Pamene odwala akudalira kwambiri othandizira ndi mautumiki awo, chisamaliro chaumoyo ku US chapanga zomwe Dr. Robert Pearl amachitcha "malingaliro apakati".
Pakati pa opanga ndi ogula, mudzapeza gulu la akatswiri omwe amathandizira kugulitsa, kuwongolera ndikutumiza katundu ndi ntchito.
Odziwika kuti amkhalapakati, amayenda bwino pafupifupi m'mafakitale aliwonse, kuchokera ku malo ogulitsa nyumba ndi malonda kupita ku ntchito zachuma ndi maulendo.Popanda oyimira pakati, nyumba ndi malaya sizingagulitsidwe.Sipadzakhala mabanki kapena malo osungiramo intaneti.Chifukwa cha oyimira pakati, tomato omwe amalimidwa ku South America amatumizidwa ndi sitima kupita ku North America, amadutsa miyambo, amathera m'sitolo ya m'deralo ndipo amathera mudengu lanu.
Oyimira pakati amachita zonse pamtengo.Ogula ndi azachuma sagwirizana ngati oyimira pakati ndi tizilombo toyambitsa matenda tofunikira ku moyo wamakono, kapena onse awiri.
Malingana ngati mkangano ukupitirira, chinthu chimodzi ndi chotsimikizika: Oyimira zaumoyo ku US ali ambiri ndipo akuyenda bwino.
Madokotala ndi odwala amakhala ndi ubale wapamtima ndikulipira mwachindunji oyimira pakati asanalowe.
Mlimi wina wa m’zaka za m’ma 1800 amene anali ndi ululu wa m’mapewa anapempha dokotala wa banja lake kuti akamuyendere, amene anamupima, kumuyeza, ndi kumupatsa mankhwala opweteka.Zonsezi zikhoza kusinthidwa ndi nkhuku kapena ndalama zochepa.Mkhalapakati safunikira.
Izi zinayamba kusintha mu theka loyamba la zaka za zana la 20, pamene mtengo ndi zovuta za chisamaliro zinakhala nkhani kwa ambiri.Mu 1929, pamene msika wogulitsa unagwa, Blue Cross inayamba ngati mgwirizano pakati pa zipatala za Texas ndi aphunzitsi am'deralo.Aphunzitsi amalipira bonasi ya masenti 50 pamwezi kuti alipirire chithandizo chachipatala chomwe akufunikira.
Mabizinesi a inshuwaransi ndi mkhalapakati wotsatira pazamankhwala, kulangiza anthu za mapulani abwino kwambiri a inshuwaransi yazaumoyo ndi makampani a inshuwaransi.Pamene makampani a inshuwaransi anayamba kupereka mapindu a mankhwala olembedwa ndi dokotala m’zaka za m’ma 1960, ma PBMs (Pharmacy Benefit Managers) anatulukira kuti athandize kuchepetsa mtengo wa mankhwala.
Oyimira pakati ali paliponse muzinthu zamakono masiku ano.Makampani monga Teledoc ndi ZocDoc adapangidwa kuti athandize anthu kupeza madokotala usana ndi usiku.Magulu a PBM, monga GoodRx, akulowa mumsika kukakambirana zamitengo yamankhwala ndi opanga ndi ogulitsa mankhwala m'malo mwa odwala.Ntchito zachipatala monga Talkspace ndi BetterHelp zayamba kuti zilumikizane ndi anthu omwe ali ndi madotolo omwe ali ndi chilolezo chopereka mankhwala amisala.
Mayankho awa amathandizira odwala kuyenda bwino pamachitidwe azachipatala osagwira ntchito, kupangitsa chisamaliro ndi chithandizo kukhala chosavuta, chopezeka, komanso chotsika mtengo.Koma odwala akamadalira kwambiri oyimira pakati ndi ntchito zawo, zomwe ndimatcha malingaliro apakati asintha pazachipatala zaku America.
Tangoganizani kuti mwapeza mng'alu wautali pamwamba pa msewu wanu.Mutha kukweza phula, kuchotsa mizu pansi ndikudzazanso dera lonselo.Kapena mutha kubwereka wina kuti azikonza njira.
Mosasamala kanthu zamakampani kapena nkhani, oyimira pakati amakhala ndi malingaliro "okonza".Cholinga chawo ndi kuthetsa vuto lopapatiza popanda kuganizira mavuto omwe amatsatira (nthawi zambiri amapangidwe) kumbuyo kwake.
Chifukwa chake wodwala akapanda kupeza dokotala, Zocdoc kapena Teledoc zitha kuthandiza kupanga nthawi yokumana.Koma makampaniwa akunyalanyaza funso lalikulu: Chifukwa chiyani zimakhala zovuta kuti anthu apeze madokotala otsika mtengo poyambirira?Mofananamo, GoodRx ikhoza kupereka makuponi pamene odwala sangathe kugula mankhwala ku pharmacy.Koma kampaniyo ilibe nazo ntchito chifukwa chake anthu aku America amalipira kuwirikiza kawiri pazamankhwala monga anthu akumayiko ena a OECD.
Chisamaliro chaumoyo ku America chikuipiraipira chifukwa oyimira pakati sakuthana ndi mavuto akuluwa, osatheka kuthetsedwa.Kuti agwiritse ntchito fanizo lachipatala, mkhalapakati angachepetse mikhalidwe yoika moyo pachiswe.Iwo samayesa kuwachiritsa iwo.
