Ngaba unayo i-inshorensi yezempilo? Okanye ujonge ukuyifumana? Ukuba ne-inshorensi efana nale yinto entle kakhulu xa kukho imeko engxamisekileyo okanye utyando olukhulu. Nangona kunjalo, kukho inkalo enye yendlela ezisebenza ngayo ezi nkampani ze-inshorensi esingathethi kakhulu ngayo, kodwa sonke ekufuneka siyazi. Ubusazi ukuba ngamanye amaxesha, imigaqo-nkqubo yenkampani yakho ye-inshorensi inokukuthintela ekufumaneni unyango olufunayo?
Yintoni esinokuyifunda kwinto eyenzekileyo eMelika?
Ukuze siqonde eli bali, masithathe umzekelo kwisiganeko sokwenyani esenzeka eMelika kwixesha elidlulileyo. Kukho inkampani enkulu kakhulu yeinshorensi yezempilo ebizwa ngokuba yi-Aetna. Ngo-1998, urhulumente welizwe laseTexas wafaka isimangalo nxamnye nale nkampani. Isityholo kukuba le nkampani yeinshorensi icinezela oogqirha ngemali kwaye ibakhuthaza ukuba banciphise unyango olufunekayo kwizigulana .
Cinga ngendlela eli tyala libaluleke ngayo. Akuyongozi na ukuba ugqirha omthembayo aphenjelelwe kwenye indawo ukuba acinge ngokunciphisa iindleko endaweni yokukunika unyango olungcono?
Ekugqibeleni, inkampani yavuma ngokuzithandela ukusombulula ityala ngaphandle kokuvuma naluphi na ulwaphulo-mthetho, yatshintsha imigaqo-nkqubo yayo emininzi. Kodwa le ngxaki ayizange iphelele apho. Amanye amazwe aliqela, kuquka iNew York neConnecticut, aqhubeka nokuphanda izenzo zenkampani. Esi siganeko sibonisa ingxabano enokubakho phakathi kwenzuzo yeenkampani zeinshorensi yezempilo kunye nempilo yezigulane.
Yintoni unobangela wale ngxabano? Masithethe 'ngokhathalelo olulawulwayo'
Isizathu esiphambili sale ngxaki yindlela ethi "Managed Care" esetyenziswa ziinkampani zeinshorensi. Ngamazwi alula, inkampani yeinshorensi "ilawula" unyango lwakho. Oko kuthetha ukuba yiyo egqibayo ukuba ngoogqirha nezibhedlele onokuya kuzo, zeziphi iimvavanyo onokuzifumana, kwanonyango olufumanayo. Olunye lolona hlobo ludumileyo lwale ngxaki yi-"Health Maintenance Organisation (HMO)".
Le nkqubo ingabonakala ilungile xa ijongwa ngaphandle. Bathi izinto ezinje ziya kulawula iindleko kwaye zinciphise uvavanyo olungeyomfuneko. Kodwa ingxaki iqala kwindlela oogqirha abahlawulwa ngayo.
Eyona nto ibalulekileyo kukuba ugqirha abe nenkululeko yokukukhethela unyango olungcono, ngokusekelwe kuluvo lwakhe lwezonyango, ngaphandle kwempembelelo yemali.
Indlela eyingozi ebizwa ngokuba yi-'Capitation'
Sihlala sicinga ukuba ugqirha uyahlawulwa emva kokuba enyange isigulane aze angenise ityala elifanelekileyo, akunjalo? Kodwa akunjalo phantsi kweenkqubo ezifana ne-``(HMO)``. Uninzi lwexesha, basebenzisa inkqubo ebizwa ngokuba yi-Capitation .
Ngamafutshane, kule meko, inkampani yeinshorensi ihlawula imali encinci ngenyanga kwangaphambili kwisigulane ngasinye esibhaliswe kugqirha (ngomntu ngamnye).Ugqirha ufumana le mali nokuba isigulane siza kumbona ugqirha ngaloo nyanga okanye akunjalo, nokuba siyagula okanye asiguli.
Ngoku jonga apho ingxaki ikhoyo:
- Khawucinge ngogqirha onezigulane ezili-100. Inkampani yeinshorensi ihlawula ugqirha ii-rupee ezili-1000 ngesigulana ngasinye, okanye ii-rupee ezili-100,000 ngenyanga.
