Nā mea āu e ʻike ʻole ai e pili ana i ka ʻinikua olakino - He haʻawina mai kahi hanana ʻAmelika

Loaʻa iā ʻoe kahi ʻinikua olakino? A i ʻole ke ʻimi nei ʻoe e loaʻa i hoʻokahi? ʻO ka loaʻa ʻana o ka ʻinikua e like me kēia he waiwai nui ia i ka wā o kahi pilikia a i ʻole kahi ʻoki kino nui. Eia nō naʻe, aia kekahi ʻano o ka hana a kēia mau ʻoihana ʻinikua ʻaʻole mākou e kamaʻilio nui ai, akā pono mākou a pau e ʻike. Ua ʻike anei ʻoe i kekahi manawa, hiki i nā kulekele o kāu ʻoihana ʻinikua ponoʻī ke pale iā ʻoe mai ka loaʻa ʻana o ka lāʻau lapaʻau āu e pono ai?

He aha kā kākou e aʻo ai mai ka mea i hana ʻia ma ʻAmelika?

I mea e hoʻomaopopo ai i kēia moʻolelo, e lawe kākou i kahi laʻana mai kahi hanana maoli i hana ʻia ma ʻAmelika i ka wā kahiko. Aia kahi ʻoihana ʻinikua olakino nui loa i kapa ʻia ʻo Aetna. I ka makahiki 1998, ua waiho ke aupuni o ka mokuʻāina ʻo Texas i kahi hoʻopiʻi kūʻē i kēia ʻoihana. ʻO ka hoʻopiʻi ʻana, ke koi kālā nei kēia ʻoihana ʻinikua i nā kauka a hoʻonāukiuki iā lākou e hōʻemi i ka lāʻau lapaʻau e pono ai nā maʻi .

E noʻonoʻo i ke koʻikoʻi o kēia hoʻopiʻi. ʻAʻole anei he mea weliweli loa ke hoʻohuli ʻia ke kauka āu e hilinaʻi nei mai kahi ʻē aʻe e noʻonoʻo e pili ana i ka hōʻemi ʻana i nā kumukūʻai ma mua o ka hāʻawi ʻana iā ʻoe i ka lāʻau maikaʻi loa?

I ka hopena, ua ʻae manawaleʻa ka ʻoihana e hoʻoponopono i ka hihia me ka ʻae ʻole i kekahi hana hewa, e hoʻololi ana i kāna mau kulekele he nui. Akā, ʻaʻole i pau ka pilikia ma laila. Ua hoʻomau kekahi mau mokuʻāina ʻē aʻe, me New York a me Connecticut, i ka noiʻi ʻana i nā hana a ka ʻoihana. Hōʻike kēia hanana i ka hakakā kūpono ma waena o ka loaʻa kālā o nā ʻoihana ʻinikua olakino a me ke olakino o nā maʻi.

He aha ke kumu o kēia hakakā? E kamaʻilio kākou e pili ana i ka 'Managed Care'

ʻO ke kumu nui o kēia pilikia, ʻo ia ke ʻano "Managed Care" a nā ʻoihana ʻinikua e hoʻohana ai. I nā huaʻōlelo maʻalahi, "hoʻokele" ka ʻoihana ʻinikua i kāu mālama ola kino. ʻO ia hoʻi, hoʻoholo lākou i nā kauka a me nā haukapila hiki iā ʻoe ke hele, nā hoʻokolohua hiki iā ʻoe ke loaʻa, a me nā lāʻau lapaʻau āu e loaʻa ai. ʻO kekahi o nā ʻano kaulana loa o kēia ʻo ia ka "Health Maintenance Organization (HMO)".

Maikaʻi paha ke ʻano o kēia ʻōnaehana mai waho mai. Wahi a lākou, e kāohi ana ia i nā kumukūʻai a hōʻemi i nā hoʻokolohua pono ʻole. Akā hoʻomaka ka pilikia me ke ʻano o ka uku ʻia ʻana o nā kauka.

