Ese ufite ubwishingizi bw'ubuzima? Cyangwa ushaka kububona? Kugira ubwishingizi nk'ubu ni ingirakamaro cyane mu gihe cy'impanuka cyangwa kubagwa bikomeye. Ariko, hari ikintu kimwe cy'uko aya masosiyete y'ubwishingizi akora tutavugaho cyane, ariko twese tugomba kumenya. Ese wari uzi ko rimwe na rimwe, politiki z'ikigo cyawe cy'ubwishingizi zishobora kukubuza kubona ubuvuzi ukeneye?
Ni iki twakwigira ku byabaye muri Amerika?
Kugira ngo dusobanukirwe iyi nkuru, reka dufate urugero rw'ibyabaye koko muri Amerika mu bihe byashize. Hari ikigo kinini cyane cy'ubwishingizi bw'ubuzima cyitwa Aetna. Mu 1998, guverinoma ya leta ya Texas yatanze ikirego kuri iyi sosiyete. Ikirego ni uko iyi sosiyete y'ubwishingizi irimo gushyira igitutu ku baganga mu by'imari ikabashishikariza kugabanya ubuvuzi bukenewe ku barwayi .
Tekereza ukuntu iki kirego gikomeye. Ese ntabwo ari bibi cyane ko umuganga wizeye aterwa ubwoba n'ahandi kugira ngo atekereze ku kugabanya ikiguzi aho kuguha ubuvuzi bwiza?
Amaherezo, isosiyete yemeye ku bushake gukemura ikibazo idakemera icyaha icyo ari cyo cyose, ihindura politiki zayo nyinshi. Ariko ikibazo nticyarangiriye aho. Izindi leta nyinshi, harimo New York na Connecticut, zakomeje gukora iperereza ku bikorwa by’isosiyete. Iki kibazo kigaragaza amakimbirane ashobora kuba hagati y’inyungu z’ibigo by’ubwishingizi bw’ubuzima n’ubuzima bw’abarwayi.
Impamvu y'aya makimbirane ni iyihe? Reka tuvuge ku 'Ubuvuzi Buyobowe'
Impamvu nyamukuru y'iki kibazo ni uburyo bwa "Managed Care" bukoreshwa n'ibigo by'ubwishingizi. Mu magambo make, ikigo cy'ubwishingizi "kigenzura" ubuvuzi bwawe. Ibyo bivuze ko ari cyo gihitamo abaganga n'ibitaro ushobora kujyamo, ibizamini ushobora gukorerwa, ndetse n'ubuvuzi uhabwa. Bumwe mu bwoko bw'ibi buzwi cyane ni ``Health Maintenance Organization (HMO)``.
Ubu buryo bushobora kugaragara neza inyuma. Bavuga ko ibintu nk'ibyo bizagenzura ibiciro kandi bigabanye ibizamini bitari ngombwa. Ariko ikibazo gitangirana n'uburyo abaganga bahembwa.
Igikuru ni uko umuganga agomba kugira ubwisanzure bwo kukwihitiramo uburyo bwiza bwo kuvura, ashingiye ku bitekerezo bye by’ubuvuzi, nta ngaruka z’amafaranga afite.
Uburyo buteje akaga bwitwa 'Capitation'
Ubusanzwe dutekereza ko umuganga ahembwa nyuma yo kuvura umurwayi no gutanga fagitire ijyanye na byo, si byo se? Ariko si ko bimeze muri sisitemu nka ``(HMO)``. Akenshi, bakoresha sisitemu yitwa Capitation .
Mu magambo make, muri iki gihe, ikigo cy’ubwishingizi cyishyura amafaranga make buri kwezi mbere y’uko buri murwayi wanditswe na muganga (kuri buri muntu).Umuganga ahabwa aya mafaranga yaba umurwayi aje kureba muganga muri uko kwezi cyangwa ataza, yaba arwaye cyangwa atarwaye.
Noneho reba aho ikibazo kiri:
- Tekereza umuganga afite abarwayi 100. Isosiyete y'ubwishingizi yishyura umuganga amafaranga 1000 kuri buri murwayi, cyangwa amafaranga 100.000 ku kwezi.
- Noneho, iyo umwe muri abo barwayi 100 aje arwaye, umuganga agomba kwishyura amafaranga yose y'ibizamini n'imiti umuntu akeneye mu bihumbi ijana yahawe mbere.
