Sharuɗɗan Amfanin Kiwon Lafiyar Lafiya ne mai kawo rigima
Abubuwan da aka yi amfani da su (wanda aka fi sani da "sha'anin asibiti na kiwon lafiya" da "sharuɗɗa") suna da amfani da ake buƙatar rufe maganin yanayin kiwon lafiya, wasu nau'o'in masu kiwon lafiya, da wasu nau'ikan masu dogara, kamar yara da aka sanya don tallafi. Yawancin sha'anin kulawa da lafiyar da aka ba da umarni ne ta kowace doka, doka ta tarayya - ko a wasu lokuta - duka.
Tsakanin gwamnatin tarayya da jihohi, akwai dubban shaidu na inshora na kiwon lafiya.
Kodayake ana ci gaba da ba da umarnin da ake bukata, a matsayin asusun haya na kiwon lafiya, suna da rikici. Masu bayar da hakuri sunyi iƙirarin cewa umarni sun taimaka wajen tabbatar da asibiti na asibiti lafiya yayin da wasu (musamman kamfanonin inshora na kiwon lafiya) sun yi zargin cewa umarni na ƙara yawan kudin kiwon lafiya da asibiti.
Dokokin Amincewa da Kiwon Lafiya na Mandated
Dokokin asibiti na asibiti wanda aka sanya a ko dai cikin tarayya ko na jihar yana yawanci sun fada cikin ɗaya daga cikin uku:
- Dole ne tsarin tsare-tsaren kiwon lafiya ya shafi nau'ukan kula da lafiya ko magunguna, irin su maganin maganin maganin, maganin hana haihuwa, haɗarin in vitro, sabis na balaga, kwayoyi magani, da kuma shan taba shan taba.
- Bukatar cewa tsarin kiwon lafiya ya ƙunshi ɗaukar hoto don masu kulawa da su banda likitoci, irin su masu binciken kwarewa, masu shan magani, masu shayarwa, masu aikin likita, da ma'aikata.
- Dole ne tsarin tsare-tsaren kiwon lafiya ya rufe masu dogara da sauran mutane, kamar su yara da aka karɓa, ɗalibai masu ɗamara, jikoki, da kuma abokan gida.
Sharuɗɗan amfani da aka ba da umarni mafi sau da yawa yana amfani da inshora na kiwon lafiya wanda ma'aikata da kamfanonin kiwon lafiya masu zaman kansu suka saya da su suka saya, ko ta hanyar musayar haya na kiwon lafiya ko musayar musayar .
Amma akwai wasu takardun da suka shafi Medicare da Medicaid / CHIP .
Asusun Biyan Kuɗi na Asusun da Asusun Kula da Lafiya
Yawancin mutane - ko a kan ko kuma a kan takaddamar - sun yarda cewa wadatar kiwon lafiyar da ake bukata ta karu da haɓakar asibiti na kiwon lafiya. Dangane da amfanin da aka ba da umarni da kuma yadda aka amfana wannan amfanin, yawan kuɗin da ake samu a kowane wata zai iya karuwa daga ƙasa da 1% zuwa fiye da 5%.
Ƙoƙarin gano yadda amfanin da aka yi amfani da shi zai shafi tasirin inshora yana da matsala. Dokokin dokoki sun bambanta daga jihar zuwa jihar kuma har ma da wannan doka, dokoki da dokoki na iya bambanta.
Alal misali, yawancin jihohin da aka ba da umarni ga masu chiropractors, amma yawan adadin da aka yi izini zai iya bambanta daga jihar zuwa jihar. Ɗaya daga cikin jihohi na iya ƙididdige adadin masu ziyara a cikin shekara hudu a kowace shekara, yayin da wata jihohi za ta iya ba da izini har zuwa masallaci 12 a kowace shekara. Tun lokacin da sabis na chiropractor zai iya zama tsada, tasiri a kan asibiti na asibiti na iya zama mafi girma a cikin jihar tare da ƙarin karimci.
Wani misali kuma shi ne rashin ɗaukar haihuwa, wanda ba'a buƙata a karkashin dokar tarayya, amma ana buƙatar da dama daga jihohi. A wa] annan jihohin, akwai bambancin bambanci game da abin da ya kamata a rufe a cikin yanayin kula da rashin haihuwa, wanda ke nufin cewa tasiri a kan kuɗin ya bambanta sosai daga jihar zuwa jihar.
