Iyo yakatanga sei uye zvinhu zvakagadzirisa ivo
Nzvimbo dzekuchengetedza dzinokurumidza kushandiswa kuva munharaunda imwechete sehofisi yechiremba. Kana iwe ukaona chirango chinokurumidza kukurumidza (chinowanzonzi chirongwa chekuchengetedza zvinokurumidza) mumakore makumi manomwe, zvichida pane imwe nzvimbo yehofisi iyo madhigirii nevarume vemazino vaiva. Uye vazhinji vavo vaiva nechipatara.
Chirongwa chekuchengetedzwa kwekukurumidzira mumazuva iwayo kutarisirwa kuti yakanga isingakurumidzi nekuda kwekuoma kwemamiriro ekurapa kwemurwere.
Vaiita nekukurumidzira (kureva pasina kusarudzwa) kuitira kuti murwere ave nyore.
Izvozvo makiriniki kana nzvimbo dzokuchengetedza dzakanga dzisina kunaka. Pfungwa yose yakanga iri itsva. Yakanga isiri iyo mushure mekutsva kwemireniyamu kuti masangano ekuchengetedza akakurumidza akatanga kutowedzera mabasa avo kuti aise kukwanisa kubata mamwe mamiriro ekurapa akaoma.
Mazuva ekare
Pakutanga, pfungwa yacho yaingova yekuti varwere vaisazofanira kuita musangano kuti vaone doc. Vangokwanisa kungopinda mazviri. Varwere panguva iyoyo vaingova nemasarudzo maviri: ita musangano nechiremba wavo wega kana kuenda kuE ER . Makambani eInishuwarenzi aishungurudzwa nevarwere nokuti havana kugadza. Vakangoenda kune ER. Zvichida ndizvo izvo vatsigiri vanofunga-uye vachiri kufunga kudaro.
Dhiyabhorosi yedhipatimendi rinoshanyira kare kare kupfuura 2000 yakaoma zvikuru kuwana. Chinhu chimwe chechokwadi ndechekuti vashandi havadi kubhadhara mari yakawedzera yekushanyirwa kwehurumende muma 1970 uye havaifariri zvakare nhasi.
Kushanyira ER kunogona kutenga mari yakawanda kanomwe katatu mushure mekushanyira hofisi yechiremba. Nzvimbo dzekuchengetedza dzinokurumidza dziri pakati nepakati.
Hapana Anoronga Kurwara
Varwere havana kumbobvira vakanyatsonaka mukugadza. Kukuvara uye zvirwere zvine tsika yekuuya nokukurumidza uye inoda kurapwa nokukurumidza pasinei nokuti iri shure kwegumi nemusi weMugovera usiku.
Emergency departments havana kuda kuona varwere kunze kwekuti vainge vari pamusuo wekufa uye mahofisi echipatara vanofara kupindura foni musi weMuvhuro mangwanani kuti vagadzire musangano weChishanu masikati.
Nzvimbo dzokutanga dzekuchengetedza dzinokurumidza dzakabva munzvimbo mbiri: kana vanachiremba vari voga vakanga vachiedza kuchinja kune varwere vavo nekuwedzera maawa manheru uye vhiki dzevhiki, kana ER madzodzi vaiedza kutsvaga nzira dzekupa kutarisira kune vanowedzera vasati vakura varwere vakanga vari kutendeukira kune dhipatimendi rekukurumidzira. Iyi nzvimbo mbiri dzakasika zvirongwa zviviri zvakasiyana kwazvo.
Basa reInishuwarenzi
Sevamwe vega, kazhinji vashandi-vakapiwa, inshuwarisi yezvehutano yakava yakajairika, ER inoshanya yakawedzera pakati pevaya vane ruzivo rwakakwana nokuti mari yekuenda kwachiremba (mushure mekunge vakamirira kusangana) yaive yakafanana nekufamba muE ER nekuonekwa kamwe . Vashandi vasina kuvimbiswa vakaenda kune dhipatimendi rekukurumidzira kunze kwekudikanwa. IEE ndiyo nzvimbo bedzi apo murwere aigona kuonekwa nekuda kwehupenyu hwake hunotyisa (kana kuonekwa kutyisidzira hupenyu) hurumende pasinei nekukwanisa kubhadhara. Zvipatara zvaidiwa kuongorora varwere uye kupa rubatsiro rwekukurumidzira kana zvichidiwa.
