So wowɔ akwahosan ho insurance? Anaasɛ worehwehwɛ sɛ wubenya bi? Insurance te sɛ eyi a wubenya no yɛ agyapade kɛse sɛ tebea bi a egye ntɛmpɛ anaa oprehyɛn kɛse bi si a. Nanso, sɛnea insurance nnwumakuw yi yɛ adwuma no fã biako wɔ hɔ a yɛnka ho asɛm pii, nanso ɛsɛ sɛ yɛn nyinaa hu. So wunim sɛ ɛtɔ mmere bi a, w’ankasa insurance adwumakuw no nkrataa betumi asiw wo kwan sɛ wubenya ayaresa a wuhia no?
Dɛn na yebetumi asua afi nea esii wɔ Amerika no mu?
Sɛ yɛbɛte saa asɛm yi ase a, momma yɛmfa nhwɛsoɔ bi mfiri asɛm bi a ɛsiiɛ ankasa a ɛsiiɛ wɔ Amerika wɔ berɛ a atwam akyirikyiri no mu. Akwahosan ho insurance adwumakuw kɛse bi wɔ hɔ a wɔfrɛ no Aetna. Wɔ 1998 mu no, Texas mantam aban no de asɛm kɔdan adwumakuw yi. Sobo no ne sɛ saa insurance adwumakuw yi de sika rehyɛ nnuruyɛfo na ɛrekanyan wɔn ma wɔatew ayaresa a ayarefo hia so .
Susuw sɛnea sobo yi yɛ aniberesɛm no ho hwɛ. So ɛnyɛ asiane kɛse sɛ wofi baabi foforo renya oduruyɛfo a wowɔ ne mu ahotoso no so nkɛntɛnso ma wasusuw ɛka a wɔbɛtew so ho sen sɛ ɔbɛma wo ayaresa a eye sen biara?
Awiei koraa no, adwumakuw no fi wɔn pɛ mu penee so sɛ wobesiesie asɛm no a wɔrennye ntom sɛ wɔayɛ bɔne biara, na wɔsesaa ne nhyehyɛe pii. Nanso asɛm no ankɔ awiei wɔ hɔ. Aman afoforo pii a New York ne Connecticut ka ho kɔɔ so hwehwɛɛ adwumakuw no nneyɛe mu. Saa asɛm yi kyerɛ ntawntawdi a ebetumi aba akwahosan ho insurance nnwumakuw mfaso ne ayarefo akwahosan ntam.
Dɛn na ɛde saa ntawntawdi yi ba? Momma yɛnka ‘Managed Care’ ho asɛm.
Ade titiriw nti a ɔhaw yi ba ne ``Managed Care`` kwan a insurance nnwumakuw de di dwuma no. Sɛ yɛbɛka no tiawa a, insurance adwumakuw no "hwɛ" w'akwahosan ho nhyehyɛe so. Ɛno kyerɛ sɛ wosi nnuruyɛfo ne ayaresabea ahorow a wubetumi akɔ, nhwehwɛmu a wubetumi ayɛ, ne ayaresa a wɔde ma wo mpo ho gyinae. Eyi ahorow a agye din sen biara no mu biako ne ``Akwahosan Sohwɛ Ahyehyɛde (HMO)``.
Ebia nhyehyɛe yi bɛyɛ fɛ wɔ akyi. Wɔka nneɛma te sɛ ɛbɛhwɛ ɛka so na ɛbɛtew sɔhwɛ ahorow a ɛho nhia so. Nanso ɔhaw no fi ase wɔ ɔkwan a wɔfa so tua nnuruyɛfo ka no so.
Nea ɛho hia sen biara ne sɛ ɛsɛ sɛ oduruyɛfo nya ahofadi de si ayaresa a eye sen biara ma wo ho gyinae, a egyina n’aduruyɛ ho adwene so, a sikasɛm mu nkɛntɛnso biara nni ho.
Ɔkwan a ɛyɛ hu a wɔfrɛ no ‘Capitation’.
Yɛtaa susuw sɛ oduruyɛfo bi nya akatua bere a wasa ɔyarefo bi yare na ɔde sika a ɛfa ho no akɔma akyi, ɛnte saa? Nanso ɛnyɛ saa na ɛte wɔ nhyehyɛe te sɛ ``(HMO)`` ase. Mpɛn pii no, wɔde nhyehyɛe bi a wɔfrɛ no Capitation .
Sɛ yɛbɛka no tiawa a, wɔ eyi mu no, insurance adwumakuw no di kan tua sika kakraa bi ɔsram biara ma ɔyarefo biara a ɔkyerɛw ne din wɔ oduruyɛfo nkyɛn (obiara).Oduruyɛfo no nya saa sika yi sɛ ebia ɔyarefo no bɛba abɛhwɛ oduruyɛfo no saa ɔsram no anaasɛ ɛnte saa, sɛ ɔyare anaasɛ onni bi.
Afei hwɛ baabi a ɔhaw no wɔ:
- Fa no sɛ oduruyɛfo bi wɔ ayarefo 100. Insurance adwumakuw no tua oduruyɛfo no rupee 1000 wɔ ɔyarefo biara ho, anaasɛ rupee 100,000 ɔsram biara.
