulwa zizohlangana nokuphikiswa.
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Ukungabi Nenhloso YamaLungu WokuzikhandlaAmalungu okuzivocavoca angenaso isisusa sokusebenzisa ushintsho ahlukile kulabo abangamelana nokushintsha. Ukuphikiswa ukwenqaba ukwamukela noma ukuhambisana nokushintsha. Ukungabi nesisusa kusho ukungafuni komunye umuntu ngenxa yokungabi nesifiso noma isithakazelo.
Omunye umehluko phakathi kokumelana nokugqugquzela ukuthi ukumelana kunganqotshwa ngokuxhumana nabasebenzi ukuthi lezi zinguquko zibandakanya, ngubani ozothinteka ngazo, nokuthi izinguquko zizobathinta kanjani ngaphambi kokuba kube nezinguquko ezisebenzayo. Ngakolunye uhlangothi, ukukhuthazwa kuyinkimbinkimbi kakhulu.
Kunezinhlobo ezimbili zezishukumisi: zangaphakathi futhi eziqhamukayo.
Abagqugquzeli be-intrinsic baqhutshwa yizici zangaphakathi. Umuntu uthola ukwaneliseka komuntu ngokwenza umsebenzi othile. Ezinye izibonelo zabashukumisayo bangaphakathi kukhona ukufeza, ukuqashelwa, ukuzijabulisa, noma umqondo wokugcwaliseka.
Abagqugquzeli be-Extrinsic baqhutshwa yizici zangaphandle. Ngokuvamile lokhu kuhilela uhlobo oluthile lokulawulwa ngokunikeza noma ukugwema imivuzo, noma uhlobo oluthile lokujeziswa. Ezinye izibonelo zabashukumisayo abaqhamukayo kukhona imali, indumiso, isinyathelo sokujeziswa, ukuphepha emsebenzini, noma izinzuzo.
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Ukungabi nobuhlobo phakathi kwamalungu okuzikhandlaUma amalungu omkhuba engenalo ubudlelwane, ahluleka ukuhlangana nokukhiqiza. Ukuze uphumelele, ikakhulukazi ngesikhathi sokushintsha, amalungu omkhuba adinga ukwethemba, ukusekela, nokuhloniphana.
Ngaphambi kokusebenzisa ushintsho kumkhuba omncane, kungadingeka ukusebenzisa imisebenzi yokwakha ithimba ukuthuthukisa ubudlelwano phakathi kwamalungu omkhuba. A
Nazi izihlonzi eziyishumi ezenza amalunga asebenze ubuhlobo:
- Izikhalazo zesineke mayelana nekhwalithi yesevisi
- Ukwenyuka kokukhiqiza
- Ukudideka ngemisebenzi kanye nemithwalo yemisebenzi
- Imisebenzi ayenzi ngendlela efanele noma ngesikhathi esifanele
- Ukungabi nesisusa
- Imisebenzi ejwayelekile efuna izinqumo eziyinkimbinkimbi
- Izingxabano phakathi kwamalungu omkhuba
- Izimo ezimbi zokuphatha
- Izikhalo zokuthandwa
- Ukungabi nokubambisana
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Ukungabi Nesikhala EsaneleyoImikhuba yendabuko yezokwelapha ngokuvamile ayikho isikhala esanele sokwenza ushintsho. Ngokuqondile, izinguquko ezenziwe ukuthuthukisa ukugeleza kwesiguli zivame ukulukhuni ngenxa yemiklamo esiphelelwe yisikhathi. Izindleko zokulungiswa noma ukuthuthela esikhaleni esikhulu kungenzeka ukuthi azikho ukhetho ngenxa yokucindezeleka kwezezimali okungabeka kulo mkhuba.
Ukwenza ukuhlolwa kokugeleza kwesiguli kungasiza ekunqumeni ukuthi isikhala siyinkinga noma uma izinguquko kuhlelo kumele zenziwe. Uma kunqunywa ukuthi isikhala siyinkinga ngempela, kuyisithakazelo esihle somkhuba ukutshala ekwakhiweni okuzokwenza ngcono ukwaneliseka kwesiguli kweziguli zamanje nezizayo.
