Chikamu chinosanganiswa pane zvose zvitsva zvevanhu uye zviduku
Pamberi peSouth Affordable Care Act (ACA, inozivikanwawo seObamacare) yakatanga kushanda, kuwanda kwekugoverwa kwakapiwa nehutano hwehutano hwehutano kwakasiyana zvikuru kubva kune imwe nyika kuenda kune imwe. Kudzivirirwa kwevatengi kwakave patchwork yenyika-based rules yaive yakasimba kune dzimwe nyika uye zvishoma mune vamwe.
Hurumende inoda kuti ive yakazara kupfuura iyo ACA ichiri kushanda, asi munzvimbo dzose, ACA yakagadzirisa zvishoma.
Zvinonyanya kukoshesa Health Benefits (EHBs) ndezvigumi gumi zvekurapa izvo zvinofanira kuvharwa- pasina dhora mamiriyoni pagore kana mararamiro ehupenyu -iwo mapoka evanhu nemapoka maduku ane zvirongwa zvakanaka zveJanuary 2014 kana kuti gare gare. EHBs yakafukidzwa pasinei nokuti chirongwa chacho chinotengeswa kuburikidza nekutsinhanisa kana kubvisa-kushandiswa .
Vabereki vakuru uye vane zvirongwa zvakawanda vachiripo, asi vakange vane mazuva anobudirira pamberi pegore ra2014. Saka EHB zvinodiwa hazvishandisi kune vazukuru uye vaine zvirongwa zvakawanda, kunze kwekuchengetedzwa kwekuchengetedza, izvo zvinodiwa kuti zvifukidzwe kune vazukuru-asi vasina kuberekwa- zvirongwa. EHB zvinodiwa hazviitiwo kune mapoka makuru eboka .
Hezvino izvo zvinonzi EHB, uye kuti zvinoshanda sei:
Ambulatory Services
Izvi zvinosanganisira kushanyira mahofisi echiremba uye makiriniki, pamwe nekuchengetwa kwechipatara kunowanikwa kunze kwepakati.
Kurwara kwechirwere chisingaperi, kuchengetwa zvakanaka, uye maitiro ekudzivirira
Kuchengetedza kwekuchengetedza kwakafukidzwa pasina kugovana mari kune murwere (kureva kuti, kambani yeinishuwarensi inobhadhara mari yakazara), asi chete kana basa rekudzivirira riri mubvunzo riri pane urongwa hwekuchengetedzwa kwekuchengetedza.
Iko kune masangano matatu ayo mazano anoshandiswa kugadzira urongwa hwekuchengetedzwa kwekuchengetedza. Nyora yacho yakagadzirwa zvikuru inobva pamabasa anogamuchira "A" kana "B" kubva kuUnited States Preventive Services Task Force (USPSTF). Chirwere chepabonde chekudzivirira vanakadzi vane makore makumi mana kusvika ku49 chinongova neC "rating" kubva kuU.S.STSTF, asi chimwe chikamu chakaitwa kuti chiiswe kune urongwa hwehupfumi hwehutano pasi pe ACA.
Kuwedzera kune mirayiridzo yeUSPSTF, CDC's Advisory Committee pamusoro pekudzivirira majekiseni (ACIP) inopa mazano ekugombedzera, uye Health Resources uye Services Administration (HRSA) inopa mamwe mazano ekudzivirira kuchengetedza vakadzi, vacheche, nevana.
Kubata pamuviri kwakavharwa pasi pekuchengetedzwa kwekuchengetedza, izvo zvinoreva kuti iripo pasina mari kune inshuwarisi. Asi hutano hwehutano inshuwarheni hunodiwa chete kuti huve nehuwandu humwe shanduko yemumwe weDAA-inogamuchirwa yemhando dzekudzivirira vanakadzi.
Emergency Services
Kunyange zvazvo inshuwarisi yehutano yevatengesi inogona kukonzera kuparidzirwa kune vakawanda mu-network providers, izvo hazvisi zvechokwadi kune zvinoitika kune dzimwe nguva.