Ichi chaiva kutanga kwekusaenzana munharaunda yekubhadhara.
Vaya vane inshuwarisi vaiwanzokanganisa musero wese nokuti inshuwarisi, pane murwere, yakanga iri kutora tab. Varwere vasina kuvimbiswa, kune rumwe rutivi, kazhinji vakanga vasingakwanisi kubhadhara. IE ER yakanga ichiri kuzovabata, asi vakagadzira kusununguka kwemashure pamashure evanotengesa inshuwarisi vatengesi.
Zvitano zvehutano zvakatanga kuwedzera zvakanyanya. Zvipatara zvaifanira kubhadhara kuchengeta vanachiremba navanachiremba muchipatara chakakomba awa, sezvo chikamu chevarwere varwere chakanga chiri kusununguka kana kuti chakanga chakasununguka kutarisirwa. Izvi zvisati zvaitika, mari yekurapa yaive yakangofanana kune vose, asi iye zvino avo vanogona kubhadhara vaibatsira avo vasingagoni.
Vanishuwarenzi vakanzwa chirwere. Vakagadzira mari yekukurudzira varwere kure nedhipatimendi rekukurumidza kunze kwekuti vaida chaizvo kuchengetedzwa kwekukurumidza.
The Carrot, the Stick, uye Crystal Ball
Vashandi vehutachiona havana kuda kumirira uye vakanga vasina nguva dzose yekugadza. Kufuridzira varwere kuronga zviri nani, vatsigiri vekuisa slide vanoita kuti vashandise kubhadharwa. Varwere vakabhadhara chikamu chiduku chinotengesa apo ER yakashanyira kugumuchirwa kuchipatara. Zvaifungidzirwa kuti kushanyira kunofanira kunge kwave kwakarurama kana chiremba akachengeta murwere usiku hwose.
Varwere, zvisinei, vakamanikidzwa kuziva ruzivo rwavo vasati vaenda kune dhipatimendi rekukurumidzira. Kana vasina kunge vane dambudziko, vaizobhadhara zvakawanda muhomwe. Paiva nechikonzero chekuenda kuhofisi yechiremba panzvimbo yechipatara kunze kwekuti murwere aive nechokwadi chekuti aizofa.
Asi varwere vakanga vasina kuronga zvakanaka. Vaida kuve nyore kwekufamba-mubasa. Vanachiremba vari voga vakapindura nehofisi maawa manheru uye neMugovera. Vakabuda kunze kwepaki dzepahofisi yezvokurapa uye kupinda mune zvivako. Munguva pfupi, vabereki vanogona kutora Junior kuti aone Santa uye aora muromo wake akatarisa rwendo rumwe chete. Aya makliniki matsva ehutachiona aive nemazita emarudzi ose, asi "kuchengetedzwa nokukurumidza" kwakanamatira. Chakanga chine chindori icho varwere vaifarira.
Zvose Zvokutarisira Hazvisiki Zvakaenzana
Kusiyana pakati pezvinotarisirwa nedhipatimendi uye masangano ekuchengetedza zvinokosha zvakange zviri zviviri mari uye mubasa rakapiwa. Nzvimbo dzekuchengetedza dzinokurumidza kazhinji dzakanga dzisina chimwe chinhu chinopa kupa kune hofisi yechiremba. Emergency departments, kune rumwe rutivi, ndiyo yaiva gedhi rekuchengetedza utano hwehupenyu hunoponesa. IE ER inogona kubata chero chinhu.
