Unayo yini inshuwalense yezempilo? Noma ufuna ukuthola eyodwa? Ukuba nomshwalense onjengalona kuyinzuzo enkulu uma kwenzeka isimo esiphuthumayo noma ukuhlinzwa okukhulu. Kodwa-ke, kunesici esisodwa sendlela lezi zinkampani zomshwalense ezisebenza ngayo esingakhulumi kakhulu ngaso, kodwa sonke okudingeka sisazi. Ubuwazi ukuthi ngezinye izikhathi, izinqubomgomo zenkampani yakho yomshuwalense zingakuvimbela ekutholeni ukwelashwa okudingayo?
Yini esingayifunda kulokho okwenzeka eMelika?
Ukuze siqonde le ndaba, ake sithathe isibonelo esisehlakalweni sangempela esenzeka eMelika esikhathini esidlule. Kukhona inkampani yomshuwalense wezempilo enkulu kakhulu ebizwa ngokuthi i-Aetna. Ngo-1998, uhulumeni wesifundazwe saseTexas wafaka icala ngokumelene nale nkampani. Icala liwukuthi le nkampani yomshuwalense icindezela odokotela ngokwezimali futhi ibakhuthaza ukuba banciphise ukwelashwa okudingekayo yiziguli .
Cabanga ukuthi lokhu kumangalelwa kungathi sína kangakanani. Akuyona yini ingozi enkulu ukuthi udokotela omethembayo uthonywe kwenye indawo ukuba acabange ngokunciphisa izindleko kunokukunikeza ukwelashwa okungcono kakhulu?
Ekugcineni, inkampani yavuma ngokuzithandela ukuxazulula icala ngaphandle kokuvuma noma yikuphi ukwenza okubi, yashintsha izinqubomgomo zayo eziningi. Kodwa udaba aluzange luphelele lapho. Ezinye izifundazwe eziningana, okuhlanganisa iNew York neConnecticut, zaqhubeka nokuphenya ngezenzo zenkampani. Lesi sigameko sibonisa ukungqubuzana okungenzeka phakathi kwenzuzo yezinkampani zomshuwalense wezempilo kanye nempilo yeziguli.
Iyini imbangela yale ngxabano? Ake sixoxe 'ngokunakekelwa okuphethwe'
Isizathu esiyinhloko sale nkinga yindlela ethi "Ukunakekelwa Okuphethwe" esetshenziswa yizinkampani zomshuwalense. Kalula nje, inkampani yomshuwalense "iphatha" ukunakekelwa kwakho kwezempilo. Lokho kusho ukuthi inquma ukuthi odokotela nezibhedlela ongaziya kuzo, ukuthi yiziphi izivivinyo ongazithatha, ngisho nokwelashwa okutholayo. Olunye uhlobo oludumile kakhulu lwalokhu yi-"Health Maintenance Organisation (HMO)".
Lolu hlelo lungase lubukeke luhle uma lungaphandle. Bathi izinto ezinjengalezi zizolawula izindleko futhi zinciphise ukuhlolwa okungadingekile. Kodwa inkinga iqala endleleni odokotela abakhokhelwa ngayo.
Into ebaluleke kakhulu ukuthi udokotela kufanele abe nenkululeko yokukunqumela ukwelashwa okungcono kakhulu, ngokusekelwe embonweni wakhe wezokwelapha, ngaphandle kwethonya lezezimali.
Indlela eyingozi ebizwa ngokuthi 'i-Capitation'
Ngokuvamile sicabanga ukuthi udokotela ukhokhelwa ngemva kokwelapha isiguli futhi ethumela ibhili efanele, akunjalo? Kodwa akunjalo ngaphansi kwezinhlelo ezifana ne-``(HMO)``. Isikhathi esiningi, basebenzisa uhlelo olubizwa ngokuthi i-Capitation .
Kalula nje, kulesi simo, inkampani yomshuwalense ikhokha imali encane ngenyanga kusengaphambili ngesiguli ngasinye esibhaliswe nodokotela (ngomuntu ngamunye).Udokotela uthola le mali kungakhathaliseki ukuthi isiguli siza ukuzobona udokotela ngaleyo nyanga noma cha, kungakhathaliseki ukuthi siyagula noma cha.
Manje bheka ukuthi inkinga ikuphi:
- Cabanga nje udokotela eneziguli eziyi-100. Inkampani yomshuwalense ikhokhela udokotela ama-rupee ayi-1000 ngesiguli ngasinye, noma ama-rupee ayi-100,000 ngenyanga.
