Ana ci gaba da bayyana tsarin kiwon lafiya a cikin Amurka ta hanyar gazawar tsarin da yawa, duk da gyare-gyaren da aka yi alkawarin inganta Dokar Kulawa mai araha. Kore ta hanyar cin riba na kamfanoni a kashe marasa lafiya da wahala, tsarin duk da yawan albarkatunsa ba ya aiki sosai. Wannan ba kawai hyperbole ba ne. A matsayin Harvard 2018 binciken A ƙarshe, tsarin kiwon lafiyar Amurka yana kashe kusan ninki biyu akan kula da lafiya fiye da sauran ƙasashe masu samun kuɗi, amma yana ba da ƙarancin samun kulawa da ƙarancin sakamako.
Sa'an nan kuma, idan kun kasance "shugaba" masana'antar kiwon lafiya mai gata, komai yana da kyau. Bisa lafazin business Insider, Babban mai inshorar lafiya na Amurka, UnitedHealthGroup, wanda kuma ke gudanar da asibitoci da sauran shirye-shiryen kiwon lafiya, ya biya shugaban kamfanin $18,107,356 a bara. Shugaba na Molina Healthcare ya sami diyya da ya kai $15,219,770. Anthem, mai siyar da inshorar Blue Cross Blue Shield, ya biya shugaban kamfanin $14,184,276 a matsayin diyya. Kuma haka abin yake.
Idan duk wani babban jami'in kula da kiwon lafiya da gaske yana da lamiri, za su iya manta da ƙarancin albashinsu don yin bayani a madadin daidaiton kula da lafiya da adalci ga miliyoyin waɗanda ba za su iya biyan kuɗin kulawa ba. Ko watakila za su iya zuba miliyoyin dalolinsu a cikin asusun GoFundMe na iyalai da ke Amurka da suka fi fama da matsananciyar wahala, suna tara kuɗi don danginsu marasa lafiya ko suka ji rauni?
Bayanin nuni tare da waɗannan layin na iya aƙalla nuna cewa sun yi imani da tallan tallace-tallace na kansu game da biyan bukatun abokan cinikinsu. Za su iya samun mafi ƙarancin albashin adadi shida? Abin takaici, a ƙarƙashin tsarin yanzu yana da wuya mu taɓa sani. Mafi girman arzikin shugabannin masana'antar kiwon lafiya yana yiwuwa ta hanyar ƙima mai tsada, kuɗin kwastomomi, inshorar haɗin gwiwa, da babban abin cirewa Amurkawa ana tilastawa Amurkawa biyan kuɗin da suka wuce kima, samfuran inshora na ƙasa.
Kalubale ga Matsayin Masana'antu Quo
Idan akwai kiba ga wannan mummunan gaskiyar, za a same shi a cikin tallafin jama'a ga mai biyan kuɗi ɗaya, ko Medicare ga Duk, tsarin kiwon lafiya. A gaskiya ma, wani zaben Reuters na 2018 ya samo 70 kashi na Amurkawa suna goyan bayan tsarin gwamnati na Medicare ga Duk tsarin. A cewar hukumar Gidauniyar Kaiser (KFF), tallafi ga mai biyan kuɗi ɗaya yana haɓaka sannu a hankali kusan kusan shekaru ashirin. Yayin da sakamakon zaben zai bambanta-KFF ta ba da rahoton mafi rinjaye kashi 56 na jama'a a yanzu don goyon bayan irin waɗannan shawarwari-mai biyan kuɗi ɗaya ya ci gaba da kasancewa sananne ga yawancin Amurkawa.