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Ukulwa kwamandlaKunezinkinga eziningi zamandla emkhakheni wezokwelapha. Enye eyisivimbela ekusebenziseni ushintsho ngumzabalazo phakathi kokuletha ukunakekelwa kwekhwalithi ngesikhathi kunciphisa izindleko. Ikhwalithi engafanele yokunakekelwa kanye nezindleko zokunakekelwa kwempilo ziye zanda phakathi kwemizamo yokuguqula impilo iminyaka eminingi.
Ukucwaninga kubonisa ukuthi izinhlobo zendabuko zokukhokha ngokwemvelo zithwala izinkinga ngekhwalithi nezindleko zokunakekelwa. Amakhodi wokukhokha asekelwe emakhakheni akhuthaza abahlinzeki ukuthi baphathe iziguli eziningi ukukhiqiza inzuzo ephakeme ngaphandle kokubheka ukuthuthukisa imiphumela yekhwalithi noma ukunciphisa izindleko ngenkathi izintandokazi zokukhokha ezisezingeni eliphezulu zikhuthaza abahlinzeki ukufeza izinyathelo ezithile zokusebenza ukuze zenzele ukubuyisela okuphezulu.
Imikhuba yezokwelapha ezama ukuthuthukisa imiphumela yekhwalithi nokunciphisa izindleko ziyakwazi ukulwa kwempi njalo phakathi kokuhlinzeka ukunakekelwa kwesiguli nokugcina impilo enempilo. Kuze kube amamodeli okukhokha ashintshe izinga lokusekela lokunakekelwa ngenkathi evumela ukuthi umuthi wezokwelapha uzuze ukusimama kwezezimali, kungenzeka ukuthi ukusebenzisa ishintsho kuzoqhubeka kuvinjelwe.
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UkuncintisanaUkuncintisana okunempilo kuhle kwezamabhizinisi, kodwa-ke, inani elikhulu lemikhuba yezokwelapha ezizimele zihlanganisa imikhuba yabo ukuze ibe ngumkhuba odokotela ochwepheshe abaningi. Abanye ochwepheshe babonisa ukuthi ukuhlanganisa izici ezihlukahlukene zezokwelapha zibe umkhuba owodwa kuzuzisa iziguli kanye nomkhuba.
Imikhuba yezokwelapha ezizimele inomthwalo wemfanelo wokugcina nokuvuselela imishini ekhona, isofthiwe (ubuchwepheshe bokwaziswa) kanye nengqalasizinda. Lezi zindleko zingafaka umfutho kwihhovisi lezokwelapha ngokugeleza kwemali elinganiselwe. Izidingo ze-ICD-10, i-HIPAA, ukusetshenziswa okuwusizo kanye nokusetshenziswa kwerekhodi yezempilo kagesi zidinga abahlinzeki bezempilo ukuba bakhulise amandla abo kwezobuchwepheshe nolwazi.
Imikhuba emikhulu isesimweni esingcono sezezimali sokusebenzisa lezi zinguquko.
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Ukuguqulwa KwentelaUkwelashwa kwemithi ye-Medicare ne-Medicaid, okubuye kubhekwe njengenguquko yokukhokha, kuyisithiyo esikhulu sokushintsha emtholampilo omncane. Ukwelashwa kwe-Medicare ne-Medicaid kwenza ukubuyiswa okukhulu kwezezimali kwemikhuba ezimele noma eyimfihlo. Inzuzo ephansi yenza kube nzima ukwenza ushintsho ngoba imikhuba encane ayikwazi ukugcina kangcono ukwenza ngcono.
Ngaphezu kwalokho, imikhuba ethatha isibalo esikhulu semithi ye-Medicare kanye / noma iMedicaid, ukunciphisa ukubuyisela kungabangela ukuba bayeke ukwamukela iziguli ezintsha zeMedare kanye neMedicaid okungenani. Kwabanye, kusho ukuvala umkhuba wabo.
