Na sebaka sa Obamacare se tla nkela bahlomphehi ba Medicare sebaka?
The Careable Affordable Act, aka Obamacare , ha ea ka ea tlisa tšebetso ea inshorense ho batho ba limilione ba Maamerica ka bophelo ba Insurance Insurance Marketplace empa hape e atolose Medicaid linaheng tse 'maloa. Batho ba neng ba ke ke ba khona ho inshorense ea bophelo bo botle ba ne ba fihlella kapele. Seo batho ba bangata ba se lebalang, leha ho le joalo, ke hore lenaneo leo le bile le phello e tebileng ho Medicare .
Molao ona o ile oa tobana le ho felisoa ka 2017 ke Republican Congress. Leha ho le joalo, phetolelo ha ea ka ea etsahala, bonyane ha e e-s'o fihle.
Morero oa sebaka sa Obamacare o tlameha ho qala ka ho hlahloba hore na Molao oa Motlakase o ka rekisetsang Medicare joang. Ebe e lokela ho nahanela hore na e tla sebetsana joang (kapa e tla rarolla) litlhoko tseo ka melao e ncha.
CMS Innovation Center
Haeba re sa fetohe, ha re hōle. Litsi tsa Medicare le Medicaid (CMS) Innovation Center e bile teng tlas'a theko e tlaase ea Care Act mme e sheba mekhoa ea ho bontša mekhoa e mecha ea ho fana ka tlhokomelo ea bophelo ho ntlafatsa boleng ba tlhokomelo empa hape ho fokotsa litšenyehelo tsa Medicare, Medicaid , le Bana ba Bophelo ba Litšebeletso tsa Bophelo bo Botle (CHIP) .
Ho se ke ha e-ba le phoso. CMS e beha sethala bakeng sa indasteri eohle ea inshorense. Haeba CMS e fumana ho hong ho sebetsang, bahiri ba inshorense ba tiile ho kena sesosa.
Ho tloha ha e thehoa, mekhoa e fetang 30 ea tefo e 'nile ea etsoa le ho hlahlojoa.
CMS Innovation Centre e shebane le mekhatlo ea tlhokomelo e ikarabellang le litefello tsa likoloto ka litsela tse fapaneng tsa ho lefa bakeng sa tlhokomelo ea bophelo. Phetoho e tsoang ho lefa-bakeng sa ts'ebeletso (ngaka ea lits'ebeletso bakeng sa tšebeletso e 'ngoe le e' ngoe) ho lefella boleng bo phahameng (ngaka e lefshoa ho latela liphello tsa tlhokomelo ea boleng) e ntse e tsoela pele.
Karolo ea 30 lekholong ea litefello tsa Medicare li se li sebelisoa ka tsela ena.
Lenaneo la tlhokomelo ea bophelo bo botle le lona le ntlafalitse boleng ba Mamirione a limilione. Lenaneo la Comprehensive Primary Care le ile la lumella ho atolosoa ha tlhokomelo ea mathomo linaheng tse itseng ho ruisa ba hlokang. Lefu la Matsoalo a Li-Renal (Comprehensive End-Stage Renal Disease) (Initial End-Stage Ending Stage) (Initial Care-Stage Disease Disease) (Initial Care-Stage Disease Disease) (Initial Care-Stage). Matla a Matla bakeng sa Bo-'mè le Bana ba sa tsoa Tsoaloa a fokotseha pele ho tsoaloa pele ho nako le mathata a nako e telele bakeng sa malapa a macha. Lenane la Thibelo ea Ts'oaetso ea lefu la tsoekere e bile le katleho e kholo e tla atolosoa ho pholletsa le naha ka 2018.
Na ho tlosoa ha Obamacare ho tla felisa mananeo aa? Sebaka sa phetoho sa Obamacare se lokela ho nahana kamoo se tla ama tsoelo-pele ea meriana nakong e tlang, ka boleng le ka litšenyehelo.