Hakanan akwai gogayya don Medicare ga Duk a cikin Majalisa. Tare da wasu kudurorin sake fasalin tsarin kiwon lafiyar jama'a a yanzu a gaban Majalisa, mafi nisa shine cikakkun kuɗaɗen masu biyan kuɗi guda ɗaya wanda Sen. Bernie Sanders (I-VT) da Rep. Pramila Jayapal (D-WA) suka ɗauka. Kudirin Majalisar na ƙarshe yanzu yana da masu tallafawa 108. Shaida ce ga yunƙurin tattara mai biyan kuɗi ɗaya cewa masu cin riba na matsayin kiwon lafiya yanzu suna shirya don bata sunan Medicare ga Duk. Kamar yadda New York Times da kuma sauran kafofin watsa labaru, da aka ruwaito a farkon wannan shekarar, ƙungiyoyin masana'antu irin su Ƙungiyar Asibitocin Amurka, Tsare-tsaren Inshorar Lafiya na Amurka, Binciken Magunguna da Masana'antun Amurka da sauran masu fafutuka na haɗin gwiwa don gudanar da yaƙin neman zaɓe na jama'a a kan duk wani shiri na doka mai biyan kuɗi ɗaya.
Shigar da Abokin Hulɗa don Makomar Kula da Lafiyar Amurka. A karkashin jagorancin babban darektan, Lauren Crawford Shaver, tsohon mai ba da shawara ga yakin neman zaben Hillary Clinton na 2016, yakin basasa na kungiyar na neman tsoratar da jama'a cewa za su biya karin kudi karkashin Medicare ga kowa fiye da yadda suke. A mayar da su suna ba da tabbaci mara kyau cewa yawancin Amurkawa sun riga sun sami kulawar lafiya mai araha, kuma duk matsalolin da ke akwai ba wani abu bane ƴan tweaks ga tsarin riba da ake da shi ba zai iya gyarawa.
Yana da wuya a ɗauki irin wannan farfagandar da mahimmanci. Kamar yadda kungiyoyi kamar Likitoci don Shirin Lafiya na Ƙasa (PNHP) sun dade suna jayayya, kawar da duk wani kari na daidaikun mutane, kwastomomi, da kuma haɗin kai a ƙarƙashin tsarin mai biyan kuɗi guda ɗaya zai inganta samun dama da araha ga ɗimbin yawancin Amurkawa. Lallai, kwanan nan nazarin RAND a jihar New York an gano cewa dokar mai biyan kuɗi ɗaya za ta rage farashin kiwon lafiya ga yawancin mutane, tare da mutane kawai suna samun sama da dala $134,000 (ko dangin mutane huɗu suna samun $276,000) suna biyan fiye da halin yanzu.
Ko da an haɗa harajin kuɗin shiga mafi girma da Medicare ga Duk, Amurkawa za su ci gaba da samun ƙarin don dalar lafiyar su. Amma za a iya ƙalubalantar hasashen cewa ƙarin haraji kan Amurkawa masu aiki zai zama dole. Bayan haka, wannan ita ce ƙasar da ke da hamshakan attajirai da kamfanoni mafi arziki a duniya. Tabbas sabbin haraji akan kashi 1 cikin ɗari da dukiyar kamfanoni kaɗai na iya tabbatar da cewa talakawan Amurkawa ba su biya ƙarin don ingantaccen kiwon lafiya ba. Idan ba haka ba, koyaushe akwai dala biliyan 718 a cikin kasafin soja na Pentagon da ke jira don tallafawa wani abu mai amfani da gaske kamar kula da lafiya.
Ƙarin Ayyuka, Ingantacciyar Kiwon Lafiya
Yana da mahimmanci kada a manta da wata maɓalli a cikin Medicare don Duk shawarwari-Inganta. Yaƙin neman zaɓe na mai biyan kuɗi ɗaya wata dama ce ba kawai don haɓaka damar samun kulawa mai araha ba, har ma da haɓaka ingancin kulawar da ke akwai ga kowane mutum.
An gane wannan a cikin lissafin Sanders da Jayapal, waɗanda ke haɓaka haɓaka ɗaukar hoto don cikakken sabis na kula da haihuwa, gami da ayyukan zubar da ciki, da hangen nesa, haƙori, da fa'idodin magunguna. Tare da sabon harin da aka yi kan 'yancin haihuwa na mata a Alabama da sauran jihohi, sanya dokar hana zubar da ciki a karkashin dokokin da ake kira "heartbeat", yana da mahimmanci a yanzu cewa Medicare ga Duk motsi ya tsaya a fili don kare zubar da ciki a matsayin halaltacciyar hanyar likita. .
