Health insurance i nei em? A nih loh leh pakhat hmuh i tum em? Hetiang insurance neih hi emergency emaw, surgery lian tak emaw a awm chuan asset ropui tak a ni. Mahse, heng insurance company-te hnathawh danah hian kan sawi vak loh, mahse kan hriat vek a ngai pakhat a awm. A châng chuan, nangmah ngeiin insurance company policy-te hian i mamawh enkawlna i dawng thei lo tih i hria em?
America rama thil thleng atang hian eng nge kan zir theih ang?
He thawnthu hi hrethiam tur chuan hun rei tak chhunga America rama thil thleng dik tak a\angin entirnan han la ila. Health insurance company lian tak mai Aetna an tih chu a awm a. Kum 1998 khan Texas state sorkar chuan he company hi thubuai a siamsak a. Thubuai siamsak chu he insurance company hian doctor te chu sum lamah a nawr a , damlote enkawlna mamawh tihtlem turin a fuih a ni
He puhna hi a nasat zia hi han ngaihtuah teh. I rintlak doctor chu hmun dang atanga enkawlna tha ber pek che ai chuan senso tihtlem dan tur ngaihtuah tura nawr a nih hi a hlauhawm hle lo em ni?
A tawpah chuan company chuan thil dik lo engmah pawm lovin a duhthusamin he thubuai hi chinfel a remti a, an policy tam tak chu a thlak danglam ta a ni. Mahse thubuai chu chutah chuan a tawp lo. New York leh Connecticut telin state dang eng emaw zatin company thiltih dan hi an chhui chhunzawm zel a ni. He thil thleng hian health insurance company-te hlawkna leh damlote hriselna inkara buaina awm thei chu a tilang chiang hle.
He buaina hi eng nge ni? ‘Managed Care’ chungchang hi han sawi ila.
Hetiang harsatna thlen chhan ber chu insurance company-te hman thin ``Managed Care`` approach a ni. A awlsam zawngin sawi ila, insurance company hian i healthcare chu a "manage" a ni. Chumi awmzia chu eng doctor leh damdawi in nge i pan theih ang tih te, eng test nge i neih theih ang tih te, enkawlna i dawn tur thlengin an rel tihna a ni. Hei hi a lar ber pakhat chu ``Health Maintenance Organization (HMO)`` hi a ni.
He system hi pawn lam atang chuan a tha hle mai thei. Hetiang thil hian senso a control dawn a, test tul lo a tih tlem phah dawn niin an sawi. Mahse buaina chu doctor-te hlawh pek dan a\angin a intan a ni.
A pawimawh ber chu, doctor chuan sum leh pai lama nghawng nei lovin, a damdawi lam ngaihdan a zirin, i tana enkawlna tha ber tur chu zalenna a nei tur a ni.
‘Capitation’ an tih dan hlauhawm tak chu.
Doctor hian damlo a enkawl hnuah leh a kaihhnawih bill a thehluh hnuah hlawh a hmu niin kan ngai tlangpui a ni lawm ni? Mahse ``(HMO)`` ang system hnuaiah chuan chutiang chu a ni lo. A tam zawkah chuan Capitation tih system an hmang thin.
A awlsam zawngin, hetiang hunah hian insurance company chuan doctor-a inziak lut damlo pakhat zel (per capita) tan thla khatah pawisa tlemte a pe hmasa a ni.Chumi thlaa damlo chu doctor hmu tura lo kal emaw lo kal emaw, damlo emaw damloh emaw pawh nise, doctor chuan he zat hi a dawng thin.
Tunah chuan buaina chu khawiah nge a awm tih hi han en teh:
- Doctor pakhatin damlo 100 a nei tih han ngaihtuah teh. Insurance company hian doctor hnenah damlo pakhat hnenah cheng 1000 a pe a, thla khatah cheng nuai 100 a pe bawk.