- Afei, sɛ ayarefo 100 yi mu biako yare ba a, ɛsɛ sɛ oduruyɛfo no tua ɛka a wɔbɔ wɔ nhwehwɛmu ne nnuru a saa onipa no hia nyinaa ho fi mpem ɔha a odii kan nyae no mu.
- Sɛ ɛsɛ sɛ ɔyarefo bi yɛ nhwehwɛmu a ɛho ka yɛ den te sɛ MRI scan a, dɛn na ɛba? Oduruyɛfo no hwere biribi.
- Afei, sɔhwɛ ne nhyɛso kɛse bi wɔ oduruyɛfo no so sɛ ɔntew ɛka so sɛnea obetumi biara, ɔnyɛ nhwehwɛmu, na ɔmfa nnuru a ne bo nyɛ den mma, ɛnte saa?
Eyi ne nea U.S. Mmaranimfo Panyin mpo gyee ho kyim. Wɔkae sɛ esiane nhyehyɛe yi nti, wɔde ɔyarefo no akwahosan ho asiane to oduruyɛfo no mmati so.
| ɔkwan a wɔfa so tua ka | Nkɛntɛnso a enya wɔ oduruyɛfo no so | Asiane a ebetumi aba ɔyarefo no so |
|---|---|---|
| Amanne kwan so kwan (Fee-for-Service) . (Adwuma a wɔayɛ ho ka a wotua) . | Nneɛma bi wɔ hɔ a ɛkanyan ɔyarefo no ma wɔde ayaresa biara a ohia bɛma no. Sikasɛm mu nkɛntɛnso biara nni hɔ tẽẽ. | Hokwan kakraa bi na ɛwɔ hɔ sɛ nhwehwɛmu ne ayaresa ahorow a ɛho nhia bɛba. |
| Ɔkwan a wɔfa so de capitation di dwuma (Sika dodow bi a wɔahyɛ ato hɔ a wotua ma ɔyarefo biara) . | Nhyɛso ne nkannyan a emu yɛ den wɔ hɔ a ɛbɛma wɔakwati nhwehwɛmu ne ayaresa a ɛho ka yɛ den. Mfaso a wonya no gyina nnwuma kakraa bi a wɔde bɛma so. | Asiane kɛse wɔ hɔ sɛ wɔrennya ayaresa a ɛho hia mpo, wɔbɛkyɛ sɛ wobehu yare no, na akwahosan tebea no asɛe. |
Dɛn na ɛsɛ sɛ yɛyɛ?
Ebia akwahosan ho insurance nhyehyɛe a ɛwɔ Sri Lanka no nyɛ den te sɛ U.S., nanso ɛho hia yiye sɛ wuhu eyi bere a worepaw insurance na woregye nnwuma afi mu no.
1. Kenkan wo insurance krataa no yiye: Ansa na wobɛtɔ insurance no, hwɛ hu sɛ wobɛte mmara ne nhyehyɛe ahorow no ase. Hwɛ hu sɛ wobɛte nea wɔakata so, nea wɔmfa nka ho, ne sɛnea wubenya ayaresa ahorow bi ho pene.
2. Nsuro sɛ wubebisa nsɛm: Sɛ wo duruyɛfo kamfo ayaresa anaa nhwehwɛmu bi kyerɛ na insurance adwumakuw no pow a, bisa nea enti ankasa. Wo ne wo duruyɛfo nka eyi nso ho asɛm.
3. Gyina hokwan ahorow a wowɔ no akyi: Sɛ wo duruyɛfo ka sɛ ayaresa pɔtee bi ho hia wo wɔ aduruyɛ mu , nanso wo insurance adwumakuw no ka sɛ wontumi ntua ho ka a, hwehwɛ sɛ akwan bi wɔ hɔ a wobɛfa so de asɛm no akɔdan asɛnnibea anaa.
Awiei koraa no, abusuabɔ a ɛda oduruyɛfo ne ɔyarefo ntam no yɛ kronkron. Ɛsɛ sɛ egyina ahotoso a edi mũ so. Ɛho hia ma ɔman a ɛwɔ apɔwmuden sɛ yɛn nyinaa hu sɛnea ebetumi aba sɛ saa ahotoso no betumi asɛe esiane sikasɛm mu nkɛntɛnso a efi abɔnten nti.
Nkrasɛm a Wɔde Kɔ Fie
- Akwahosan ho insurance nnwumakuw yɛ nnwuma a wɔhwehwɛ mfaso, enti ɛtɔ mmere bi a akasakasa betumi aba wɔn mfaso ne ɔyarefo no akwahosan ntam.
- Ansa na wobɛtɔ akwahosan ho insurance no, kenkan ne nsɛm, nea wɔde tua ho ka, ne anohyeto ahorow no yiye na te ase.
- Kae sɛ akwan a wɔfa so tua sika te sɛ ``Capitation'' betumi de nhyɛso aba nnuruyɛfo so sɛ wɔremma wo ayaresa a wuhia.
- Sɛ wo insurance adwumakuw no pow ayaresa bi a wo duruyɛfo kamfo kyerɛ a, bisa nea enti a ɛte saa. Wo ne wo duruyɛfo nkasa pefee na munsusuw ano aduru a eye sen biara ho.
- Ɛsɛ sɛ wogyina wo duruyɛfo no aduruyɛ ho adwene so na wusi gyinae a etwa to, na ɛnyɛ insurance adwumakuw bi sikasɛm nhyehyɛe. Gyina hɔ ma w’akwahosan.
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