340% inoshandiswa nevachiremba veEER vanokwana 110% vachigadziriswa nevasati vari ER ER internists
Bhuku raMay 2017 rakabudiswa muJAMA Internal Medicine rinoratidza kuti mitengo yakakwirira inowanzoonekwa mumatare eAmerica anomhanyisa-akawanda anokanganisa varombo, vashoma varwere.
Kakawanda, mazano anopiwa nevarapi venguva yakajeka vanachiremba vakaratidzirwa ne 340 muzana vachienzaniswa ne 110 muzana yemari yebasa rakapiwa nevashandi kunze kwemukana wekutsvaga.
Overview
Mitengo inokwidzwa kumaseji akafanana anosiyana zvikuru kubva kune dhipatimendi rekukurumidzira kuenda kune dhipatimendi rinokurumidza. Uyezve, nguva dzose inodhura kuwana kurapwa kwemamiriro ezvinhu mune dhipatimendi rekukurumidzira kunze kwekugamuchira kurapwa mune hofisi yechiremba kana nzvimbo yekuchengetedza nokukurumidza.
Vanhu vazhinji vanogamuchira zvikwereti zvakanyanya kubva muzvipatara ndevaya vanogona kukwanisa kuzvipa: vashomanana vasina inshuwarisi. Zvikwereti zvepamusoro zvekurapa zvinogona kutungamirira kune kuderera kunowedzera uye ndiyo inotungamirira chikonzero nei vanhu vachizivisa bankruptcy.
Kutya pamusoro pekuwanda kwezvipatara zvinopawo kuodza mwoyo vanhu kuti vatsvake rubatsiro rwakakodzera. Vanhu ava vanopedzisa pakupedzisira vachipa dhipatimendi rekukurumidzira nemamiriro ekutsvaira kwete kungotora huwandu hwehupenyu hwehupenyu asiwo hunoguma huchidhura zvimwe.
Iko Mari Inoshandiswa
Zvipatara zvinoshandisa goroja, izvo zvinongororwa zvebasa uye zvekubhadhara, kubatanidza mutero wevarwere. Zvisinei, mutengo wechokwadi wehutano hunosiyana zvichienderana nerudzi rwehushuwarisi iyo murwere ane uye yehutano hwehutano.
Varwere vari mu-network uye avo vanoita bhizimisi vanowanzobhadhara zvishoma; asi, varwere avo vari kunze kwe-network uye vasina inshuwalisi vanobhadhara zvipatara zvizere, izvo zvinogona kuva nezvizhinji zveMedare inopa mari. Zvipatara zvinodhura zvikuru zvinogona kukweretesa zvinodarika mazana 900 kubva kuzana kune izvo Medicare inowedzera.
Kuongorora ER Pricing
Muchidzidzo ichi-kuongorora, vatsvakurudzi vakaongorora zvinyorwa zvekubhadhara kubva kuna 12 337 vanachiremba vanokurumidza vanachiremba vanoita mune zvipatara zvinenge 2,707 muUnited States yose. Saizvozvowo, vakaongorora zvinyorwa zve 57 577 mishonga yemukati madakitiri vanoita zvipatara 3 669.
Kushandisa idzi marekodhi, vatsvakurudzi vakaverenga "huwandu hwemhosva dzinodhura uchishandiswa kuenzanisa, iyo inoyera yezvikwereti zvinotengeswa kuMurengeti we Medicare unobvumirwa." Ne Medicare inobvumirwa kuti ive "muwandu weiyo Mishonga inobhadhara, iyo inokonzerwa nemari inobhadharwa mari yakawanda iyo iyo inobhadhara mubhadharo inobhadhara kubhadhara, uye chero chikamu icho chechitatu chinotarisirwa kubhadhara. "
Uyezve, vatsvakurudzi vakagadzirisa zvinhu zvinotevera kune rimwe dhipatimendi rekukurumidzira :
- Size
- Nzvimbo
- For-profit status
- Kudzidzisa chimiro
- Musha wekumaguta kana kumaruwa
- Kuchengetedza-chipatara chipatara
Kubva pane ruzivo rwakapiwa neUnited States Census vatsvakurudzi vakafungidzirawo zvinotevera:
- Urombo huwandu
- Uninsureded status
- Minority populations
Kufumura Mutengo Wekusiyana
Apo maitiro akafanana akaitwa nechiremba wekukurumidzira kana mushandi wepamusoro, kuwedzera kwaive kwakakwirira zvakanyanya nokuda kwebasa rakapiwa nechiremba chiremba chinokurumidzira.
Semuenzaniso, mutero wepakati pemutambo we electrocardiogram waiva $ 95 apo wakadudzirwa nechiremba chiitiko chekukurumidzira; asi, kuverengerwa nomunhu anodzidzira mari kunodhura madhora 62.
Maererano nevatsvakurudzi:
Mukufungisisa mabasa ese ED, kune zviyero zvemadhora 100 muM Medicare zvisingabvumirwi, zvipatara zvakasiyana-siyana zvakapa varwere pakati pe $ 100 (marginal ratio, 1.0) uye $ 12,600 (markup ratio, 12,6), ine mamiririri e $ 420 (markup ratio, 4.2); Kusiyana neizvi, chipatara chemukati chechipatara chemishonga chinodhaka chaive chaive $ 200 (markup ratio, 2.0).
Heano zvimwe zvimwe zvakanyatsotsvaga zvakawanikwa kubva pakudzidza:
- Emergency physicians vakapedzisira vachibhadhara $ 4 bhiriyoni, inenge madhora 3,1 mabhiriyoni kupfuura Medicare inokwanisika.
- Kuwedzera kwaive kwakakura pakugunun'una kwezvinyorwa (kureva, kusvurwa kwevanga).
- CT kuongorora kwemusoro kwaiva nekusiyana kukuru kwemutengo pakati pezvipatara zvakaongororwa. Mune mamwe mazwi, CT inotarisa yemusoro yakarongeka zvikuru mumutengo.
- Emergency dhipatimendi iyo yaipomerwa zvikuru ndiyo yaiva chikamu chezvipatara zvebasa uye iri muMidwest uye kumaodzanyemba kwakadziva kumabvazuva kweUnited States. Aya mapurisa ekukurumidzira akashanda nhamba dzakawanda dzevanhu vasina kufambiswa veInpanishe uye veAfrica vanhu veAfrica.
Shoko Rinobva
Kana munhu achibatwa mune dhipatimendi rekukurumidzira, kazhinji ane chisarudzo chiduku, ivo vanoteererwa kune vagaries yemutengo. Maererano nevanyori, "Zvino, kupfuura kare kose, kuchengetedza vasina kuvimbiswa uye kunze kwe-network vanorwara kubva kune zvipatara zvakasiyana-siyana zvechipatara vanofanira kuva chirevo chekutanga."
Migumisiro yenyaya ino inokurudzira kukosha kwekujekesa muchipatara kubhadhara. Vanotsigirawo kudikanwa kwehurumende uye vezvematongerwo enyika kuti vadzivirire varwere vanorwiswa mutengo.
> Sources:
> Medline. Electrocardiogram.
> Medline. Nenguva yekushandisa imba yekukurumidzira.
> Xu, T, et al. Kusiyana muEmergency Department vs Internal Medicine Mutengo Wakawandisa muUnited States. JAMA Internal Medicine. 2017.