Zvino sezvo varwere vechipupuriro vakanga vachienda kunzvimbo dzinochengetedzwa dzinokurumidza mumawanda makuru, rutivi rukuru rwevarwere vasina kuvimbiswa vakasara kuti vabate pane dhipatimendi rekukurumidzira. Mari yehutano yakaramba ichingomuka sezvo zvipatara zvakaedza kuchengetedza pamwe nehuwandu hwevarwere vasina kusimbiswa. Vatsigiri vanoita balked uye munhu wose akapa mhosva varwere vasina uninsured. Vakanga vari nyore kutarirwa, kazhinji vachidzoka kuE ER kakawanda nokuda kwekutarisirwa kumwe. Kuita kuti zvinhu zviwedzere kuipa, varwere vasina kuvimbiswa vanowanzove nezvinetso zvezvehutano izvo zvisingagamuchirwe nevanhu, zvakadai sehutano hwehutano kana kusagadzikana.
Mamwe Inishuwarenzi-Ichashanda Here?
The push to get more insured insured was seen as a panacea. Kana ava varwere vasina kuvimbiswa vangave nekuwana zviri nani kuhutano hwehutano-kana kuti fungiro yakaenda-ivo vaizochechera nechiremba wega pane nzvimbo yekushanyira ER.
Maiwe, zvaisazova. Chiratidzo chekutanga chakauya muOregon. Kuwedzerwa kweMedicaid muna 2008 kwakaita kuti mukana wakakwana wokuona kana mamwe inshuwarisi aizotungamirira kune varwere kuenda kuchiremba pane ER. Pane kudaro, varwere vakaenda kune dhipatimendi rekukurumidzira kunyanya. Pane imwechete iyo Inotengeswa Care Care Act yakazara yakazununguka, zvakafanana zvakaitika kune dzimwe nyika.
Kunyange Zvimwe Zvimwe
Nzvimbo dzekuchengetedza dzichikurumidzirwa dzakaparidzwa pamwe chete nehutano hwehutano inshuwarheni, asi ndizvo zvakaitwa nhepfenyuro yepamusoro. Freestanding makamuri ekukurumidzira anowanikwa mune dzakawanda dzinosvika makumi matatu nematatu. Aya ndiwo muchinjikwa pakati pekuchengetedzwa kwekukurumidzira uye ER. Vane mabasa ehurumende inoshamwaridzana, asi, sechirongwa chekuchengetedza kwekukurumidzira, haisi nguva dzose yakabatanidzwa kana kuwirirana nechipatara uye inoda kushandisa ambulensi kuti vawane varwere kuti vakwanise kutarisira.
Nzira yakanakisisa yepamusoro yekuchengetedza kwekukurumidzira (mune maonero angu) yakabva mukati mebazi rekukurumidzira. Murwere anofamba mumusuo uye anoona mukoti, uyo anoongorora kunyunyuta uye anotumira murwere kune imwe yenzira mbiri: ER kana kliniki.
Kusununguka kunzvimbo dzekukurumidzira uye nzvimbo dzinochengetedzwa dzinokurumidza dzinogona kunge dziri pano. Kunze kwekuti utano hwehutano hwakasimudzira isu mune imwe nzira, kushayikwa kwechirongwa chechiremba chiremba uye zviitiko zvezvemari zvehutano zvinorayira mufananidzo kunze kwehupfumi hurumende kana hofisi yechiremba. Healthcare iri kuchinja nokukurumidza. Zvakaoma kufungidzira kwatiri kuenda, zvimwe kunze kwekuwedzera, kwete kuE ER.
> Sources:
> (2017). Cdc.gov . https://www.cdc.gov/nchs/data/ahcd/NHAMCS_2011_ed_factsheet.pdf
> O'Malley JP, O'Keeffe-Rosetti M, Lowe RA, Angier H, Goro R, Marino M, Hatch B, Hoopes M, Bailey SR, Heintzman J, Gallia C, DeVoe JE. Utano Hushandiswa Kushandiswa Kwemari Shure kweOregon's 2008 Medicaid Kuwedzerwa: Mukati-Boka uye Pakati-Kusiyana kweboka Mukati Pakati Pakati Patsva, Kudzoka, uye Ramba Richiendeswa Kuchengetedzwa. Med Care . 2016 Nov; 54 (11): 984-991.
> Iwe wakafunga kuti yakanga iri kukurumidza kuchengetedza nzvimbo, kusvikira wagamuchira bhiri. (2017). NBC News . https://www.nbcnews.com/health/health-care/you-thought-it-was-urgent-care-center-until-you-got-n750906