Bugu da ƙari, rashin maƙasudin umarni na iya kara yawan kuɗin kiwon lafiya da kuma asibiti na asibiti. Idan wanda ke da matsalar lafiya ba tare da kulawa da lafiya ba saboda inshora ta rufe shi, zai iya zama lafiya kuma yana buƙatar sabis masu tsada a nan gaba. Misali na wannan shi ne gaskiyar kulawar kula da hakori ba ado ɗaya daga cikin amfanin kiwon lafiyar da ake bukata a ƙarƙashin ACA ba, kuma ba a kula da hakikanin hakori ba don a rufe shi a karkashin Medicaid (wasu jihohi sun haɗa da haɗin ƙwayoyi a cikin shirin Medicaid, yayin da wasu ke bayarwa 't). Rashin samun dama ga kulawa da hakori na iya haifar da rikitarwa mai tsanani.
Amfanin lafiyar lafiya na tarayya
Dokar Tarayya ta haɗa da adadin takardun inshora:
ACA muhimmin amfanin kiwon lafiya (EHBs).
Dokar Kulawa mai Kulawa ta kasance wani canji mai matukar muhimmanci a kan ka'idodin amfanin lafiyar jiki, haifar da ƙasa ta duniya dangane da muhimmancin kiwon lafiyar da ya kamata a haɗa a kowane sabon tsarin lafiyar mutum da kananan kungiyoyi a kowace jiha. Abinda ake buƙata ya haɗa da EHBs ya shafi kowane mutum da ƙananan ƙungiyoyi tare da kwanakin ranakun Janairu 1, 2014 ko daga bisani. Jerin EHBs sun haɗa da:
- Ayyukan ba da agaji (kula da kayan aiki)
- Ayyukan gaggawa
- Ginin (inpatient kulawa)
- Kula da jarirai da jarirai
- Maganin tunani da tunani da kuma amfani da kayan amfani
- Dokar magunguna
- Ayyukan rehabilitative da habilitative da na'urori
- Ayyukan laboratory
- Gudanar da kariya da ciwon cututtuka ( wasu takamaiman kulawa masu kariya suna da kyauta a kan dukkan sababbin tsare-tsaren, ba tare da la'akari da ko mutumin da ya yi shirin ya sadu da shi ba).
- Hanyoyin lafiyar yara, ciki har da kulawa ta hanyar maganganu da hangen nesa ( ƙananan hakori da hangen nesa ba a buƙata su rufe su ba , kuma akwai wasu sassauci dangane da umarnin don hakori na yara).
Baya ga kulawa da kulawa da asibiti, EHB ba dole ba ne a rufe manyan tsare-tsaren kungiyar ("babban ƙungiya" na nufin ma'anar da ma'aikata ke bayarwa tare da ma'aikata fiye da 50, ko da yake akwai jihohi hu u inda "kananan ƙungiya" ya hada da ma'aikata tare da har zuwa ma'aikata 100 ).
Ƙungiyoyin manyan kungiyoyi ba su da kyau sosai, duk da haka. Kuma wasu wasu umarni (alal misali, abin da ake buƙata-aka bayyana a kasa-cewa duk shirye-shiryen da ma'aikata masu aiki da ma'aikata 15 ko fiye suke bayarwa na kulawa da haihuwa) suna amfani da kasuwannin manyan kamfanoni.
COBRA ci gaba da ɗaukar hoto
COBRA na ba da wasu tsoffin ma'aikata da masu goyon bayansu damar da za su ci gaba da ɗaukar hoto na tsawon watanni 18 zuwa 36.
Ƙungiyar yara masu amfani
Wasu tsare-tsaren kiwon lafiya dole ne su ba da damar ɗaukar hoto ga yara waɗanda aka sanya tare da iyalansu don tallafawa a ƙarƙashin ka'idodin da suke amfani da su ga yara na halitta, ko tallafi ya zama karshe ko a'a.
Amfanin kiwon lafiya
Idan tsarin lafiyar ya shafi ayyukan kiwon lafiya na kwakwalwa, halayen shekara-shekara ko iyaka na dollar zai kasance daidai ko fiye da iyakokin amfanin likita.
