Zinthu zomwe simungadziwe zokhudza inshuwalansi yazaumoyo - Phunziro kuchokera ku ngozi ya ku America

Kodi muli ndi inshuwaransi yazaumoyo? Kapena mukufuna kupeza imodzi? Kukhala ndi inshuwaransi ngati iyi ndi chinthu chabwino kwambiri pakagwa ngozi kapena opaleshoni yayikulu. Komabe, pali mbali imodzi ya momwe makampani a inshuwaransi awa amagwirira ntchito yomwe sitilankhula zambiri, koma tonsefe tiyenera kudziwa. Kodi mukudziwa kuti nthawi zina, mfundo za kampani yanu ya inshuwaransi zingakulepheretseni kupeza chithandizo chomwe mukufuna?

Kodi tingaphunzire chiyani kuchokera ku zomwe zinachitika ku America?

Kuti timvetse nkhaniyi, tiyeni titenge chitsanzo kuchokera ku chochitika chenicheni chomwe chinachitika ku America kalekale. Pali kampani yayikulu kwambiri ya inshuwaransi yazaumoyo yotchedwa Aetna. Mu 1998, boma la boma la Texas linapereka mlandu motsutsana ndi kampaniyi. Mlandu wake ndi wakuti kampaniyi ya inshuwaransi ikukakamiza madokotala kuti achepetse chithandizo chomwe odwala amafunikira .

Taganizirani momwe mlanduwu ulili woopsa. Kodi sizowopsa kuti dokotala amene mumamudalira akusonkhezeredwa ndi ena kuti aganizire zochepetsa ndalama m'malo mokupatsani chithandizo chabwino kwambiri?

Pamapeto pake, kampaniyo inavomera mwaufulu kuthetsa nkhaniyi popanda kuvomereza zolakwa zilizonse, kusintha mfundo zake zambiri. Koma nkhaniyi sinathere pomwepo. Mayiko ena angapo, kuphatikizapo New York ndi Connecticut, adapitiliza kufufuza zomwe kampaniyo idachita. Chochitikachi chikuwonetsa kusamvana komwe kungachitike pakati pa phindu la makampani a inshuwaransi yazaumoyo ndi thanzi la odwala.

Kodi chifukwa cha mkangano uwu n'chiyani? Tiyeni tikambirane za 'Chisamaliro Choyang'aniridwa'

Chifukwa chachikulu cha vutoli ndi njira ya ``Managed Care`` yomwe makampani a inshuwaransi amagwiritsa ntchito. Mwachidule, kampani ya inshuwaransi "imasamalira" chisamaliro chanu chaumoyo. Izi zikutanthauza kuti imasankha madokotala ndi zipatala zomwe mungapiteko, mayeso omwe mungalandire, komanso chithandizo chomwe mumalandira. Chimodzi mwa mitundu yotchuka kwambiri ya izi ndi ``Health Maintenance Organisation (HMO)``.

Dongosololi lingawoneke bwino kuchokera kunja. Amati zinthu ngati zimenezi zidzawongolera ndalama ndikuchepetsa mayeso osafunikira. Koma vuto limayamba ndi momwe madokotala amalipirira.

Njira yoopsa yotchedwa 'Capitation'

Nthawi zambiri timaganiza kuti dokotala amalipidwa akalandira chithandizo cha wodwala ndikutumiza bilu yoyenera, sichoncho? Koma sizili choncho pansi pa machitidwe monga ``(HMO)``. Nthawi zambiri, amagwiritsa ntchito njira yotchedwa Capitation .

Mwachidule, pankhaniyi, kampani ya inshuwalansi imalipira ndalama zochepa pamwezi pasadakhale kwa wodwala aliyense wolembetsedwa ndi dokotala (pa munthu aliyense).Dokotala amalandira ndalama zimenezi kaya wodwalayo abwera kudzaonana ndi dokotala mwezi umenewo kapena ayi, kaya akudwala kapena ayi.

Tsopano onani komwe vuto lili:

• Tangoganizirani dokotala ali ndi odwala 100. Kampani ya inshuwalansi imalipira dokotalayo ma rupee 1000 pa wodwala aliyense, kapena ma rupee 100,000 pamwezi.
• Tsopano, pamene mmodzi mwa odwala 100 awa abwera akudwala, dokotalayo ayenera kulipira ndalama zonse zoyezetsa ndi mankhwala omwe munthuyo amafunikira kuchokera ku 100,000 omwe adalandira kale.
• Kodi chimachitika ndi chiyani ngati wodwala akuyenera kuyesedwa kokwera mtengo monga MRI scan? Dokotalayo sadzalandira chithandizo.
• Kenako, pali chiyeso chachikulu ndi kukakamizidwa kwa dokotala kuti achepetse ndalama momwe angathere, osachita mayeso, ndikupatsa mankhwala otsika mtengo, eti?

Izi ndi zomwe ngakhale a US Attorney Generals adafunsa. Iwo adati chifukwa cha dongosololi, chiopsezo cha thanzi la wodwalayo chimayikidwa pamapewa a dokotala.

Kodi tiyenera kuchita chiyani?

Dongosolo la inshuwaransi yazaumoyo ku Sri Lanka silingakhale lovuta monga momwe limakhalira ku US, koma ndikofunikira kwambiri kudziwa izi posankha inshuwaransi ndi kulandira chithandizo kuchokera kwa iwo.

1. Werengani bwino inshuwalansi yanu: Musanagule inshuwalansi, onetsetsani kuti mwamvetsa malamulo ndi zikhalidwe. Onetsetsani kuti mwamvetsa zomwe zikuperekedwa, zomwe sizikuperekedwa, komanso momwe mungapezere chilolezo cha chithandizo china.

2. Musaope kufunsa mafunso: Ngati dokotala wanu akulangizani kuti mulandire chithandizo kapena mayeso ndipo kampani ya inshuwalansi ikukana, funsani chifukwa chenicheni. Lankhulani ndi dokotala wanu za izi.

3. Limbikirani ufulu wanu: Ngati dokotala wanu wanena kuti chithandizo china chake ndi chofunikira kwa inu, koma kampani yanu ya inshuwalansi yanena kuti sichingatetezedwe, fufuzani ngati pali njira zopitira apilo.

Pomaliza, ubale pakati pa dokotala ndi wodwala ndi wopatulika. Uyenera kukhazikika pa kudalirana kwathunthu. Ndikofunikira kuti anthu azikhala ndi thanzi labwino kuti tonse tidziwe za kuthekera kwa kudalirana kumeneko kusokonezedwa ndi mphamvu zachuma zakunja.