Oposa 340% akugwiritsidwa ntchito ndi madokotala a ER poyerekeza ndi 110% kupyolera mwa anthu osakhala ER internists
Phunziro la May 2017 lofalitsidwa mu JAMA Internal Medicine likuwonetsa kuti mitengo yapamwamba imakhala yowonongeka m'madipatimenti odzidzidzi a ku America-omwe amakhudza kwambiri osauka, odwala ochepa.
Zonsezi, madokotala amapereka madokotala okwana 340 peresenti poyerekeza ndi 110 peresenti yazinthu zoperekedwa ndi ogwira ntchito kunja kwa chipinda chodzidzimutsa.
Mwachidule
Mitengo yomwe imayikidwa pazinthu zomwezo zimasiyanasiyana kwambiri kuchokera ku dipatimenti yapadera ku dipatimenti yapadera. Kuwonjezera apo, nthawi zonse zimakhala zodula kwambiri kupeza chithandizo cha vuto mu dipatimenti yowopsa kusiyana ndi kulandira chithandizo ku ofesi ya dokotala kapena kuchipatala chofunika kwambiri.
Anthu ambiri omwe amalandira ngongole zapamwamba kuchokera kuchipatala ndi omwe sangathe kuwapatsa ndalama: ang'onoang'ono omwe alibe inshuwalansi. Misonkho yapamwamba ya zamankhwala ingayambitse kugwa pansi ndipo ndi chifukwa chotsogolera chifukwa chomwe anthu amalengeza bankruptcy.
Kuopa kuti zipatala zambiri zimaperekanso bwanji kulepheretsa anthu kupeza chisamaliro chofunikira. Anthuwa amatha kumaliza ntchitoyi ku dipatimenti yowonjezereka ndi mavuto omwe amachititsa kuti anthu azikhala ndi moyo wabwino komanso amathera zambiri.
Momwe Makhalidwe Amagwirira Ntchito
Mazipatala amagwiritsira ntchito zipangizo zamagazi, zomwe ndi mndandanda wa ntchito ndi ndalama zawo, kusonkhanitsa ndalama za wodwalayo. Komabe, mtengo weniweni wa mautumiki umasiyana malinga ndi mtundu wa inshuwalansi yomwe wodwalayo ali nayo ndi malo ake ochezera.
Odwala omwe ali mu-network ndi awo inshuwalansi amalipira pang'ono; pomwe, odwala omwe ali kunja-of-network ndipo alibe inshuwalansi amalipira milandu yonse ya chipatala, zomwe zingakhale zochulukitsa zambiri zomwe Medicare imabweza. Zipatala zamtengo wapatali kwambiri zimatha kupereka ndalama zopitirira 900 peresenti kuposa zomwe Medicare imabweza.
Kufufuza ER Pricing
Mu kufufuza kwa mtengo wamtengo wapatali, ofufuza anafufuza zolemba zokhudzana ndi madokotala odwala oposa 12,337 omwe akugwira ntchito m'mazipata pafupifupi 2,707 ku United States. Mofananamo, iwo adafufuza zolembedwa za madokotala 57,607 omwe ali m'zipatala 3,669.
Pogwiritsira ntchito zolembazi, ochita kafukufuku anawerengera "kuchuluka kwa ndalama zomwe amagwiritsa ntchito pogwiritsira ntchito ndalama, zomwe ndi chiŵerengero cha ndalama zomwe zimaperekedwa ku Medicare ndalama zovomerezeka." Ndi mankhwala a Medicare ovomerezeka kukhala "chiwerengero cha zomwe Medicare amalipira, deductible ndi coinsurance ndalama zomwe wopindulayo ali ndi udindo wolipilira, ndi ndalama iliyonse imene munthu wachitatu akuyenera kulipira. "
Kuphatikiza apo, ochita kafukufuku anapeza zotsatirazi pa dipatimenti iliyonse yodzidzimutsa :
- Kukula
- Malo
- Phindu la phindu
- Chikhalidwe cha kuphunzitsa
- Mzinda wa kumidzi kapena kumidzi
- Malo otetezeka a chipatala
Malingana ndi zomwe zinafotokozedwa ndi kafukufuku wa United States, ofufuza apeza kuti:
- Umphaŵi
- Udindo wosatsimikiziridwa
- Anthu ochepa
Kuzindikira kusiyana kwa mtengo
Pamene mautumiki omwewo ankachitidwa ndi dokotala wachipatala kapena mwadzidzidzi, kupititsa patsogolo kunali kwakukulu kwambiri kwa mautumiki operekedwa ndi dokotala wachipatala.
Mwachitsanzo, malipiro apakati pa electrocardiogram anali $ 95 pamene atanthauziridwa ndi dokotala wa chipatala; pomwe, kuwerenga kwa munthu wophunzirayo kulipira madola 62.
Malinga ndi ochita kafukufukuwo:
Poganizira ntchito zonse za ED, ndalama zokwana madola 100 mu Medicare zili zovomerezeka, zipatala zosiyanasiyana zimapereka odwala pakati pa $ 100 (kubwereketsa chiwerengero, 1.0) ndi $ 12,600 (kubwereza chiŵerengero, 12.6), ndipakati pa $ 420 (kuwerengera, 4.2); Mosiyana ndi, chipatala chamkati cha chipatala chamkati chimakhala $ 200 (markup ratio, 2.0).
Nazi zotsatira zina zowonjezera kuchokera ku phunziro:
- Madokotala oopsa anagulitsa madola 4 biliyoni, pafupifupi madola 3.1 biliyoni kuposa Medicare ovomerezeka.
- Kuchuluka kwapadera kunali kwakukulu koti azidwalitsa (kutanthauza, kutseka kwa chilonda).
- Mutu wa CT unali ndi kusiyana kwakukulu kwa zipatala zomwe anazifufuza. Mwa kuyankhula kwina, CT zojambula za mutu zinagwirizana kwambiri ndi mtengo.
- Dipatimenti yowopsa yomwe idapatsa anthu ambiri ntchitoyi inali gawo la zipatala zopindulitsa ndipo inali ku Midwest ndi kum'mwera chakum'mawa kwa United States. Dipatimenti yosavuta imeneyi inathandiza anthu ambiri a ku Spain ndi a ku America omwe sanalimbikitsidwe.
Mawu Ochokera
Pamene munthu amachizidwa mu dipatimenti yosautsa, nthawi zambiri alibe chosankha, amakhala pansi pa vagaries wa mtengo. Malingana ndi olembawo, "Tsopano, kuposa kale lonse, kuteteza odwala osatetezedwa ndi otuluka kunja kwa odwala kuchokera ku mitengo yosiyanasiyana ya chipatala ayenera kukhala chofunika patsogolo."
Zotsatira za phunziroli zikutsindika kufunika kokhala owonetsetsa bwino pa kubwezera kuchipatala. Amathandizanso kufunikira kwa akuluakulu a boma komanso a boma kuti ateteze odwala omwe sakhudzidwa.
> Zotsatira:
> Malinga. Electrocardiogram.
> Malinga. Nthawi yogwiritsa ntchito chipinda chodzidzimutsa.
> Xu, T, et al. Kusiyanasiyana mu Dipatimenti Yowopsa ndi Dongosolo la Internal Medicine Misonkho Yowonjezera ku United States. JAMA Internal Medicine. 2017.