Kodi Medicaid Idzachepetsera Kuchepetsa Chithandizo cha Chithandizo?
Kuledzera kwa opioid ndi vuto lalikulu ku United States. Kuyambira chaka cha 1999 mpaka chaka cha 2015, kaya kuchokera ku mankhwala osokoneza bongo kapena opioids osayenera monga heroin, anthu oposa theka la milioni anafera ndi opioid overdose. Centers for Medicare ndi Medicaid Services (CMS) imanena kuti anthu 91 amamwalira tsiku ndi tsiku chifukwa chozunzidwa ndi opioid, ndipo amatiyika pamsewu kwa anthu 32,400 mu 2017.
Medicaid imathandiza kwambiri pochiza mowa. Ndi mmodzi mwa asanu ku America akudalira pa Medicaid chifukwa cha zosowa zawo zaumoyo, kodi pulogalamuyi imapereka chithandizo chiti ndipo kodi mautumikiwa adzapitirizabe ngati chipani cha Republican chikugonjetsa chisamaliro cha Affordable Care Act , aka Obamacare?
Mavuto Opioid Ali Ponseponse
Kugwiritsira ntchito opioid si vuto chabe la boma. Ndi vuto ladziko.
Kufa kwa anthu oposa chiwerengero cha anthu ochulukirapola chinawonjezeka kuchokera kumphepete mwa nyanja m'chaka cha 2014. Ohio ndi California zinazunzika kwambiri ndi anthu oposa 2,000 odwala opioid, pamene New York, Florida, Illinois, Texas, Massachusetts, Pennsylvania, ndi Michigan aliyense anali ndi imfa yoposa 1,000 .
Monga momwe opioid akugwiritsira ntchito sichigawo, Medicaid sichimangokhala pazochitikazo. Medicaid, komabe imayang'aniridwa ndi mayiko, imathandizidwa pang'onopang'ono ndi madola a federal. Boma la federal limapereka malamulo ochepa omwe ali oyenerera ku Medicaid ndipo ndi chithandizo chofunikira chotani chomwe chiyenera kuikidwa mu pulogalamuyi.
American Health Care Act , yomwe inatchulidwa ku Nyumba ya Aimuna ya US, inapempha kuti pakhale ndondomeko yaikulu ku pulogalamu ya Medicaid. Ndalama, yomwe tsopano imatchedwa Better Care Reconciliation Act, ikuyembekezera voti ku Senate ya US isanafike kukhala lamulo. Ngati zidaperekedwa, lamulo lingasinthe zomwe zimapindulitsa pa thanzi - kuphatikizapo chithandizo chamaganizo ndi mankhwala osokoneza bongo - amadziwika ndi inshuwalansi ya umoyo wanu.
Izi zikuphatikizapo Medicaid.
Kuchiza Mankhwala Opioid
The Affordable Care Act imafuna kuti athandizidwe kuwonjezera pa mankhwala a Medicaid chivundikiro chogwiritsa ntchito mankhwala osokoneza bongo. Komabe, lamuloli linapereka chisinthiko ndipo linalola boma lirilonse kusankha ntchito zomwe akufuna kuti zibwezere.
Bungwe la Better Care Reconciliation Act lidzathetsa Medicaid kuonjezera ndikuletsa chithandizo chovomerezeka cha mankhwala osokoneza bongo.
Pali njira zinayi zosiyanasiyana zochizira zomwe zingaganizire:
- Ntchito zapakatipakati (kuphatikizapo gulu la mankhwala, chithandizo cha munthu aliyense, ndi chithandizo chothandizira kuchipatala)
- Ntchito zochiritsira zapadera
- Ntchito zapakati pa nthawi yayitali komanso yanthaŵi yaitali
- Kuchepetsa kwambiri matenda osokoneza bongo
Kafukufuku wa Health Affairs adawonetsa mauthenga okhudzana ndi mankhwala osokoneza bongo kuyambira chaka cha 2015 mpaka 2016. Chodabwitsa n'chakuti, ofufuza adapeza kuti kufalitsa sikunali kokwera m'madera omwe kudalira Medicaid .
Maiko khumi ndi atatu ndi District of Columbia anagwira ntchito zonse, ndipo 26 zinanena ntchito imodzi yokha pa njira iliyonse ya chithandizo. Maiko asanu ndi anayi sanapereke mankhwala a Medicaid kuti azigwiritsa ntchito mankhwala osokoneza bongo m'magulu awiri kapena kuposa.
Komabe, kupereka zoperekazi sizinatanthawuze kuti zinali zophweka kupeza.
Pafupi theka la mayikowa ankafuna mtundu wa ndondomeko yoyenera kuvomerezedwa yotchedwa chilolezo chisanayambe kubweza chisamaliro chokwanira. Maiko asanu ndi anayi adawonjezerapo chithunzithunzi cha momwe angagwiritsidwire ntchito pazinthu zowonongeka.
Kuchiza Mankhwala Opioid Mankhwala
Mankhwala opangira mankhwala opioid ndi buprenorphine (dzina lachidziŵitso la Suboxone), methadone, ndi naltrexone (mayina a chizindikiro Depade, Revia, ndi Vivitrol). Mankhwalawa amamangiriza opioid receptors mu ubongo kuti akwaniritse zotsatira zake:
- Buprenorphine: Buprenorphine nthawi zambiri amawoneka ngati mankhwala chifukwa amakhala motalika kwambiri m'thupi. Zimalepheretsa mphuno ya opiates yomwe imayambitsa, ndipo ili ndi theka la moyo kuyambira maola 24 mpaka 42.