Kamar yadda sanarwar 16 ga Mayu ta PNHP ta twitter ta ayyana, “Muna buƙatar sauya hanya cikin gaggawa kuma fadada samun damar kula da lafiyar haihuwa, gami da zubar da ciki. Wannan yana nufin garantin ɗaukar hoto, samun dama ga masu samarwa a duk al'ummomi, da Zero raba kudi."
Hakanan, don kiyaye inganci da amincin haƙuri, lissafin Sanders shima zai yi umarni iyaka akan ma'auni na ma'aikatan jinya da ma'aikatan jinya da matakan ma'aikata don likitoci da sauran masu samarwa, dangane da shigarwa daga ƙungiyar ma'aikatan jinya ta ƙasa da sauransu. Musamman ma, lissafin Sanders ya kuma sanya Ma'aikatar Kiwon Lafiya da Sabis na Jama'a (HHS) don tantance waɗanne "masu haɗa kai da haɗin kai" sabis na likita suka haɗa cikin sabon tsarin jama'a.
Wannan yana da mahimmanci. Kusan 40 kashi na manya na Amurka suna amfani da wani nau'i na ƙarin kulawa ko haɗin kai. Yayin da wasu daga cikin abubuwan da ke ƙarƙashin wannan rukunin sun haɗa da samfurori ko ayyuka da aka fi rarraba su azaman kulawa da kai a waje da tsarin kula da kiwon lafiya na ƙwararru, jiyya ta ƙwararrun masu lasisi don acupuncture, chiropractic, kula da naturopathic, da ayyuka masu alaƙa sun cancanci haɗa su cikin ɗayan guda- lissafin fa'idodin da aka rufe.
A haƙiƙa, akwai tabbataccen tushe na shaida don haɗa yawancin ayyukan kulawa da haɗin kai. A cikin 2017, dan Ostiraliya binciken ya sami shaida don tasirin acupuncture don jiyya 122 wanda ya ƙunshi yankuna 14 na asibiti. Wani meta-bincike na gwaje-gwajen asibiti 39 da suka shafi marasa lafiya sama da 20,827 da aka buga a cikin Jaridar Pain (Mayu 2018) ya sami acupuncture don zama ingantaccen magani mai zafi. A matsayin Cibiyar Nazarin Likitocin Iyali ta Amurka (AAFP) Rahoton An lura, an samo fa'idodin acupuncture na ci gaba da wanzuwa na tsawon lokaci kuma ba a iya bayyana su kawai a sakamakon tasirin placebo.
Tare da ci gaba da rikicin lafiyar jama'a na opioid, amfani da ingantattun zaɓuɓɓukan jiyya marasa magani kamar acupuncture da sauran tsoma baki sun sami sabon gaggawa. A cewar hukumar Cibiyar Kula da Cututtuka (CDC), fiye da mutane 700,000 ne suka mutu sakamakon yawan shan miyagun ƙwayoyi daga 1999 zuwa 2017. A cikin 2017, kimanin kashi 68 cikin dari na fiye da 70,000 na mutuwar kwayoyi sun hada da opioid. Adadin yawan mace-mace a cikin 2017 wanda ya shafi opioids (ciki har da na doka da na doka) ya ninka sau shida fiye da na 1999.
Waɗannan alkalumman sun bayyana wani rikicin lafiyar jama'a da ke dada karuwa, wanda ke da tushen tasirin Big Pharma akan magani. "Yawan adadin mutanen da aka yi amfani da su na yin amfani da magani na opioid yanzu yana wakiltar ɗayan manyan cututtukan iatrogenic a cikin tarihi," in ji Scott Poldosky, MD, da abokan aiki. The New England Journal of Medicine (NEJM). Labari ne na riba na kamfani (da na mutum ɗaya) mara hankali a kashe lafiyar jama'a.