- Ngoku, xa omnye waba baguli bali-100 efika egula, ugqirha kufuneka ahlawule zonke iindleko zovavanyo kunye namayeza afunekayo kuloo mawaka alikhulu awafumene ngaphambili.
- Kuthekani ukuba isigulana kufuneka senze uvavanyo olubizayo olufana ne-MRI scan? Ugqirha akaphumeleli.
- Emva koko, kukho isilingo esikhulu kunye noxinzelelo kugqirha ukuba anciphise iindleko kangangoko kunokwenzeka, angenzi uvavanyo, aze anike amayeza angabizi, akunjalo?
Oku koko kwabuzwa yi-US Attorney Generals. Bathi ngenxa yale nkqubo, umngcipheko wempilo yesigulana ubekwe emagxeni kagqirha.
| uhlobo lokuhlawula | Impembelelo kugqirha | Ingozi enokwenzeka kwisigulana |
|---|---|---|
| Indlela yendabuko (Intlawulo yeNkonzo) (Intlawulo yeenkonzo ezinikezelweyo) | Kukho isikhuthazo sokubonelela ngalo naluphi na unyango olufunekayo kwisigulana. Akukho mpembelelo ngqo kwezemali. | Amathuba okuba kwenziwe uvavanyo nonyango olungeyomfuneko anciphe kakhulu. |
| Indlela yokubhala amagama (Intlawulo yangaphambili yesixa esimiselweyo ngesigulana ngasinye) | Kukho uxinzelelo olukhulu kunye nenkuthazo yokuphepha iimvavanyo kunye nonyango olubizayo. Inzuzo ixhomekeke ekuboneleleni ngeenkonzo ezimbalwa. | Kukho umngcipheko omkhulu wokungafumani unyango oluyimfuneko, ukulibaziseka kokuxilongwa, kunye nokuba mandundu kweemeko zempilo. |
Simele senze ntoni?
Inkqubo yeinshorensi yezempilo eSri Lanka isenokungabi nzima njenge-US, kodwa kubaluleke kakhulu ukuqaphela oku xa ukhetha inshorensi kwaye ufumana iinkonzo kuyo.
1. Funda ipolisi yakho yeinshorensi ngononophelo: Ngaphambi kokuba uthenge i-inshorensi, qiniseka ukuba uyayiqonda imiqathango nemiqathango. Qiniseka ukuba uyayiqonda into egutyungelweyo, into engagutyungelwayo, kunye nendlela yokufumana imvume yonyango oluthile.
2. Musa ukoyika ukubuza imibuzo: Ukuba ugqirha wakho ucebisa unyango okanye uvavanyo kwaye inkampani yeinshorensi iyala, buza isizathu esichanekileyo. Thetha nogqirha wakho ngale nto.
3. Mela amalungelo akho: Ukuba ugqirha wakho uthi unyango oluthile luyimfuneko kuwe ngokwezonyango , kodwa inkampani yakho yeinshorensi ithi alunakugutyungelwa, fumana ukuba kukho na iindlela zokubhena ngalo.
Ekugqibeleni, ubudlelwane phakathi kogqirha nesigulana bungcwele. Kufuneka busekelwe ekuthembekeni ngokupheleleyo. Kubalulekile kuluntu oluphilileyo ukuba sonke siqaphele ukuba olo themba lunokutshatyalaliswa ziimpembelelo zemali zangaphandle.
Umyalezo Wokuya Ekhaya
- Iinkampani zeinshorensi yezempilo ziinkampani ezenza inzuzo, ngoko ke ngamanye amaxesha kunokubakho ingxabano phakathi kwenzuzo yazo nempilo yesigulana.
- Ngaphambi kokuba uthenge i-inshorensi yezempilo, funda uze uyiqonde ngononophelo imigaqo yayo, ukhuseleko kunye nemida yayo.
- Khumbula ukuba iindlela zokuhlawula ezifana ne-"Capitation" zinokubangela uxinzelelo koogqirha ukuba bangakunika unyango olufunayo.
- Ukuba inkampani yakho yeinshorensi iyala unyango olucetywayo ngugqirha wakho, buza ukuba kutheni. Thetha ngokukhululekileyo nogqirha wakho nize nixoxe ngesisombululo esifanelekileyo.
- Isigqibo sokugqibela masisekelwe kuluvo lukagqirha wakho lwezonyango, kungekhona kumgaqo-nkqubo wezemali wenkampani yeinshorensi. Yima ukhusele impilo yakho.
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