Izindleko ezihlukene zezinyathelo ezifanayo
Kufanele ulindele ukukhokha inani elifanayo ngezinsizakalo zokunakekelwa kwezempilo kungakhathaliseki ukuthi ubenze kuphi. Ngokumangazayo, iMedare ayizange ibambelele kulezi zimiso. Amasevisi we-Medicare ne-Medicaid abelokhu ekhokhela iminyango yezibhedlela ezingaphandle izivivinyo kanye nezinqubo ezifanayo ezingenziwa ehhovisi likadokotela wakho. Lokhu kungase kube mayelana nokushintsha.
Izinkokhelo Zingaxhunywanga Zini?
Uma udinga ukuhlolwa, udokotela wakho uzoyala ukuhlolwa. Uma umkhuba wakho wezokwelapha uhambisana nesibhedlela, ungathunyelwa emnyangweni wezidakamizwa esibhedlela ukuze uwenze. Empeleni, lokhu kungakubiza kakhulu.
Ihhovisi lakho lokwelapha lingakwazi ukunikeza izivivinyo ezifanayo ezihlinzekwa emnyangweni weziguli eziphululelwe iziguli. Isibonelo, izazi ze-cardiologists eziningi zingenza ama- echocardiograms nokuhlolwa kokucindezeleka ehhovisi labo. Amanye odokotela abahlinzayo bama-orthopedic bangase babe nemibala engu-x kusayithi ukuze babheke ama- fractures . Izikhungo zokuhlinzeka ngezidakamizwa zingase zincintisane nezibhedlela ngezinqubo ezithile ezingekho ngaphansi kwengozi.
Njengamanje okwamanje, ngenxa yezimo ezifanayo zomtholampilo, uMedare ukhokha ngaphezulu ngezinsizakalo ezenziwa eminyangweni yezibhedlela ezingaphandle kunezinye izingosi. Lokhu kunjalo ngisho nalapho kungadingeki ukuba ube esibhedlela. Kalula nje, izinga lokunakekela alifani nendawo eyodwa kuya kwesinye.
Ngokombiko we-Medicare Payment Advisory Commission (i-MedPAC), i-Medicare ikhokhele iminyango yeziguli eziphulukisiwe esibhedlela cishe cishe kabili inani lemikhakha ye-echocardiograms ngo-2013. Ngaloo nyaka, izikhungo zokuhlinza izidakamizwa zahlawulwa cishe ngamaphesenti angu-78 ngezinqubo ezifanayo ezingekho ngaphansi kwengozi eyenziwa esibhedlela ukusetha.
Ukuthi Izitifiketi Zezingathathi Zangasese Zithinta Kanjani Imithi
I-MedPAC ihlongoze ukuthi ukukhokhelwa kwezinqubo ezifanayo ezinkampanini zomtholampilo ezifanayo okumele zikhokhwe kuzokhokhelwa yi-Medicare ngamanani afanayo. Lezi zinkokhelo ezingathathi hlangothi kuzosindisa wena kanye nemali ye-Medicare.
Ihhovisi le-Inspector General lishonele ukuthi ukuguqulwa kwamazinga okuhlinzeka kulabo abakhokhelwa izikhungo zokuhlinzeka ngokugaya kungasindisa iMedare imali engaba ngu-R15 billion ngaphezu kweminyaka emihlanu. Izinkokhelo ze-Site-hlangothi zinganciphisa izinkokhelo ze-Medicare ezibhedlela ngezigidi eziyizigidi eziyizigidi zamaRandi ngonyaka ngamunye, ngokusho kukaMedPAC.
Ukuthi Izitifiketi Zingahambisani Nezindlela Zithinta Izibhedlela
I-American Hospital Association (AHA) iphikisana nezinkokhelo ezingathathi hlangothi. Bathi iminyango yezibhedlela ezingaphandle zibona inani elingenakuqhathaniswa labantu abakwaMedicaid , abantu abafanelekile (kokubili Medicare kanye neMedicaid), nabantu abangaqinisekisiwe. Njengoba iziguli ezihola kancane zikwazi ukukhokha ingxenye yawo yesikweletu, ukushintshwa kwezinkokhelo ezingathathi hlangothi kungaholela ekunciphiseni izinga lokubuyisela jikelele lezibhedlela.
Iziguli ze-Medicare ezisebenzisa iminyango yezibhedlela ezingaphandle zivame ukuba nezimo ezingokwelashwa ezingapheli. Ingozi ekhulayo yokubhekana nezinkinga kulezi ziguli idinga ukucatshangelwa.
I-AHA iphawula ukuthi ngenxa yalezi ziguli eziphakeme ezingozini, iminyango yezibhedlela eziphuthumayo inamathuba amaningi okuba nomhlengikazi ngaphezu komdokotela ohilelekile ezimweni ezahlukene zokuhlola. Lokhu kunezela ezindleko eziphezulu zalezi zifundo.
Izibhedlela zizolahlekelwa yizigidigidi uma izinkokhelo ezingathathi hlangothi zisebenza. Ukulahlekelwa kwemali kungabangela izibhedlela ezinzima ukwenza izinguquko, kungenzeka kuthinte abasebenzi kanye nezinye izinkinga zokufinyeleleka.
Ukuthi Izitifiketi Zezingathathi Zendlela Zithinta Kanjani
Izinkokhelo ze-neutral zendawo ngeke zisindise imali uma unakekelwa emnyangweni wesibhedlela ongapheli. Phela, ukhokha ukuhlolwa okufanayo kanye nekhwalithi efanayo yokunakekelwa.
I-caveat yukuthi lezi zinguquko zepolitiki zingase zize nezinguquko ekufinyeleleni. Ukwehliswa kwemali yesibhedlela kungenza kube nzima ukuthola izivivinyo ezithile.
Imithombo
I-American Hospital Association. Ukuqhathaniswa Nokunakekelwa Eminyangweni Yeziguli Eziphuthumayo kanye namaHhovisi Odokotela. http://www.aha.org/content/15/hopdcomparison.pdf. Kushicilelwe ngo-February 2015.
IKhomishana Yokucebisa Ngama-Medicare. Bika kwiCongress: Inqubomgomo Yokukhokhelwa Kwemithi. http://www.medpac.gov/documents/reports/mar2015_entirereport_revised.pdf?sfvrsn=0. Kushicilelwe ngo-Mashi 2015.
Ihhovisi le-Inspector General. I-Medicare kanye nabanikezwayo bangakwazi ukugcina amabhiliyoni uma i-CMS iyanciphisa iziguli ezibhekene neziguli ezibhekene neziguli ezikhokhelwa iziguli ezikhokhelwa izikhungo zokuhlinzeka ngezikhungo ezihlinzekwayo zokuhlinzekwa ngezikhungo ezihlinzekwayo zokuhlinzekwa ngezindleko. http://oig.hhs.gov/oas/reports/region5/51200020.pdf. Kushicilelwe ngo-Ephreli 2014