Ƙananan asibiti suna dakatar da jariri da uwaye
A karkashin Dokar Kariya na Lafiyar Na'ura da Dokar Mata na 1996, tsarin kiwon lafiyar bazai iyakance amfanin ga kowane asibiti ba tsawon lokacin da ya shafi haihuwa ga jaririn ko jariri.
Labaran sake gina jiki bayan mastectomy
Dole ne tsarin kiwon lafiyar ya ba wa wanda ke karɓar amfanoni da suka danganci mastectomy tare da ɗaukar hoto don sake farfaɗar nono wanda aka yi mastectomy.
Amurkan Amirkawa tare da Dokar Harkokin Cutar (ADA)
Dole ne a bayar da magungunan marasa lafiya da mutane marasa amfani kamar amfanin gonar, kuɓuta, ƙididdigar ɗaukar hoto, da lokutan jiragen da suka wuce.
Dokar Dokar Kasuwanci ta iyali da kuma likita (FMLA)
Yana buƙatar mai aiki don kula da lafiyar jiki don tsawon lokacin barin FMLA.
Dokar Bayar da Harkokin Ayyukan Ayyukan Kasuwanci da Dokar Kare Hakki (USERRA)
Ya ba ma'aikaci dama ta ci gaba da kula da lafiya a karkashin tsarin kiwon lafiyar ma'aikata yayin da ba shi da aiki daga aiki saboda hidima a cikin sabis na uniformed.
Dokar nuna bambancin ciki
Shirye-shiryen kiwon lafiya da ma'aikata ke da shi wanda ke da ma'aikata 15 ko fiye dole ne su samar da irin wannan nauyin ɗaukar ciki don daukar ciki kamar sauran yanayi.
Bayanin Kula da Lafiya na Jihar
Jihohi sun bambanta ƙwarai a cikin lambar da kuma irin amfanin da ake bukata, amma a duk fadin jihohi 50, akwai kusan takardun amfani da 2,000 waɗanda aka sanya a cikin shekaru 30 da suka gabata.
Kuna iya samun bayani game da takaddun jihohin mutum daga maɓuɓɓuka masu yawa:
- Asusun inshora na jiharku, wanda za ku iya samun dama daga shafin yanar gizo na Ƙungiyar Ƙungiyar Ƙungiyar Assurance
- Dokokin Majalisar Dokoki na kasa (NCSL)
- Ƙungiyar Family Foundation ta Ƙungiyar Kula da Lafiya ta Jihar
A karkashin ACA, duk sababbin (tasiri tun shekarar 2014) mutum da ƙananan ƙungiyoyi a cikin jihohi dole su haɗa da ɗaukar hoto ga EHB, dole ne su sami cibiyoyin sadarwa masu dacewa, kuma dole ne su rufe yanayin da suka rigaya su kasance ba tare da la'akari da tarihin likita ba.
Wannan shi ne mafi ƙarancin daidaituwa wanda shirin zai bi, amma jihohi na iya wuce bayan bukatun ACA. Wasu misalan ƙarin ƙarin takaddama na musamman na ƙasashe sune ɗaukar ƙaramin jima'i, autism ɗaukar hoto, da kuma taƙaita farashin kayan aiki na kayan aiki.
Amma akwai dokoki da ke buƙatar jihohi-maimakon masu sayarwa-don su biya kudin da za su iya amfani da takardun da suka wuce bayanan ACA, wanda ke nufin wasu jihohi sun yi ƙoƙari su yi amfani da sababbin ka'idojin kawai don tsara manyan ƙungiyoyi, waɗanda ba su da alaka da Aikin ACA muhimmiyar bukatun kiwon lafiya (sanarwa dai, an tsara tsare-tsaren da aka yi wa kansu a karkashin dokoki na tarayya maimakon kulawa, don haka ba su bin ka'idodin da suke buƙatarwa;
> Sources:
> Kayan Gida na Kaiser. Sanin lafiyar lafiyar jama'a
> Majalisun Majalisar Dokoki na kasa. Autism da Harkokin Assurance, Dokokin Shari'a. Yuni 7, 2017.
> Majalisun Majalisar Dokoki na kasa. 2011-2014 Tsaftacewar Assurance Kiwon Lafiya An kafa Dokokin Hukumomi da suka shafi Dokar Kulawa mai Kulawa. Yuni 17, 2014.
> Majalisun Majalisar Dokoki na kasa. Asusun Harkokin Asibiti na Jihar da ACA Masu Amfani. Maris 8, 2017.