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Ukubandakanya ngesinekeNgaphandle kokubandakanyeka ngesineke, kunzima ukufeza ushintsho. Indlela elula futhi ephumelelayo yokuqinisekisa ukuthi iziguli zakho zithola ulwazi olubalulekile ekunakekeleni kwazo ukunikeza izibonelelo. Izibonelelo eziyisihlanu ezidingekayo iziguli ezintsha zihlanganisa:
- Ukuvakasha kokuqala kokuhambisa
- Umlayezo owamukelekile wesineke
- Isingeniso kumkhuba wezokwelapha
- I-bio emfushane kadokotela ngamunye
- Okufanele bakulindele ekuhlolweni kwabo kokuqala
- Ulwazi lokuxhumana
- Amahora okusebenza
- Izinsizakalo zinikeziwe
- Ezinye izindawo
- Uhlu lwalokho okufanele ulethe ukuvakashelwa ngalunye
- Ulwazi lomshuwalense
- I-ID yesithombe
- Ithimba elimele / ulwazi
- Ulwazi Lwezibalo
- Izinkokhelo
- Ulwazi lwezokwelapha
- Oxhumana nabo abaphuthumayo
- Ulwazi Lwezingozi
- Izikhombisi-ndlela eziseduze
- Ukugunyazwa kwangaphambili / okudlulisiwe
- Inqubomgomo yokukhokha
- Ama-co-pay, ama-deductibles, kanye nemali yomshuwalense kumele kubonakale ngaphambi kokuhlinzeka ngezinsizakalo zokuvakashelwa ngalunye
- Iziguli ezizikhokhela zibophezele ukukhokha yonke imali ngokugcwele
- Izinhlobo zokukhokha ezamukelekayo ezifana nokuhlola komuntu siqu, amakhadi esikweletu, kanye namakhadi we-debit
- Imali ekhokhwayo yokukhokhwa kwemali ekhokhwayo engakhokhiwe ngesikhathi esithile
- Izinkokhelo zezincomo ezingabanjwanga azikhanseliwe noma zihlelwe kabusha ngaphambi kwesikhathi
- Uhlu lwezinkampani zomshuwalense ezibandakanyekayo
- Iziguli kufanele zinikeze ubufakazi bomshwalense ngaphambi kokwelashwa noma zibhekwe njengokuzikhokhela
- Isaziso semikhuba yobumfihlo
- Indlela umhlinzeki azosebenzisa ngayo futhi adalule i-PHI yabo
- Amagciwane amalungelo aqondene ne-PHI yawo
- Isitatimende esitshela isiguli semithetho efuna umhlinzeki ukuthi alondoloze ubumfihlo be-PHI yabo
- Iziguli ezingathintana nazo ukuze uthole olunye ulwazi mayelana nezinqubomgomo zobumfihlo zomhlinzeki
- Inhlolovo yokwaneliseka kwesiguli
- Ingabe isiguli sasikhulunywa ngenhlonipho lapho singena ngemvume ukuze siqashwe?
- Ingabe isiguli samukelwa umkamukeli ngenhlonipho nangenhlonipho?
- Isikhathi eside isiguli silinde isikhathi esingakanani ukubona udokotela?
- Ingabe umhlengikazi nodokotela bachaza imininingwane yezinsizakalo ezinikezwe isiguli?
- Ingabe umhlengikazi nodokotela baphendula yonke imibuzo yesiguli?
- Ingabe isiguli sithole isevisi yamakhasimende enhle kakhulu?
- Ingabe igumbi lokuhlola lihlanzekile, likhululekile futhi lilungisiwe?
- Ingabe indawo yokulinda iphephile, ihlanzekile futhi ivulekile?
Lokhu akulona uhlu lonke olubandakanya kodwa nje ezimbalwa izindlela eziyisisekelo zokugcina iziguli ezithintekile futhi wazi ukuthi ukubaluleka kwabo kubaluleke kangakanani ekunakekeleni kwabo.
Izinkomba
Arar, uNedal H., et al. "Ukusebenzisa Ukuthuthukiswa Kwemfanelo Emisebenzini Eyinhloko Yokunakekelwa Kwezingane Eziyinhloko: Izimpendulo Zomkhaya Wezokwelapha Ophethwe Iziguli." I-Quality In Primary Care 19.5 (2011): 289-300. CINAHL nge Umbhalo ogcwele.
Forbes. I-Forbes Magazine, n