ʻO ke ʻano hana weliweli i kapa ʻia ʻo 'Capitation'

Manaʻo pinepine mākou e uku ʻia ke kauka ma hope o kona mālama ʻana i kahi mea maʻi a waiho i ka bila pili, ʻeā? Akā, ʻaʻole pēlā ma lalo o nā ʻōnaehana e like me ``(HMO)``. ʻO ka hapa nui o ka manawa, hoʻohana lākou i kahi ʻōnaehana i kapa ʻia ʻo Capitation .

I ka ʻōlelo maʻalahi, ma kēia hihia, uku ka ʻoihana ʻinikua i kahi liʻiliʻi i kēlā me kēia mahina ma mua no kēlā me kēia mea maʻi i hoʻopaʻa inoa ʻia me ke kauka (no kēlā me kēia kanaka).Loaʻa i ke kauka kēia kālā inā paha e hele mai ka mea maʻi e ʻike i ke kauka i kēlā mahina a i ʻole, inā paha he maʻi ʻo ia a i ʻole.

I kēia manawa, e nānā i kahi o ka pilikia:

• E noʻonoʻo he 100 mau maʻi ko ke kauka. Uku ka ʻoihana ʻinikua i ke kauka he 1000 rupees no kēlā me kēia maʻi, a i ʻole 100,000 rupees i kēlā me kēia mahina.
• I kēia manawa, ke hele mai kekahi o kēia mau maʻi 100 i ka maʻi, pono ke kauka e uhi i nā lilo āpau no nā hoʻokolohua a me nā lāʻau lapaʻau e pono ai kēlā kanaka mai hoʻokahi haneli tausani āna i loaʻa ma mua.
• He aha ka mea e hana ai inā pono ka mea maʻi e hana i kahi hoʻokolohua pipiʻi e like me ka MRI scan? Ua nalowale ke kauka .
• A laila, aia kahi hoʻowalewale nui a me ke kaomi ma luna o ke kauka e hōʻemi i nā kumukūʻai i ka hiki, ʻaʻole e hana i nā hoʻokolohua, a e hāʻawi i nā lāʻau lapaʻau makepono, ʻeā?

ʻO kēia ka mea a nā Loio Kuhina Nui o ʻAmelika Hui Pū ʻIa i nīnau ai. Ua ʻōlelo lākou ma muli o kēia ʻōnaehana, ua kau ʻia ka pilikia olakino o ka mea maʻi ma luna o nā poʻohiwi o ke kauka.

He aha kā mākou e hana ai?

ʻAʻole paha i paʻakikī ka ʻōnaehana ʻinikua olakino ma Sri Lanka e like me ʻAmelika Hui Pū ʻIa, akā he mea nui loa ia e ʻike i kēia i ke koho ʻana i ka ʻinikua a me ka loaʻa ʻana o nā lawelawe mai ia mea.

1. E heluhelu pono i kāu kulekele ʻinikua: Ma mua o kou kūʻai ʻana i ka ʻinikua, e hōʻoia ua maopopo iā ʻoe nā ʻōlelo a me nā kūlana. E hōʻoia ua maopopo iā ʻoe ka mea i uhi ʻia, ka mea i uhi ʻole ʻia, a pehea e loaʻa ai ka ʻae no kekahi mau lāʻau lapaʻau.

2. Mai makaʻu e nīnau i nā nīnau: Inā ʻōlelo kāu kauka i kahi lāʻau lapaʻau a hoʻāʻo paha a hōʻole ka ʻoihana ʻinikua, e noi i ke kumu pololei. E kamaʻilio pū me kāu kauka e pili ana i kēia.

3. E kū no kou mau pono: Inā ʻōlelo kāu kauka he mea pono kekahi lāʻau lapaʻau nou, akā ʻōlelo kāu ʻoihana ʻinikua ʻaʻole hiki ke uhi ʻia, e ʻike inā he mau ala e hoʻopiʻi ai.

ʻO ka mea hope loa, he pilina kapu ka pilina ma waena o ke kauka a me ka mea maʻi. Pono ia e kau ʻia ma luna o ka hilinaʻi piha. He mea nui no kahi kaiāulu olakino e makaʻala kākou a pau i ka hiki ke hoʻohaʻahaʻa ʻia kēlā hilinaʻi e nā mana kālā o waho.