Une inishuwarenzi yehutano here? Kana kuti uri kutsvaga imwe here? Kuva neinishuwarenzi yakaita seiyi chinhu chakanaka kana paine emergency kana kuvhiyiwa kukuru. Zvisinei, pane chimwe chinhu pamusoro pemashandiro anoita makambani aya einishuwarenzi chatisingataure zvakawanda nezvacho, asi chatinofanira kuziva tese. Waizviziva here kuti dzimwe nguva, mapolisi ekambani yako yeinishuwarenzi anogona kukutadzisa kuwana kurapwa kwaunoda?
Chii chatingadzidza kubva pane zvakaitika kuAmerica?
Kuti tinzwisise nyaya iyi, ngatitorei muenzaniso kubva pane zvakaitika zvechokwadi muAmerica kare kare. Kune kambani yeinishuwarenzi yehutano yakakura kwazvo inonzi Aetna. Muna 1998, hurumende yedunhu reTexas yakaendesa nyaya kudare ichipikisa kambani iyi. Mhosva yacho ndeyekuti kambani iyi yeinishuwarenzi iri kumanikidza vanachiremba nemari uye ichivakurudzira kuti vaderedze kurapwa kunodiwa nevarwere .
Funga nezvekuti kupomerwa uku kwakakomba sei. Hazvina njodzi here kuti chiremba waunovimba naye ari kukurudzirwa kubva kune imwe nzvimbo kuti afunge nezvekuderedza mari pane kukupa kurapwa kwakanakisisa?
Pakupedzisira, kambani yakabvuma nekuzvidira kugadzirisa nyaya yacho isina kubvuma chero chakaipa, ichichinja marongero ayo akawanda. Asi nyaya yacho haina kugumira ipapo. Dzimwe nyika dzinoverengeka, kusanganisira New York neConnecticut, dzakaramba dzichiferefeta zvakaitwa nekambani. Chiitiko ichi chinoratidza kusawirirana kunogona kuitika pakati pepurofiti yemakambani einishuwarenzi yehutano nehutano hwevarwere.
Chii chinokonzera kusawirirana uku? Ngatikurukurei nezve 'Kutarisirwa Kunotarisirwa'
Chikonzero chikuru chedambudziko iri inzira ye "Managed Care" inoshandiswa nemakambani einishuwarenzi. Muchidimbu, kambani yeinishuwarenzi "inotarisira" hutano hwako. Izvi zvinoreva kuti ndivo vanosarudza kuti ndevanachiremba vapi nezvipatara zvaunogona kuenda, bvunzo dzipi dzaunogona kuitwa, uye kunyange marapirwo aunowana. Imwe yemhando dzakakurumbira dzeizvi i "Health Maintenance Organisation (HMO)``.
Sisitimu iyi inogona kutaridzika zvakanaka kubva kunze. Vanoti zvinhu zvakaita seizvi zvichadzora mitengo uye kuderedza bvunzo dzisina basa. Asi dambudziko rinotanga nenzira inobhadharwa vanachiremba.
Chinhu chinonyanya kukosha ndechekuti chiremba awane rusununguko rwekusarudza marapirwo akanakira iwe, zvichibva pamaonero ake ekurapa, pasina simba remari.
Nzira ine njodzi inonzi 'Capitation'
Tinowanzo funga kuti chiremba anobhadharwa mushure mekunge arapa murwere uye atumira bhiri rakakodzera, handiti? Asi handizvo zvinoitika pasi pehurongwa hwakaita se "(HMO)". Kazhinji, vanoshandisa hurongwa hunonzi Capitation .
Muchidimbu, muchiitiko ichi, kambani yeinishuwarenzi inobhadhara mari shoma pamwedzi pachine nguva kune murwere wega wega akanyoreswa nachiremba (pamunhu wega wega).Chiremba anowana mari iyi kunyangwe murwere achiuya kuzoona chiremba mwedzi iwoyo kana kwete, kungave achirwara kana kwete.
Zvino tarisai kuti dambudziko riri papi:
- Fungidzira chiremba aine varwere zana. Kambani yeinishuwarenzi inobhadhara chiremba chiuru cherupi pamurwere mumwe nemumwe, kana kuti chiuru cherupi pamwedzi.