Bisa ga Ofishin Lantarki na Gwamnatin Amurka (GAO), kudaden shiga na siyar da magunguna da fasahar kere-kere ya karu daga dala biliyan 534 zuwa dala biliyan 775 tsakanin shekarar 2006 da 2015. Musamman ma, GAO ya kuma bayar da rahoton cewa kashi 67 na kamfanonin magunguna sun karu ribar da suke samu na shekara-shekara a cikin wadannan shekaru, tare da manyan kamfanoni 25 da ke bayar da rahoton matsakaicin riba na shekara-shekara. gefe a wani wuri a cikin kewayon kashi 15 zuwa 20. Don sanya wannan a cikin hangen zaman gaba, GAO ya lura da matsakaicin ribar shekara-shekara a duniya don manyan kamfanoni 500 da ba na magunguna ba ya bambanta tsakanin 4 da 9 bisa dari.
Fiye da kowane lokaci, ma'aikatan kiwon lafiya suna buƙatar madadin zuwa opioids, duka amintattun magunguna da zaɓuɓɓukan jiyya marasa magani. Musamman ma, Hukumar Haɗin gwiwa, ƙungiyar da ke ba da izini ga ƙungiyoyin kiwon lafiya da yawa, yanzu bukatar Ƙungiyoyin asibitocin da aka amince da su don samar da irin waɗannan zaɓuɓɓukan magani marasa magani irin su acupuncture don saduwa da ka'idodin kula da ciwo.
Samfurin Kulawa na Holistic
Idan Amurka a ƙarshe ta karɓi tsarin kiwon lafiya mai biyan kuɗi ɗaya, faɗaɗa ɗaukar hoto don mahimman ayyukan kiwon lafiya zai nuna buƙatar ƙarin tsari ko cikakkiyar tsarin kulawa. Wannan batu ne da Margaret Chan, MD, tsohuwar darekta-janar ta Hukumar Lafiya ta Duniya (WHO) ta yi a cikin 2016. address keyword a taron kasa da kasa kan zamanantar da magungunan gargajiya na kasar Sin.
Kamar yadda Dr. Chan ya lura, yayin da tsarin kiwon lafiya ke fadada mahimman ayyukan kiwon lafiya, ba kawai tsammanin tsammanin kulawa ba, amma har ma farashin da ake bukata. "An fuskanci wannan matsala, kuma musamman ma farashin maganin cututtukan da ke da alaƙa da salon rayuwa, masana da yawa suna ganin akwai buƙatar canza tsarin isar da sabis na kiwon lafiya daga tsarin ilimin halittu, mai da hankali kan cututtukan mutum, zuwa ga cikakkiyar tsari." ” inji Dr. Chan. "Wannan wata hanya ce da ke jaddada rigakafi da kuma magani, tana ba da sabis na haɗin gwiwar da ke magance matsalolin kiwon lafiya da yawa, kuma suna neman mutane su ɗauki nauyin lafiyar nasu."
Kamar yadda irin wannan, acupuncture da maganin gargajiya na iya taka muhimmiyar rawa a cikin tsarin kiwon lafiya mafi girma, in ji Dokta Chan. Akwai bambance-bambancen irin wannan aikin da suka riga sun wanzu a cikin wasu tsarin kiwon lafiya na zamani, kamar a Japan inda magungunan ganye ("maganin Kampo") suke. Hadakar cikin aikin likita a ƙarƙashin tsarin inshorar lafiya na ƙasa.
Bugu da ari, a cikin al'ummarmu ta zamani inda ba kawai damuwa ba, amma damuwa mai ban tsoro ya zama gama gari, hanyoyin kwantar da hankali waɗanda ke magance ilimin halin ɗan adam na rashin lafiya na iya ƙarin hidima ga jin daɗin al'umma. Wannan ya haɗa da ba kawai nau'ikan ilimin tunani daban-daban ba, amma ayyukan tunani, yoga, acupuncture da hanyoyin kwantar da hankali na jiki. Abin sha'awa, Bessel van der Kolk, MD, likitan hauka kuma marubucin Jiki Yana Rike Maki: Kwakwalwa, Hankali, da Jiki a cikin Warkar da Raɗaɗi (Littattafan Penguin, 2015) ya ba da labarin yadda bayan harin ta'addanci na 9/11 a 2001, ya shiga cikin ƙwararru a cikin birnin New York wanda Cibiyar Kiwon Lafiya ta ƙasa da sauran ƙungiyoyi suka shirya don ba da shawarar jiyya ga mutanen da harin ya rutsa da su. Cibiyar Ciniki ta Duniya.