Ho qhekella, ho senya le ho hlekefetsa
Ho qhekella, litšila le tlhekefetso li atile haholo litabeng tsa bophelo bo botle, ho lefella ba lefang tefo chelete e telele. Molao oa Ts'ebeliso ea Tlhokomelo o nkiloeng o ile oa nka mehato ea ho fokotsa tšebeliso ena hampe le ho tsamaisa chelete hore e khutlele lenaneong la Medicare. E entse joalo ka ho matlafatsa Medicare Fraud Strike Force.
The Medicare Fraud Strike Force e thehiloe ka 2007 'me e sebetsa ka kopano le Lefapha la Toka, Lefapha la Lefapha le Lefapheng la Liphuputso, Ofisi ea Mohlokomeli oa Molao, le ts'ebetsong ea molao.
Ho sebetsa metseng e robong naheng eohle - Baton Rouge, Louisiana; Brooklyn, New York; Chicago, Illinois; Dallas, Texas; Detroit, Michigan; Houston, Texas; Miami, Florida; Los Angeles, California; le Tampa, Florida - ea Medicare Fraud Strike Force e bolokile lenaneo ka makhetlo a mabeli ho feta kamoo le entseng kateng pele lekhotla la tlhokomelo ea chelete le theko e tlamisoa ka 2010.
Ho tloha ka June 2016, boiteko ba Medicare Fraud Strike Force bo ile ba lebisa liqoso tse 2 522. Ntho e kholo ka ho fetisisa historing ea Task Force e etsahetse ka June 2016 ha batho ba 301, ba 61 ba bona ba le tumello ea litsebi tsa bongaka, ba qosoa ka bolotsana ba ho etsa bolotsana ba tlhokomelo ea bophelo, ho hlakola chelete le ho utsoetsa boitsebiso bo eketsehileng .
Ts'ebetso ea bona ea tlōlo ea molao e ne e le chelete e ka bang limilione tse likete tse limilione tse likete tse makholo (6) likoloto tsa bohata
Phetoho ea tlhokomelo ea bophelo bo botle e tsoelang pele e tlameha ho tsoela pele ho nka morero ho ba lekang ho sebelisa hampe mokhoa ona. E tla ba eona feela tsela ea ho boloka litšenyehelo bakeng sa ba li hlokang ka ho fetisisa.
Boemo ba ho bala sepetlele
E mong le e mong o lumela hore tlhokomelo ea sepetlele e lokela ho ba boleng bo phahameng ka ho fetisisa. Bophelo ba batho le boiketlo ba bona bo itšetlehile ka eona. Lekhotla la Tlhokomelo e theko e tla nka mehato ea ho susumetsa lipetlele ho ntlafatsa boleng ba tlhokomelo ea bona. Ba ile ba etsa joalo ka ho hlahloba hore na hangata batho ba ile ba khutlisetsoa sepetlele joang pele ho matsatsi a 30. Kaha ba ne ba khutlisetsoa sepetlele, ba ne ba nahana hore e tla ba pontšo ea hore sepetlele se ne se sa hlokomele motho ka mong pele se lokolloa.
Lenaneo la ho fokotsa li-Readmissions, le bōpiloeng tlas'a Molao oa Tlhokomelo ea theko e tlaase, o sheba ka ho khetheha ho amoheloa ha pelo ea pelo , khatello ea pelo , pneumonia , lefu la mokuli le motsoako oa lefuba (COPD) . Lipetlele tse neng li e-na le litlaleho tse ngata sebakeng sena li ne li koalloa ke ho fokotseha ha liphesente tsa litefiso tsa bona tsa Medicare.
Ho tloha ka 2012, litefello tsa ho kenyelletsa sepetlele li se li fokotsehile. Liphello tsa ho hlaseloa ke pelo li ile tsa theoha ke karolo ea 2,8 lekholong, likhaello tsa pelo ka liphesente tse 2,8, le palo ea matšoafo ka karolo ea 1,5 lekholong ho tloha ka 2007 ho ea ho 2014. Potso ke hore na ha e le hantle e bonahatsa ntlafatso ea tlhokomelo ea boleng. Ho na le ts'oaetso ea hore lipetlele li ka 'na tsa qoba kotlo ka ho beha batho "tlas'a tlhokomelo" ho fapana le ho li balla e le likooa.