- Zvino, kana mumwe wevarwere ava zana auya achirwara, chiremba anofanira kubhadhara mari yese yekuongororwa nemishonga yaanoda kubva pazviuru zana zvaakagamuchira kare.
- Chii chinoitika kana murwere achifanira kuongororwa zvinodhura zvakaita seMRI scan? Chiremba anorasikirwa netariro.
- Zvadaro, pane muedzo mukuru uye kumanikidzwa kwachiremba kuderedza mari yakawanda sezvinobvira, kwete kuita bvunzo, uye kupa mishonga yakachipa, handiti?
Izvi ndizvo zvakabvunzwa kunyange neMagweta eUS. Vakati nekuda kwehurongwa uhwu, njodzi yehutano hwemurwere inoiswa pamafudzi achiremba.
| nzira yekubhadhara | Kukanganiswa kwakaitwa nachiremba | Njodzi inogona kuitika kumurwere |
|---|---|---|
| Nzira yechinyakare (Mari yeSevhisi) (Kubhadhara mabasa akaitwa) | Pane chikonzero chekupa chero kurapwa kunodiwa nemurwere. Hapana mhedzisiro yemari yakananga. | Pane mukana mudiki wekuti bvunzo nekurapwa zvisina kufanira zviitike. |
| Nzira yekunyora zvinyorwa (Kubhadhara mari yakatarwa pamurwere mumwe nemumwe pachine nguva) | Pane kumanikidzwa kwakasimba uye kurudziro yekudzivirira miedzo nekurapwa zvinodhura. Purofiti inobva pakupa mabasa mashoma. | Pane njodzi huru yekusawana kurapwa kwakakosha, kunonoka kuongororwa, uye kuwedzera kwezvirwere. |
Tinofanira kuitei?
Sisitimu yeinishuwarenzi yehutano muSri Lanka ingasave yakaoma seUS, asi zvakakosha kuziva izvi pakusarudza inishuwarenzi uye kugamuchira masevhisi kubva kwairi.
1. Verenga inishuwarenzi yako nokungwarira: Usati watenga inishuwarenzi, iva nechokwadi chekuti wanzwisisa mitemo nemamiriro ezvinhu. Iva nechokwadi chekuti wanzwisisa zviri kuvharwa, zvisiri kuvharwa, uye kuti ungawana sei mvumo yekurapa kwakasiyana.
2. Usatya kubvunza mibvunzo: Kana chiremba wako akakurudzira kurapwa kana kuongororwa uye kambani yeinishuwarenzi ikaramba, bvunza chikonzero chaicho. Taurawo nachiremba wako nezvazvo.
3. Tsigira kodzero dzako: Kana chiremba wako akati mushonga waunoda kurapwa , asi kambani yako yeinishuwarenzi ikati haugone kuvharwa, tsvaga kana paine nzira dzekukwidza nyaya yacho kudare.
Pakupedzisira, hukama huripo pakati pachiremba nemurwere hunokosha. Hunofanira kunge hwakavakirwa pakuvimbana kwakazara. Zvakakosha kuti nzanga ine hutano izive kuti kuvimbana ikoko kunogona kukanganiswa nepfungwa dzemari dzekunze.
Mharidzo Yekuenda Nayo Kumba
- Makambani einishuwarenzi yehutano mabhizinesi ekutsvaga purofiti, saka dzimwe nguva panogona kuva nekusawirirana pakati pepurofiti yavo nehutano hwemurwere.
- Usati watenga inishuwarenzi yehutano, verenga wonzwisisa mitemo yayo, kufukidza kwayo, uye zvirambidzo zvayo nokungwarira.
- Yeuka kuti nzira dzekubhadhara dzakadai se "Capitation" dzinogona kumanikidza vanachiremba kuti vasakupai kurapwa kwaunoda.
- Kana kambani yeinishuwarenzi yako ikaramba kurapwa kwaunokurudzirwa nachiremba wako, bvunza kuti sei. Taura pachena nachiremba wako uye kurukurai mhinduro yakanakisisa.
- Sarudzo yekupedzisira inofanira kunge yakavakirwa pamaonero echiremba wako, kwete mutemo wezvemari wekambani yeinishuwarenzi. Tsigira hutano hwako.
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