Vatsigiri vakaisa mitambo yakasungirirwa semari yekuchengetedza mari
Vakawanda vedu isu tinoshandiswa pakufunga kuti hurongwa hwehutano hwehutano hwehutano hwakapa mitero. Inishuwarenzi dzinotarisana dzinobvumirana nezvibvumirano nevamwe vanachiremba uye zvipatara kuti vape mutengi wevanopa mazano, uye vanobata mitemo vanowanzofanira kugamuchira kutarirwa kubva kune-network network (zvirongwa zvevanhu zvakadai seMedicaid uye Medicare vanewo vatapi vechikamu; vazhinji vanoita basa vanobatana neMedare, uye zvisinei vazhinji vanobvuma Medicaid, vazhinji vechiremba vanotora Medicaid).
PPOs kazhinji inobvumira varwere kuti vaone vashandi vari kunze kwekambani, asi huwandu hwepamusoro pehomwe hunogona kuva hwakareba kudarika mitemo yakatarwa mu-network. PPOs inowedzera kaviri yekunze kwekunze kwekuchengetwa kwakagadzirirwa kunze kwenhare, kunyange zvazvo iri kuve yakanyanya kufanana nePPOs kuti ive nemagumisiro asingagoneki-e-pocket for out-of-network care (kureva, kana uchienda panze network , pangave pasina chikwata chekuti iwe unofanira kubhadhara chikamu cheiyo mari).
HMO uye EPOs zvinowanzodikanwa kuti varwere vashandise mu-network network providers uye havafukidze kunze-kwe-network kuchengetedza zvachose, kunze kwekuti iri dambudziko.
Tiered Networks
Mataredhi akabatanidzwa akachengetedzwa munyika yose muna 2015, apo Blue Blue Cross Blue Shield yakagadziriswa mumatare omnia Omnia anoronga muNew Jersey. MuItaly, Nyika yeLincoln Health (iyo ACA-yakagadzirwa CO-OP) inoshandisa mitambo yakasungirirwa, uye inowanikwa mumakambani ega uye yeboka mune dzimwe nzvimbo dzakawanda.
Chaizvoizvo, mitambo yakasungirirwa inobvumira inishuwarenzi yehutano yehutano kuchengetedza hutano hwavo hukuru hukuru, nekugadzirisa zvakakwana nhengo dzakawanda kumusangano muduku kuduku-asi kusarudzwa kuri kumunhu.
Neine mambure akabatanidzwa, nhengo dzinobhadhara mari shoma shoma kunze kwekuona mupiro mumutambo wepamusoro.
Vane rusununguko kuti vaone vatsigiri mucheteresi pasi, asi ivo vachabhadhara mari yakawanda kunze kweiyo kana vachiita.
IAACA inogumira pamari yekuti-ye-pocket inoshandiswa kana murwere achisarudza kuona mupiro ari mumutambo asi kwete muchengeti wepamusoro. Chero bedzi mubatsiri ari muurongwa hwehutano, mari yemurwere yezvinodiwa zvehutano hunokosha mukati megore haipfuuri muganhu wakaiswa neAACA (yegore ra2016, iyo $ 6 850 kune mumwe chete, uye $ 13,700 yemhuri, muna 2017 , yakawedzera kusvika $ 7150 kune munhu mumwe chete uye $ 14,300 yemhuri ).
Uye urongwa hunoita kuti hurumende yepamusoro yehutano iwane humwe hutachiona hwepamusoro hwevashandi (heino muenzaniso kubva kuLau Blue Blue Cross Blue Shield muNew Jersey - pasinei nokuti varwere vanoshandisa mumwe kana vatatu vanogovera, Gore rega rega re-pe-pocket rinenge rakafanana).
Asi varwere vanosarudza vatungamiri ve-top-tier vachabhadhara mari shoma mune zve-in-pocket mari nguva dzose kuchengetwa kunogamuchirwa (somuenzaniso, $ 15 copay kuona chiremba pane $ 30, kana copay kuona chiremba pane kuripa iyo deductible uye coinsurance, kana kwete deductible panzvimbo ye $ 2,500 inotsvaga). Kune varwere vasina kugumisa kusangana kwepurogiramu iri kunze kwehomwe yepamusoro mukati megore, kune chikonzero chakakosha chekushandisa vanachiremba uye zvipatara muchengeti wepamusoro wehutano.
Tiered Networks Haisi Idzva
Nhare dzehutano haisi itsva - dzinotangira ACA uye dzakagara dziri imwe yenzira dzehutano hwehutano dzinoshandisa kurwisana nekukwira mari. Chirongwa cheBBCBS cha Omnia chirongwa muNew Jersey chinoda mari inodarika 15% kudarika inofanana neIndaneti zvirongwa muna 2015 izvo zvisingashandisi mitambo. Hazvishamisi kuti mapurogiramu akaderera pamagetsi emagetsi anowedzera kune vanotengesa nevashandi.
Kusarudza Zvimwe
Vatsigiri vezvehutano vanogona kushandisa zvinyorwa zvematriki kuti vaone kuti vanachiremba uye zvipatara zvinopedzisira kupi. Kazhinji, hutsika uye mari inoshandiswa zviyero zvinoshandiswa, kunyange zvazvo vatungamiri vepamusoro-soro vanobvumiranawo kubvuma mitengo yepamusoro yekubhadhara kubva kune vehutano hwehutano, mune zvekutengeswa kwekuti ivo vanenge vachinyatsogamuchira murwere wepamusoro wevarwere semupiriri wepamusoro.
Asi panogona kuva nharo kana zvisingazivikanwi kuti vatakuri vematriki vanoshandisa sei kuziva kuti vanachiremba uye zvipatara zvichaguma sei mukuchiva kwepamusoro. MuNew Jersey, vateereri vezvemitemo vakapindira, uye mitezo yakawanda yemitemo yakagadziriswa kugadzirisa hutano hwakasununguka uye kujeka maererano nezvokuti vashandi vanogoverwa sei kune mumwe. Hafu yezvipatara zvehurumende yakaguma muzvikamu zviviri (kureva, iyo yaisati yakasarudzwa) pasi peO Horizon BCBS's Omnia network design, uye zvinonzwisisika haifariri nezvazvo.
Vadzidzisi vemitemo uye vatsigiri vevatengi vanonetsekawo kuti zvipatara mune vamwe vasingasaruri vanogona kukanganisa kutambura kwemari pamusana pekuderedza chirwere chevarwere (sezvo varwere vachisarudza zvipatara chimwe chete kuitira kuti vashandise mari shoma iri kunze) , uye izvozvo zvinogonawo kuvhiringidza vatengi vanogara pedyo nezvipatara zviviri izvi - kunyanya apo zvipatara zviri mubvunzo zviri "zvipatara" zvipatara izvo zvinowanzoona huwandu hwevarwere vashoma uye vasina kuvimbiswa.