Kunena zomveka, vuto ndi mankhwala si kukhalapo kwa amkhalapakati.Kusowa kwa atsogoleri omwe ali okonzeka komanso okhoza kubwezeretsa maziko owonongeka a chithandizo chamankhwala.
Chitsanzo cha kusowa kwa utsogoleri ndi njira yobwezera "malipiro a ntchito" yomwe imapezeka mu chisamaliro chaumoyo ku US, momwe madokotala ndi zipatala amalipidwa potengera kuchuluka kwa ntchito (mayeso, chithandizo, ndi njira) zomwe amapereka.Njira yolipira iyi "yomwe mumalandira mukamagwiritsa ntchito" ndiyomveka m'mafakitale ambiri.Koma mu chisamaliro chaumoyo, zotulukapo zake zakhala zodula ndi zosapindulitsa.
Pantchito yolipira, madokotala amalipidwa kwambiri pochiza vuto lachipatala kuposa kuliletsa.Iwo ali ndi chidwi chopereka chisamaliro chochulukirapo, kaya chikuwonjezera phindu kapena ayi.
Kudalira kwa dziko lathu pa malipiro kumathandiza kufotokoza chifukwa chake ndalama zothandizira zaumoyo ku US zakwera kawiri mofulumira kuposa kukwera kwa mitengo pazaka makumi awiri zapitazi, pamene nthawi ya moyo sichinasinthe nthawi yomweyo.Pakadali pano, dziko la US likutsalira m'mbuyo mwa mayiko onse otukuka pazachipatala, ndipo chiwerengero cha imfa za ana ndi amayi oyembekezera chikuwirikiza kawiri maiko ena olemera kwambiri.
Mungaganize kuti akatswiri a zaumoyo adzachita manyazi chifukwa cha zolephera izi - iwo amaumirira m'malo mwa chitsanzo chopanda malipiro ichi chomwe chimayang'ana pa mtengo wa chisamaliro choperekedwa osati kuchuluka kwa chisamaliro choperekedwa.Inu simuli bwino.
Chitsanzo cholipira mtengo chimafuna kuti madokotala ndi zipatala aziika pangozi zachuma pazotsatira zachipatala.Kwa iwo, kusintha kwa ndalama zolipiriratu kumakhala ndi chiwopsezo chazachuma.Chifukwa chake m'malo mogwiritsa ntchito mwayiwu, adatengera malingaliro apakati, kusankha kusintha pang'ono kuti achepetse chiopsezo.
Pamene madokotala ndi zipatala akukana kulipira mtengowo, makampani a inshuwaransi wamba ndi boma la feduro amagwiritsa ntchito mapulogalamu olipira omwe amayimira malingaliro apakati.
Mapulogalamu olimbikitsawa amapereka ndalama kwa madokotala nthawi iliyonse akamapereka chithandizo chapadera chodzitetezera.Koma chifukwa pali mazana a njira zozikidwa paumboni zopewera matenda (ndipo ndalama zochepa zolimbikitsira zilipo), njira zopewera zosalimbikitsa nthawi zambiri zimanyalanyazidwa.
Malingaliro amunthu-wapakati amakula bwino m'mafakitale osagwira ntchito, kufooketsa atsogoleri ndikulepheretsa kusintha.Chifukwa chake, posachedwa makampani azachipatala aku US abwereranso ku malingaliro ake a utsogoleri, ndizabwinoko.
Atsogoleri amapita patsogolo ndikuthetsa mavuto akulu ndi zochita molimba mtima.Anthu apakatikati amagwiritsa ntchito zingwe kuti abise.Zinthu zikavuta, atsogoleri amatenga udindo.Maganizo a mkhalapakati amaika mlandu munthu wina.
N'chimodzimodzinso ndi mankhwala aku America, pomwe ogula mankhwala amadzudzula makampani a inshuwaransi chifukwa chokwera mtengo komanso kudwaladwala.Komanso, kampani ya inshuwalansi imaimba dokotala mlandu pa chilichonse.Madokotala amadzudzula odwala, owongolera ndi makampani opanga zakudya mwachangu.Odwala amaimba mlandu mabwana awo komanso boma.Ndi bwalo loipa losatha.
Zoonadi, pali anthu ambiri omwe ali m'makampani a zaumoyo-ma CEO, mipando ya matabwa a oyang'anira, apurezidenti a magulu a zachipatala, ndi ena ambiri-omwe ali ndi mphamvu ndi luso lotsogolera kusintha kwa kusintha.Koma malingaliro a mkhalapakati amawadzaza ndi mantha, amachepetsa kuyang'ana kwawo, ndikuwakankhira ku kusintha kwakung'ono.
Njira zing'onozing'ono sizokwanira kuthetsa mavuto omwe akuipiraipira komanso ofala.Malingana ngati yankho lathanzi likadali laling'ono, zotsatira za kusachitapo kanthu zidzakwera.
Zaumoyo zaku America zimafunikira atsogoleri amphamvu kuti athetse malingaliro apakati ndikulimbikitsa ena kuchitapo kanthu molimba mtima.
Kupambana kudzafuna kuti atsogoleri agwiritse ntchito mtima wawo, ubongo, ndi msana - zigawo zitatu (mophiphiritsira) za anatomical zofunika kuti abweretse kusintha.Ngakhale mawonekedwe a utsogoleri samaphunzitsidwa m'masukulu azachipatala kapena anamwino, tsogolo lamankhwala limadalira.
Nkhani zitatu zotsatira munkhani zino zifotokoza za umunthu ndi kufotokoza zomwe atsogoleri angatenge kuti asinthe chisamaliro chaumoyo ku America.Gawo 1: Chotsani malingaliro apakati.