- Bigenda bite iyo umurwayi agomba gukorerwa ikizamini gihenze cyane nka MRI scan? Muganga aratsindwa.
- Hanyuma, hari igishuko gikomeye n'igitutu kuri muganga cyo kugabanya ibiciro uko bishoboka kose, kudakora ibizamini, no gutanga imiti ihendutse, si byo se?
Ibi nibyo ndetse n'Abashinjacyaha Bakuru ba Amerika babajije. Bavuze ko kubera ubu buryo, ibyago by'ubuzima bw'umurwayi bishyirwa ku bitugu bya muganga.
| uburyo bwo kwishyura | Ingaruka kuri muganga | Ingaruka zishobora guterwa n'umurwayi |
|---|---|---|
| Uburyo gakondo (Ikiguzi cya serivisi) (Kwishyura serivisi zatanzwe) | Hari uburyo bwo gutanga ubuvuzi ubwo aribwo bwose umurwayi akeneye. Nta ngaruka zitaziguye ku bijyanye n'imari. | Hari amahirwe make yo gupimwa no kuvurwa bitari ngombwa. |
| Uburyo bwo kwandika (Kwishyura mbere y'igihe amafaranga ahoraho kuri buri murwayi) | Hari igitutu gikomeye n'inkunga yo kwirinda ibizamini n'ubuvuzi bihenze. Inyungu zishingira ku gutanga serivisi nke. | Hari ibyago byinshi byo kutabona ubuvuzi bw'ibanze, gutinda gusuzuma indwara, no kurwara indwara zirushaho kuba mbi. |
Dukwiye gukora iki?
Sisitemu y'ubwishingizi bw'ubuzima muri Sri Lanka ishobora kuba idakomeye nka Amerika, ariko ni ngombwa cyane kubimenya mu gihe uhitamo ubwishingizi no guhabwa serivisi muri bwo.
1. Soma neza ubwishingizi bwawe: Mbere yo kugura ubwishingizi, banza usobanukirwe amabwiriza n'amategeko agenga ubwishingizi. Menya neza ko usobanukiwe n'ibirimo kwishyurwa, ibitarimo kwishyurwa, n'uburyo bwo kubona uburenganzira bwo kuvurwa bumwe na bumwe.
2. Ntutinye kubaza ibibazo: Niba muganga wawe agusabye kuvurwa cyangwa gupimwa hanyuma ikigo cy'ubwishingizi kikabyanga, bariza impamvu nyayo. Vugana na muganga wawe kuri ibi.
3. Guharanira uburenganzira bwawe: Niba muganga wawe avuze ko ubuvuzi runaka ari ngombwa kuri wewe, ariko ikigo cy'ubwishingizi kikavuga ko budashobora kwishyurwa, shakisha niba hari uburyo bwo kujuririra.
Amaherezo, umubano uri hagati y'umuganga n'umurwayi ni uw'umweru. Ugomba gushingira ku kwizerana kwuzuye. Ni ngombwa kugira ngo umuryango ube mwiza twese tumenye ko icyizere gishobora kwangizwa n'ingaruka z'imari ziturutse hanze.
Ubutumwa bwo kujyana mu rugo
- Ibigo by'ubwishingizi bw'ubuzima ni ubucuruzi bugamije inyungu, bityo rimwe na rimwe hashobora kubaho amakimbirane hagati y'inyungu zabo n'ubuzima bw'umurwayi.
- Mbere yo kugura ubwishingizi bw'ubuzima, soma witonze amabwiriza, ubwishingizi n'imbogamizi zabwo.
- Wibuke ko uburyo bwo kwishyura nka "Capitation" bushobora gushyira igitutu ku baganga kugira ngo bataguha ubuvuzi ukeneye.
- Niba ikigo cy'ubwishingizi cyawe cyanze kuvurwa na muganga wawe, baza impamvu. Vugana na muganga wawe mu buryo bweruye kandi muganire ku gisubizo cyiza.
- Umwanzuro wa nyuma ugomba gushingira ku gitekerezo cya muganga wawe cy’ubuvuzi, ntabwo ari politiki y’imari y’ikigo cy’ubwishingizi. Gerageza kurengera ubuzima bwawe.
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