Ka Molao oa Tlhokomelo e Tsitsitseng, tlosa Lenaneo la ho Fokotsa Li-Readmissions le ka fela. Re tšepa hore ho tla ba le ts'ebetsong, kapa boiteko bo bocha ba ho sebetsana le boleng ba tlhokomelo batho ba fumanoang lipetlele.
Karolo ea D Donut Hole
Medicare Karolo ea D e ile ea e-ba teng tlas'a Mopresidente George W. Bush ha Molao oa Medicare Modernization o phethahala ka 2003. Ba ruileng molemo ba ile ba khona ho sebelisa melemo ea Karolo ea D ea meriana ea lithethefatsi e qalileng ka January 2006 ka lekholo le le leng. Molao ona o ne o kenyelletsa "sekoti se seholo" seo ho neng ho hlokahala hore basebetsi ba Medicare ba lefe karolo ea 100 lekholong ea meriana hang ha bona le morero oa karolo ea D ba sebelisa chelete e itseng selemong se fanoeng.
Obamacare e thusitse ho fokotsa litšenyehelo tsa li-pocket .
Pele, e ile ea buisana le baetsi ba litšenyehelo ba ka u lefang meriana ea hau. Bahlahisi ba lebitso la mabitso, haholo-holo ba ne ba tla fana ka lithethefatsi tsa bona ka theko ea 50 lekholong nakong eo u neng u le mokoting oa donto.
Ea bobeli, Obamacare o fokotsehile hore na o tla lefa bokae ka ho hloka hore karolo ea D e rere ho lefella karolo e nyane ea litšenyehelo tsa lithethefatsi nakong ea lehare la donut. U ne u tla 'ne u lefe haholoanyane hore u ka tsoa ka ntle ho sekoti sa mokelikeli, empa chelete e ne e le ea bohlokoa. White House e tlaleha hore ho boloka chelete ho ruile molemo ho batho ba fetang limilione tse 8, ho ba pholosa ka liranta tse limilione tse 11,5 ho tloha ka 2010.
Ntlha ea boraro, tekanyo ea morero oa hau bakeng sa meriana ea hau e tla nyoloha butle-butle ho fihlela karohano e koaloa ka ho feletseng ka 2020. Ka mantsoe a bonolo feela, u tla lefa litšenyehelo tsa hau tse tloaelehileng, li-deductibles, li-copayments, le ho se letho.
Sekoti sa donut se ne se tla khutla ka ho tlosoa ha Obamacare. Ha lithethefatsi tsa meriana li lefshoa ho feta leha e le neng pele, tšusumetso ho batho ba baholo ba Amerika e ka ba e sithabetsang. Sebaka se seng sa Obamacare se tla nkeloa sebaka sena ho netefatsa hore batho ba ka fumana meriana eo ba e hlokang.
Litšebeletso tsa ho Etsa Litlhahiso tse thibelang
Obamacare e boetse e ntlafalitse ho fana ka litšebeletso bakeng sa litšebeletso tsa ho hlahloba tšireletso. Hafeela ngaka ea hau e amohela kabelo , ho bolelang hore o ile a lumellana le Kemiso ea Medicare Physician Fee, litšebeletso tsa thibelo ha li sa tla hlola li hloka chelete ea likoloto kapa lichelete tsa lichelete. Ba ne ba tla nehelanoa ka uena mahala.