- Methadone: Methadone ndi opiate yomwe imathandiza kuchepetsa zikhumbo. Komabe, monga ma opioid ena, amatha kudalira thupi. Methadone imagwiritsidwa ntchito monga chithandizo chokonzekera ndipo akhoza kuyamwa nthawi. Moyo wake wautali umasinthasintha, kuyambira maola 8 mpaka 59.
- Naltrexone: Naltrexone imalimbikitsa kuchepetsa chilakolako cha opioid ndipo nthawi zina imagwiritsidwanso ntchito poledzeretsa mowa. Theka la moyo ndi maola 4 kapena 13.
Bungwe la Health Affairs linasonyeza kuti boma lirilonse ndi District of Columbia zinaphimba buprenorphine, ndipo mayiko makumi anayi mphambu asanu ndi atatu adatsembedwa naltrexone. Chophimba cha methadone, komabe, chinali chosasinthasintha. Zina 32 zokha zinaphatikizapo kufotokoza kwa methadone m'mapulogalamu awo a Medicaid.
Mofanana ndi uphungu ndi odwala matenda opatsirana, chilolezo chisanayambe chinathandiza pakugwiritsira ntchito mankhwala. Malamulo ambiri adayenera kuperekedwa kwa buprenorphine pamene gawo limodzi mwa magawo atatu a iwo amafuna zolemba.
Zimasokoneza pamene mukuganiza za izo. Anthu ofuna thandizo kwa opioid oledzeretsa amatsutsidwa mwamsanga kuchipatala pamene akufunikira kwambiri. Kuchedwa kwa chithandizo ndi chinthu chomwe chikhoza kuwatsogolera kuti abwererenso.
Ndalama Zimadutsa ku Medicaid
Kuyembekeza Medicaid kukonza mliri wa dziko sizowona, osati ngati ndalama zowonjezereka zikudulidwa. Mwatsoka, ndicho chomwe chingachitike.
Ngati Bungwe la Better Care Reconciliation Act lidzakhala lamulo, Medicaid ikuwonjezeka monga tikudziwira pansi pa Chithandizo cha Care Care chosatha. Zomwe ziyenera kuphatikizapo mankhwala osokoneza bongo monga gawo la Medicaid pulogalamu idzakhalanso.
Ngakhale akunena kuti sanalowe nawo kuwonjezeka kwa Medicaid kungakhudzidwe. Izi ndizo chifukwa ndalama zothandizira pulogalamu ya Medicaid zidzasintha. Mmalo mwa boma la federal likufanana ndi zomwe boma lirilonse limapereka dola kwa dola, Bungwe la Better Care Reconciliation Act likhoza kuchepetsa malipiro kwa munthu aliyense . Izi zikutanthauza kuti boma lirilonse lingalandire ndalama zokwana dollar kuchokera ku boma malinga ndi chiwerengero cha anthu pa Medicaid.
Malingana ndi Congressional Budget Office, kusintha kwa ndalamazi kudadola $ 772 biliyoni ku Medicaid pofika 2026.
Izi zidzetsa zolemetsa kwambiri kuti apeze njira zina zoperekera ndalama pamene ndalama zawo za boma zatha kale. Ziyembekezeredwa kuti mayiko ambiri adzafunika kuthana ndi chithandizo cha Medicaid kuti apitirize kuyenda. N'zomvetsa chisoni kuti chithandizo chamaganizo ndi mankhwala osokoneza bongo angakhale oyamba kupita.
Mawu ochokera
Palibe kukayikira kuti Bungwe la Better Care Reconciliation Act likhoza kuchepetsa mwayi wopezeka kuntchito zaumoyo. Ziribe kanthu ngati muli pa medicaid, ndondomeko yaumoyo, kapena bwana inshuwalansi. Zosintha zomwe zolingazi ziyenera kuchitika, mwachitsanzo, kusintha kwa ubwino wa thanzi, zidzakhudza mautumiki omwe mudzalandira ndipo zidzakhala zovuta kwa iwo omwe akuvutika ndi chizolowezi chopeza thandizo lomwe akusowa.
> Zotsatira:
> Grogam CM, Andrews C, Abraham A, et al. Kusiyana Kwakuyikira Kusiyanasiyana Mubuku la Medicaid Kwa Chithandizo Chakumagwiritsa Ntchito ndi Opioid Kugwiritsa Ntchito Matenda Ovuta. Health Aff. December 2016. 35 (12): 2289-2296. lembani: 10.1377 / hlthaff.2016.0623
> HR 1628 . Ofesi ya US Senate. https://www.budget.senate.gov/imo/media/doc/SENATEHEALTHCARE.pdf. Idasindikizidwa pa June 22, 2017.
> HR 1628, Act Care Reconciliation Act wa 2017. Ofesi ya Budget ya Congressional. https://www.cbo.gov/publication/52849. Idasindikizidwa pa June 26, 2017.
> Kupewa Kuipa ndi Kulamulira: Kutaya kwa opioid - Kumvetsetsa Mliliwu. Maofesi a Webusaiti Yowononga ndi Kuteteza Matenda. https://www.cdc.gov/drugoverdose/epidemic/index.html. Idasinthidwa pa June 21, 2016.
> Rodriguez CH. Chithandizo cha Medicaid Chachilombo Choyambitsa Matenda Chimawoneka Mwachidwi. Webusaiti ya Kaiser Health News. http://khn.org/news/medicaid-coverage-for-addiction-treatment-varies-dramatically/. Idasindikizidwa pa December 6, 2016.