- Manje, uma esinye salezi ziguli eziyi-100 sifika sigula, udokotela kufanele akhokhele zonke izindleko zokuhlolwa kanye nemithi umuntu ayidingayo kuzinkulungwane eziyikhulu azitholile ngaphambilini.
- Kwenzekani uma isiguli kufanele sihlolwe ngendlela ebiza kakhulu njenge-MRI scan? Udokotela uyalahlekelwa.
- Bese kuba nesilingo esikhulu kanye nengcindezi kudokotela yokunciphisa izindleko ngangokunokwenzeka, hhayi ukwenza izivivinyo, kanye nokunikeza imithi eshibhile, akunjalo?
Yilokhu ngisho nabameli be-US Attorney General abakubuzile. Bathi ngenxa yalolu hlelo, ingozi yempilo yesiguli ibekwa emahlombe kadokotela.
| indlela yokukhokha | Umthelela kudokotela | Ingozi engaba khona esigulini |
|---|---|---|
| Indlela yendabuko (Imali Yesevisi) (Inkokhelo yezinsizakalo ezinikeziwe) | Kukhona isisusa sokuhlinzeka nganoma yiluphi ukwelashwa isiguli esiludingayo. Akukho mthelela oqondile wezezimali. | Amathuba amancane okuhlolwa nokwelashwa okungadingekile angenzeka. |
| Indlela yokubhala (Inkokhelo kusengaphambili yenani elinqunyiwe ngesiguli ngasinye) | Kukhona ingcindezi enkulu kanye nesisusa sokugwema ukuhlolwa nokwelashwa okubizayo. Inzuzo incike ekuhlinzekeni ngezinsizakalo ezimbalwa. | Kukhona ingozi enkulu yokungatholi ngisho nokwelashwa okubalulekile, ukuxilongwa okuphuzile, kanye nokuwohloka kwezimo zempilo. |
Yini okufanele siyenze?
Uhlelo lomshuwalense wezempilo eSri Lanka lungase lungabi yinkimbinkimbi njenge-US, kodwa kubaluleke kakhulu ukuqaphela lokhu lapho ukhetha umshuwalense futhi uthola izinsizakalo kuwo.
1. Funda inqubomgomo yakho yomshuwalense ngokucophelela: Ngaphambi kokuthi uthenge umshwalense, qiniseka ukuthi uyaqonda imigomo nemibandela. Qiniseka ukuthi uyaqonda ukuthi yini emboziwe, yini engamboziwe, nokuthi ungayithola kanjani imvume yokwelashwa okuthile.
2. Ungesabi ukubuza imibuzo: Uma udokotela wakho encoma ukwelashwa noma ukuhlolwa futhi inkampani yomshuwalense ikwenqaba, buza isizathu esiqondile. Khuluma nodokotela wakho ngalokhu futhi.
3. Melela amalungelo akho: Uma udokotela wakho ethi ukwelashwa okuthile kuyadingeka kuwe ngokwezokwelapha , kodwa inkampani yakho yomshuwalense ithi akunakumbozwa, thola ukuthi zikhona yini izindlela zokufaka isikhalazo ngakho.
Ekugcineni, ubudlelwano phakathi kukadokotela nesiguli bungcwele. Kumelwe busekelwe ekwethembeni okuphelele. Kubalulekile emphakathini ophilile ukuthi sonke sazi ukuthi lokho kwethembana kungancishiswa yithonya lezezimali langaphandle.
Umlayezo Wokuya Nawe Ekhaya
- Izinkampani zomshuwalense wezempilo ziyibhizinisi elenza inzuzo, ngakho ngezinye izikhathi kungaba khona ukungqubuzana phakathi kwenzuzo yazo nempilo yesiguli.
- Ngaphambi kokuthi uthenge umshwalense wezempilo, funda futhi uqonde imigomo yawo, ukumbozwa kwawo, kanye nemikhawulo yawo ngokucophelela.
- Khumbula ukuthi izindlela zokukhokha ezifana ne-"Capitation" zingase zibeke odokotela ingcindezi yokuthi bagweme ukukunikeza ukwelashwa okudingayo.
- Uma inkampani yakho yomshuwalense yenqaba ukwelashwa okunconywa udokotela wakho, buza ukuthi kungani. Khuluma ngokukhululekile nodokotela wakho bese nixoxa ngesisombululo esingcono kakhulu.
- Isinqumo sokugcina kufanele sisekelwe embonweni kadokotela wakho wezokwelapha, hhayi enqubomgomo yezezimali yenkampani yomshuwalense. Mela impilo yakho.
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