Bayan tattaunawa mai yawa, ƙwararrun sun ba da shawarar ilimin halin ɗan adam ne kawai da kuma ilimin halayyar mutum. Kamar yadda ya kasance, New Yorkers kaɗan ne suka yi amfani da waɗannan ayyukan da jama'a ke ɗaukar nauyi. Daga baya, Dr. van der Kolk ya fada The New York Times, Bayanan da aka tattara game da kula da lafiyar tunanin mutum fiye da 10,000 da suka tsira daga 9//11 sun sami acupuncture mafi mashahuri sabis da aka yi amfani da su don shawo kan tasirin gwaninta, sannan yoga, tausa, da EMDR far (wani nau'i na psychotherapy).
Wannan labarin ya yi magana game da buƙatar ƙarin hanyoyin haɗin kai don kula da lafiya, don mayar da martani ga nauyin da ke tattare da kwakwalwa da zamantakewar al'umma da kuma raunin da al'ummar zamani ke dora wa daidaikun mutane. Lallai adalcin kiwon lafiya yana farawa da kulawa mai sauƙi kuma mai araha. Amma kula da lafiya kuma yana nufin ɗaukaka taɓa ɗan adam a cikin magani, daidaita alaƙa da tausayi a matsayin alamomin tsarin kiwon lafiya wanda da gaske ke hidima ga kowane mai bukata. Kula da lafiya shine haɗin kai na zamantakewa a mafi girman matakin kai tsaye.
A wannan ma'anar, likitancin ɗan adam ya ƙunshi fiye da tantance sakamako daga gwaje-gwajen da aka sarrafa bazuwar don kafa menene "maganin kimiyya" kuma don haka halaltaccen aiki. Bayan haka, likitanci wani kimiyya ne da aka yi amfani da shi, wani nau'i na ilimin da ke tasowa wanda ke jawo hanyoyi masu yawa na bincike, dubawa na asibiti da hukunci, da shigarwar haƙuri don nemo hanyoyi masu tasiri zuwa warkarwa da jin dadi.
Yanzu, a zamanin da zalunci ke mulki a cikin siyasa, inda taurin kai, hangen nesa na dama ke yin barazanar tashin hankali a duk faɗin duniya, inda wariyar launin fata da jahilci, talauci da cin zarafi ke tasowa kamar muguwar hydra na rashin ɗan adam, hangen nesa na adali, tsarin kula da lafiyar ɗan adam na iya zama ɗan ƙaramin abu fiye da mafarki mai ban tsoro. Ba haka ba ne. A gaskiya ma, gwagwarmayar tabbatar da adalci na kiwon lafiya a Amurka ba ta da bambanci da manyan kalubalen siyasa da zamantakewar da ke tattare da cin nasara a kan zamewar dabbanci da ke fuskantar bil'adama.
Daga Big Pharma zuwa masana'antar inshora, masana'antun na'urorin likitanci, tsarin asibitoci mallakar masu saka hannun jari da ƙari, jari-hujja na kamfani yana karkatar da magani daga abin da ya kamata ya zama manufa ta ɗan adam zuwa wata hanyar riba. Don kayar da harkokin kiwon lafiya na kamfanoni da masu cin moriyar sa yana yiwuwa, amma zai ɗauki fiye da sanya begen mu a cikin 'yan jam'iyyar Democrats, waɗanda da yawa daga cikinsu suna fama da halin karɓar buƙatun ci gaba kamar mai biyan kuɗi ɗaya kawai lokacin da irin waɗannan buƙatun ba su da damar aiwatarwa. .
Shahararriyar goyon baya ga Medicare ga Duk yana wakiltar ƙaƙƙarfan motsi mai yuwuwar wanda ba zai iya tsayawa ba. Amma idan muna son tsarin kula da lafiyar jama'a na adalci, adalci, dole ne jama'a su yi magana, su yi taro kuma su yi tsarin siyasa. Idan muna son mu kwato magani da gaske daga masu cin riba, kamfen na shirya taron jama'a shine hanyar canza abin da ke buƙatar canzawa.
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