Litšebeletso tse thibelang mahala tse koahetsoeng ke Medicare li kenyeletsa:
- Maeto a Selemo le Selemo
- Ho hlahloba khatello ea mali
- Ho hlahloba kankere ea matsoele ( mammograms )
- Ho hlahlojoa ha kankere ea mokokotlo (pap smear le tlhahlobo ea batho ba papillomavirus (HPV)
- Ho hlahloba kankere ea Colon (tlhahlobo ea mali ea tlhaho ea mali, colonoscopy, sigmoidoscopy)
- Ho hlahloba ho tepella maikutlo
- Lipid ho hlahloba
- Ho hlahloba kankere ea prostate (prostate-specific antigen)
- Liente (feberu, pneumococcal)
Litšebeletso tse ling-ho hlahlojoa ka mpeng ho na le ho hlahlojoa ke lefu la sebete, ho hlahloba lefu la tsoekere , ho hlahloba lefu la lefu la sebete, ho hlahloba kankere ea matšoafo, ho hlahloba lefu la ho fokola ha masapo le ho hlahloba maloetse a tšoaetsanoang ka ho kopanela liphate-ho tla ba mahala empa ho fumaneha feela ho batho ba nkoang ba le kotsing e kholo. Ho hlahlojoa ha kankere ea Colon ka teko ea DNA ea likoti e tla koaheloa feela haeba motho a ne a le kotsi kotsing.
Ho fokotsa melemo ea litlaleho ho batho ba baholo e ka ba bolokang ba phetse hantle kapa e ka lumellang ho phekoloa kapele ho maloetse a thata. Ke ne ke tla e bua le ho phahamisa litaba tsa boitšoaro. A re se keng ra lebala hore lefu le tsoetseng pele haholo ke ha le fumanoa, ho tla ba le litšenyehelo tse ngata ho phekola. Sebaka sa phetoho sa Obamacare se lokela ho nahana ka liphello tsa bophelo bo botle le litšenyehelo tsa nako e telele ho tseo e li koahelang.
Lentsoe ho
Ofisi ea Bongoli ea Congressional Budget e hlokometse liphello tsa ho tlosoa ha Obamacare 'me ea bolela hore chelete ea Medicare e tla eketseha ka liranta tse limilione tse likete tse 802 ho feta lilemo tse 10. Lenane le lecha la tlhokomelo ea bophelo bo botle le ne le tla hloka hore ho be le ntlha ena ho equation.
Taba ea phetoho ea tlhokomelo ea bophelo bo botle hase feela ea lipolotiki empa e le ea maikutlo. Ho sa tsotellehe hore na o lumela tumellanong le tlhokomelo ea Care Act, u lokela ho utloisisa hore na phekolo ea Medicare e tla fetoha ka ho felisoa ha molao. E tla u tsebisa seo u lokelang ho e shebella ha ho e-na le sebaka se ka qojoang sa Obamacare se ntseng se etsahala.
> Mehloli:
> Boccuti C, Casillas G. A ikemiselitse ho fokotsa lipetlele tse fokolang haholo: Lenaneo la ho fokotsa boithaopo ba Medicare Hospital. http://kff.org/medicare/issue-brief/aiming-for-fewer-hospital-u-turns-the-medicare-hospital-readmission-reduction-program/. E hatisitsoe ka la 30 September, 2016.
> Litšenyehelo tsa moralo le moruo oa ho pheta-pheta molao oa tlhokomelo ea tlhokomelo. Websaete ea Congressional Budget website. https://www.cbo.gov/publication/50252. E phatlalalitsoe ka la 19 June, 2015.
> Mesebetsi e ka sehloohong ea Tlhokomelo ea tlhokomelo ea chelete ka selemo. Lefapha la Bophelo le Lefapha la Litšebeletso tsa Botho la United States. https://www.hhs.gov/healthcare/facts-and-features/key-features-of-aca-by-year/index.html. E ntlafalitsoe ka la 13 August, 2015.
> Medicare Strike Force Force. Ofisi ea Mohlokomeli-Kakaretso - Websaeteng ea Lefapha la Bophelo le Lits'ebeletso tsa US. https://oig.hhs.gov/fraud/strike-force/.
> Litšebeletso tsa ho thibela le ho hlahloba. Medicare.gov. https://www.medicare.gov/coverage/preventive-and-screening-services.html.