Mushandi wako wehutano haagoni kuisa mari yepamusoro-kugoverana kwekubuda kwe-network yepamusoro yekuchengetedzwa kwekuchengetedzwa kwemukati, uye inofanira kukubvumira kuenda kune imwe nzvimbo yepamhanho yekukurumidza, kunyange kana isiri muurongwa hwepurogiramu yako.
Chirevo chekuti vehutano vehutano vanovhara kurapwa kwekukurumidza kunowedzerawo kune ambulance kutakura, kusanganisira air ambulance.
Zvakakosha kucherechedza, zvisinei, kuti kubhadharisa kubhadhara kunogona kuva nharo mumamiriro ezvinhu epamusoro apo kunze kwe-network makamuri ekukurumidzira uye / kana ambulance zvishandiswa zvinoshandiswa. Kunyange zvazvo ACA inoda kuti vatakuri vabate chirwere chisingaitiki mu-network mazinga kunyange kana chipatara kana kuti ambulensi aripo kunze kwe-network, izvo hazviregi chipatara, vanachiremba vanokurumidza, kana kambani yeku ambulensi kubva kubhadhara murwere nehana mushumo wavo, pamusoro pezvose zvakabhadharwa nekambani yehurumende yveshuwarenzi.
Dzimwe nyika dzakarambidzwa kubhadharisa kubhadhara mumamiriro ezvinhu anowedzera, uye mutemo wakafanana wakambofungidzirwa-asi husati wapfuura-ku federal level.
Hospitalization
Izvi zvinosanganisira huwandu hwakazara hwekuchengetwa kwepfungwa, kusanganisira kurapwa navanachiremba uye vanamukoti, inpatient labor and pharmacy services, uye nekuvhiya.
Mazano ekurapa
Basa rebasa rinowira pasi pehuwandu hwehutano hwekudzivirira hunorondedzerwa pamusoro apa hwakafukidzwa pasina kugovana-mari kune murwere.
Zvimwe basa rinokosha rebasa rinofukidzwa pasi peurongwa hwekugadzirisa-kugovera mazano.
Maternity neNewborn Care
Izvi zvinosanganisira kuberekwa, kutakura, uye kutarisirwa patsva, kunyange kutariswa kwepabonde kunowanikwa pasi pekuchengetedzwa kwekuchengetedza (kunotsanangurwa pamusoro apa) uye kunogona kuvharwa pasina kugovana-mari kune mukadzi anotarisira.
Maererano neH HRSA, kutarisirwa kwepabonde kunowira pasi peboka rekuchengetedza zvakanaka mukadzi. Uye kunyange muzviitiko zvakawanda izvo zvakavharwa kamwechete pagore, sangano rinotaura kuti pane dzimwe nguva "kushanyira kakawanda kunogona kudiwa kuti uwane zvose zvinodiwa zvekudzivirira mabasa."
Mukuwedzera kune vanozvitsvaga pachavo, pane zvimwe zviedzo zvakananga (zvegestational chirwere cheshuga, Hepatitis B, uye Rh Incompatibility) iyo inowanikwa kuvakadzi vane pamuviri pasi peboka rekuchengetedza, kusina kugovana-mari.
Kurapa kwepfungwa uye kushandisa zvinodhaka
Izvi zvinosanganisira chirwere chepfungwa uye kurapwa kwepfungwa kwehutano hwepfungwa uye kushandiswa kwezvinodhaka.
Maonero ehutano hwehutano hunotarisirwa mberi kweAACA, kunyange zvazvo ACA yakawedzera mutemo wekufananidza kushanda kumagadziro emakambani ega uye pamwe nekushandiswa kwebasa. Pasi pemudiwa wehutano, chirongwa chehutano hachigoni kuvhara zvikwereti zvekurapa kwehutano hwepfungwa pane zvazviri kune kurapwa / kurapwa.
Matambudziko emishonga, kusanganisira mazino uye maonero ekutarisira vana
Kusiyana nedzimwe EHBs, mazino emwana haafaniri kuiswa muhutano hwehutano huri munyika dzakawanda. Pane kudaro, kutengesa kunogona kungopa kupa-self pediatric meno zvirongwa zvekutengesa.
