Will Medicaid Inoderedza Kurasikirwa Kurapa Zvimwe?
Opioid zvinodhaka ndeye dambudziko rinowedzera muUnited States. Kubva muna 1999 kusvika muna 2015, kana kubva pamishonga yemishonga kana kubva kune maoriiid asina kukodzera se heroin, vanopfuura hafu yemamiriyoni vakafa nehuputi hweopioid kudarika. ICenter for Medicare neMedicaid Services (CMS) inoshuma kuti vanhu 91 vanofa zuva roga roga kubva mukutswa kweopioid, vachiisa munzira yevanhu vakafa 32,400 muna 2017.
Medicaid inobatsira zvikuru mukurapa kunodhaka. Kune mumwe muvashanu veAmerica vanovimba neMedicaid nekuda kwekudiwa kwavo kweutano, chirongwa ichi chinopa hupi uye hurumende iyo inopfuurira kana sangano reRepublican rinobudirira mukudhinda Affordable Care Act , aka Obamacare here?
Kushandiswa kweApioid Is Everywhere
Kushandisa zvisina kufanira haiti kwete dambudziko rehurumende chete. Icho chinetso chenyika.
Kuwedzera kwekufa kwevakafa kwakasimuka kubva kumahombekombe kusvika kumahombekombe muna 2014. Ohio neCalifornia vakatambura zvikuru nemapfuuri anopfuura 2 000 opioid-akafanirwa mumwe nomumwe, nepo New York, Florida, Illinois, Texas, Massachusetts, Pennsylvania, neMichigan mumwe nomumwe aive nemakore anopfuura 1 000 vakafa kupfuura vamwe .
Kungofanana nekushandiswa kweipioid hakusi nzvimbo, Medicaid haigoni kune zvese. Medicaid, apo inyanzvi inotarisirwa nehurumende, inobhadharwa mari nehurumende yehurumende. Hurumende yehurumende inogadzirisa zvishoma zvishoma kuti ndiani akakodzera Medicaid uye chii chinokosha chinofanira kuiswa mune purogiramu.
IAmerican Health Care Act , iyo yakatumidzwa muUnited States House of Representatives, yakaronga kupedzisira kukuru kune chirongwa cheMedicaid. Mutemo uyu, unozonzi "Better Care Reconciliation Act," unotarisira kuvhota muSeneti yeUnited States asati asvika mutemo. Kana ikapfuura, mutemo unogona kuchinja zvakakosha zvakabatsiro zvehutano - kusanganisira hutano hwehutano nemishonga yekurapa - zvakabatwa nehutano hwehutano.
Icho chinosanganisira Medicaid.
Kurapa Opioid Dhiyabhorosi
Iko Inogadziriswa Care Act inoda kuti inotora chikamu mu Medicaid kuwedzerwa chivharo chekushandisa kushandisa kusagadziriswa kurapwa. Zvisinei, mutemo wakapa kuchinja uye wakabvumira hurumende imwe neimwe kuti isarudze hupi hupi hupi hwavanoda kubhadhara.
I-Better Care Reconciliation Act inogumisa Medicaid kuwedzera uye kumisa kurapwa kwakagadzirirwa kwekusvuta.
Iko kune maitiro mana akasiyana ekurapa kutora munyaya iyi:
- Outpatient services (kusanganisira boka remishonga, kurapa mumwe munhu, uye mabasa ekutsigirwa)
- Intensive outpatient services
- Yenguva-refu uye nguva refu yekugara inpatient services
- Intensive inpatient kutarisira detoxification
Chimwe chekuongorora mune zvehutano kwakaongorora hurumende yekutengesa kusvuta kubva muna 2015 kusvikira muna 2016. Zvinofadza kuti vatsvakurudzi vakaona kuti kupararira kwaisava kwakakwirira mumatunhu aiva neMedicaid kuwedzera .
Hurumende gumi nemitatu uye Dunhu reColumbia rakavhara mabasa ose, uye makumi maviri nemakumi maviri nemasere akafukidza humwe hutano pahupi hwehutano hwehutano. Nzvimbo gumi nhatu dzisina kupa Medicaid kuvhara kwekushandisa chero kupi zvako kwekushandisa zvinodhaka muviri kana kupfuura mazinga ekurapa.
Zvisinei, kupa zvibasa izvi hazvina kureva kuti zvakanga zviri nyore kuwana.
Inenge hafu yezvematongerwo enyika yaida rudzi rwebvumirano yekubvumidzwa kunonzi inotanga kubvumirwa vasati vazobhadhara nekuda kwekuchengetedzwa kwepachipatara. Nhamba yepfumbamwe inowedzera chikwata chekuti ingashandiswa zvakadini pamishonga yekurapa zvirongwa.
Kuchengetedza Kushandiswa Kwemaopioid Nemishonga
Mishonga inoshandiswa mukurapa maopioid zvinodhaka ndeye buprenorphine (zita rechigamu Suboxone), methadone, uye naltrexone (marita mazita Depade, Revia, uye Vivitrol). Mishonga imwe neimwe inosunga maopioid receptors muuropi kuti agadzirise mamiriro ayo:
- Buprenorphine: Buprenorphine inowanzove yakasarudzwa semuchirwere nokuti inogara kwenguva refu mumuviri. Izvo zvinodzivirira maitiro euphoric ayo opiates anowanzotanga, uye ane hafu yeupenyu kubva maawa 24 kusvika ku 42.