- Tunah chuan heng damlo 100 zinga pakhat damlo a lo luh chuan, chu mi chuan a hmaa a dawn zat sangkhat atang chuan chu mi chuan a mamawh test leh damdawi senso zawng zawng chu doctor chuan a tum vek a ngai ta a ni.
- Damlo pakhatin MRI scan ang chi test man to tak a neih a ngai a nih chuan eng nge thleng ang? Doctor chuan a hloh ta a ni.
- Tichuan, doctor chu a theih ang anga senso tihtlem a, test ti lo tur leh damdawi man tlawm zawk pe turin thlemna leh nawrna nasa tak a awm a ni lawm ni?
Hei hi US Attorney General-te pawhin an zawtfiah a ni. He system avang hian damlo hriselna atana hlauhawmna chu doctor kekawrteah a dah thin niin an sawi.
| pawisa pek dan tur | Doctor chunga nghawng a neih dan | Damlo tan risk awm thei |
|---|---|---|
| Hmanlai thil tih dan (Fee-for-Service) 1.1. (Service pek chhuah man pek) | Damlo mamawh enkawlna pek theihna tur incentive a awm. Sum leh pai lama nghawng direct a awm lo. | A tul lo taka test leh enkawlna a awm theihna chance a tlem hle. |
| Capitation hman dan tur (Damlo pakhat tan pawisa ruat sa pek hmasak) | Test leh enkawlna man to tak tak tih loh nan pressure leh incentive nasa tak a awm a ni. Profit chu service tlem zawk peknaah a innghat a ni. | Enkawlna pawimawh tak tak pawh dawng lo, natna hmuhchhuah tlai, hriselna dinhmun a chhe zual theihna a sang hle. |
Engtin nge kan tih ang?
Sri Lanka rama health insurance system hi US angin a buaithlak lo mai thei a, mahse insurance thlan leh a hnen atanga service dawn hunah hei hi hriat a pawimawh hle.
1. I insurance policy kha ngun takin chhiar la: Insurance i lei hmain a terms and conditions i hriatthiam hmasak phawt ang che. Eng nge cover tih te, eng nge cover loh te, leh enkawlna thenkhat atana phalna lak dan tur te i hriatthiam ngei ngei tur a ni.
2. Zawhna zawh hlau suh: I doctor-in enkawlna emaw test emaw a rawt a, insurance company-in a hnial a nih chuan a chhan dik tak zawt rawh. Hemi chungchang pawh hi i doctor nen sawiho rawh.
3. I dikna chanvo humhim turin ding rawh: I doctor-in enkawlna engemaw tak chu damdawi lama i tan a tul a ti a, mahse i insurance company-in a cover theih loh a tih chuan appeal theih dan tur a awm em tih zawng rawh.
A tawpah chuan doctor leh damlo inzawmna hi thil thianghlim tak a ni. Rinna famkim atanga innghat a ni tur a ni. Khawtlang hrisel tak tan chuan chu rinna chu pawn lam sum leh pai lama nghawng a neih theih dan tur kan hriat vek a pawimawh hle.
Take-Home Thuchah a ni
- Health insurance company te hi hlawkna zawnga sumdawnna an nih avangin a chang chuan an hlawkna leh damlo hriselna inkara buaina a awm thei.
- Health insurance i lei hmain a terms, coverage leh limitation te ngun takin chhiar la, hrethiam rawh.
- ``Capitation'' ang chi pawisa pek dan hian doctor-te chu i mamawh enkawlna pek loh nan a nawr thei tih hre reng ang che.
- I insurance company chuan i doctor-in a rawt enkawlna a hnial chuan a chhan zawt rawh. I doctor nen zalen takin inbiakna nei la, a chinfel dan tur tha ber sawipui rawh.
- Thutlukna hnuhnung ber chu insurance company sum leh pai policy ni lovin, i doctor damdawi lam ngaihdan atanga siam tur a ni. I hriselna atan ding rawh.
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