Kana kugoverana kunotengesa mahara-pediatric menyano zvirongwa uye mhuri inotenga chirongwa chehutano pamwe chete nehutano hwemadzinza ehutano hwakasiyana, chete mari yeurongwa hwehutano inotarirwa apo ruyamuro rwavo rwemari inotaridzirwa. Izvozvo zvinogona kuchinja, zvisinei, pasi pemutemo wakarongwa wakabudiswa neRS muna July 2016 . Pasi pemutemo unorongerwa, mari yekurapa mazino ehutachiwana ingadai yakabatanidzwa muhuwandu hwekubhadhara mazino, kunyange kana kuvhara mazino kunotengeswa kuburikidza nekutsinhanisa semutemo wakasiyana, kwete pane chikamu chakabatanidzwa chirongwa chehutano.
Hapana chidimbu chokuti zvirongwa zvehutano zvine mazino kana maonero kuvanhu vakuru.
Prescription drugs
Zvirongwa zveboka rimwe nerimwe uye zviduku zvinofanira kuvhara mishonga yemishonga, uye yavo inoshandiswa inofanira kunge inosanganisira kamwe chete mishonga muUnited States Pharmacopeia (USP) uye chikoro (kana zvimwe, kana chirongwa chekuenzanisa kwehurumende chinosanganisira zvakawanda).
Formularies inowanikwawo nehurukuro inobva ku pharmacy uye therapeutics (P & T) dzemakomiti, asi dzinogona kusiyanisa zvakasiyana kubva kune umwe wehutano wehutano kune imwe.
Pasi pemitemo yekuchengetedza inorondedzerwa pamusoro apa, hurongwa hwehutano hunofanira kuvhara-pasina mari kune inshuwarisi-kana imwechete yemhando yese yeAIDS inobvumirwa nekudzivirira pamuviri.
Kune mamwe madhiragi, zvirongwa zvekugovana-kugoverana kwemari zvinoshandiswa, uye zvirongwa zvinogona kutora danho remishonga (izvo zvinotarisirwa kuti inishuwarenzi inotanga nemishonga inoshandiswa uye inotyisa-ine ngozi kuti ione kana iri kushanda, tisati tamboedza mari inodhura, mishonga ine riskier) .
Vakawanda vehutano vehutano vakavhara mishonga mumatare, kubva kune imwe kusvika kune mana. Chimwe chirwere chemishonga chinodhura zvakaderera kunze kwehomwe, uye Machina madhiragi (kana anokosha madhiragi) ane mari yakakwirira kupfuura yose.
Mabasa ekugadzirisa uye anobatsira
Izvi zvinosanganisira zvose zvipatara uye zvigadziri zvinodiwa zvekugadzirisa uye kugadzirisa.
Mishandiro ekuvandudza anongotarisa kuburikidzazve kuwana mikana yakarashika, yakadai sehutano hwehutano kana hwepanyama mushure mengozi kana kurohwa.
Mabasa anobatsira anopa rubatsiro pakuwana unyanzvi pakutanga, zvakadai sekutaura kana kuti kurapwa kwemabasa kune mwana asiri kutaura kana kufamba maererano nezvinodiwa.
Zviyero pamusoro pechiverengero chekushanyirwa gore negore zvinoshanda (kunyange zvazvo zvirongwa zvisingakwanisi kuisa mhirizhonga yedhora kune EHBs, shanyira miganhu inobvumidzwa). Mune dzimwe nyika, muganhu unoshanda kune kusanganiswa kwehutano hwepanyama, basa remishonga, uye chirwere chekutaura, asi vamwe vane mitsara yakasiyana yemhando imwe yehutano.
> Sources:
> Nzvimbo yeVatengi Information uye Inishuwarenzi yekuongorora, Mental Health Parity uye Addiction Equity Act.
> Nharaunda dzeDaase Control uye Kudzivirira, Komiti Yemazano pamusoro Pemaitiro Okudzivirira (ACIP).
> Dhipatimendi reUnited Health reHuman Services, Human Resources and Services Administration.
> Dhipatimendi reUnited Health of Health and Human Services, Health Resources uye Services Administration, Women's Preventive Services Guidelines.
> US Preventive Services Task Force, USPSTF A uye B Mazano.