- Methadone: Methadone inonzi opiate inobatsira kuderedza zvido. Zvisinei, sevamwe opioid, inogona kukonzera kuvimba. Methadone inowanzoshandiswa sechirongwa chekuchengetedza uye inogona kurumurwa kudarika nguva. Hupenyu hwayo hupenyu hunosiyana, kubva pa8 kusvika maawa makumi mashanu.
- Naltrexone: Naltrexone inotarisirwa kuderedza chido che opioid uye mune dzimwe nguva inoshandiswa kupedza doro rinodhakwa. Ihafu-hupenyu ndeye maawa mana kusvika ku13.
IEalth Affairs yakaratidza kuti humwe hurumende neDunhu reColumbia rakaputika buprenorphine, uye makumi mana nemasere enyika dzakavharwa naltrexone. Nhamba ye methadone, zvisinei, yakanga isinganyanyi kuenderana. Zvinyorwa 32 chete zvinosanganisira kugoverwa kwemethadone mumapurogiramu avo eMedicaid.
Kufanana nekupa mazano nekurapa mahara, kubvumirwa kusati kwaitwa kwakaita basa mukurapa mishonga. Zvizhinji zvematongerwo enyika zvinoda kubvumirwa mberi kwebuprenorphine apo chetatu chavo chinoda copays.
Zvinoshungurudza paunofunga nezvazvo. Vanhu vanotsvaka rubatsiro rwekutsvaga maopioid vanorambidzwa kupinda nekukurumidza kurapwa kana vachichida zvikuru. Kurara kwekurapa ndicho chinhu chaicho chingaita kuti vadzoke zvakare.
Mari Inobatsira kuMedicaid
Kutarisira Medicaid kugadzirisa dambudziko renyika hakusi kwechokwadi, kwete kana mari yepurogiramu ichigurwa. Zvinosuruvarisa, ndizvo zvingaitika.
Kana Izvo Zviri nani Kuchengetedzwa Kwekuita Mutemo inova mutemo, Medicaid kuwedzerwa sezvatinoziva pasi peNotengeswa Care Care Act ichapera. Zvinotarisirwa kuisa kushandiswa kwekushandisa zvinodhaka sechikamu cherongwa hweMedicaid chichabvawo.
Kunyange inotaura kuti haina kubatanidzwa mukuwedzera kweMedicaid yaizobatwa. Izvi ndezvokuti mari yezvemitambo yeMedicaid zvirongwa zvakare. Panzvimbo yehurumende yehurumende inofananidzwa nehurumende imwe neimwe inoshandisa dhora rebhadha, I-Better Care Reconciliation Act inogona kugadzirisa hurumende kune imwe neimwe mari yekubhadhara . Izvi zvinoreva kuti, hurumende imwe neimwe inogona kugamuchira dhora rakasimbiswa kubva kuhurumende zvichienderana nehuwandu hwevanhu paMedicaid muhurumende iyoyo.
Maererano neC Congressional Budget Office, kuchinja uku kwekubhadhara kunogona kuderedza $ 772 mabhiriyoni kubva kuMedicaid muna 2026.
Izvi zvichaisa mutoro unorema kune vehurumende kuti vawane dzimwe nzira dzekubhadhara kana huri hwavo huri hupfumi hwematongerwo enyika huripo hushoma. Zvinotarisirwa kuti hurumende dzakawanda dzichadikanwa kuderedza maMedicaid services kuitira kuti varambe vachifamba. Zvinosuruvarisa, hutano hwehutano uye hutachiona hwehutano hunogona kuva wekutanga kuenda.
Shoko kubva
Hapana mubvunzo kuti I-Better Care Reconciliation Act inogona kuderedza kuwanikwa kwehutano hwepfungwa. Hazvina mhosva kana uri paMedicaid, chirongwa chehutano hwepachipiri, kana mushandirwi-wakatsigirwa inshuwarisi. Kuchinja mune izvo zvirongwa izvi zvinofanira kuvhara, kureva, kuchinja mune zvinodiwa zvehutano hunokosha, kuchaita kuti hupi hupi hupi hupi huchawana uye huchaita kuti zvive zvakaoma kune avo vari kurwisana nemishonga yekuwana rubatsiro rwavanoda.
> Sources:
> Grogam CM, Andrews C, Abraham A, et al. Survey Highlights Kusiyanisa MuMedicaid Coverage For Substance Use Treatment And Opioid Use Disorder Medication. Health Aff. December 2016. 35 (12): 2289-2296. doi: 10.1377 / hlthaff.2016.0623
> HR 1628 . US Senate Office. https://www.budget.senate.gov/imo/media/doc/SENATEHEALTHCARE.pdf. Yakabudiswa naJune 22, 2017.
> HR 1628, Mutemo weChechi Care Reconciliation wa 2017. Congressional Budget Office. https://www.cbo.gov/publication/52849. Yakabudiswa naJune 26, 2017.
> Kukuvadza Kudzivirira & Kudzora: Opioid Overdose - Kunzwisisa Dambudziko. Nzvimbo dzeDaase Control and Prevention website. https://www.cdc.gov/drugoverdose/epidemic/index.html. Yakaperedzwa June 21, 2016.
> Rodriguez CH. Medicaid Coverage For Addiction Treatment Inoshandiswa zvinoshamisa. Kaiser Health News website. http://khn.org/news/medicaid-coverage-for-addiction-treatment-varies-dramatically/. Yakabudiswa musi waDecember 6, 2016.