Midzi ya m’midzi ku United States yakhala ikulimbana ndi kulephera kwa njira zaumoyo m’madera a m'mizinda ndi m’midzi. Kudzipatula kwa anthu ogwira ntchito zaumoyo, kuchepa kwa antchito, ndi kulephera kwa zachuma kumayambitsa mavuto aakulu kwa anthu mamiliyoni a ku America amene amakhala kutali ndi zipatala, akatswiri, ndi ntchito zotetezera. Olamulira a boma, oikidwa pa kukhazikitsa malamulo a boma ndi kukonza zinthu zakumaloko, ayamba kukhala omanga mapulani a zinthu zatsopano. Mwa malamulo a akuluakulu, malo oyamba a zaudindo, ndi kuikizira zinthu zapamwamba, akuthetsa mavuto osatha a kumidzisungira ndi kuphatikizana zisonkhetso, ntchito, ndi kuthandizira kwa makampani ambiri oyang'anira a m'makwawa akugwiritsira ntchito kulowa mla, kukonzanso zinthu zaumoyo, ndi kusungitsa chitukuko, ndipo sakutsimikizira kuti dziko lachokera kumbuyo. Nkhaniyi ikufufuza zopinga za .

Mavuto Okhalitsa a Kusamalira Thanzi Lakumidzi

Mavuto amene anthu a kumidzi amakumana nawo si achilendo, koma awonjezeka chifukwa cha kusinthasintha kwa chiŵerengero cha anthu, mavuto azachuma, ndi mavuto a zaumoyo monga mliri wa CHOVID-19. Kumvetsa mavuto ameneŵa n’kofunika kwambiri kuti tiyamikire malamulo amene abwanamkubwa akonza.

Kutsekeka kwa Thanzi ndi Kulimbitsa

Chiyambire 2010, zipatala zoposa 130 zakumidzi zatsekedwa ku United States, mogwirizana ndi chidziŵitso cha Cecil G. Sheps Center for Health Services Research pa University of North Carolina . Kutsekeka kumeneku kwasiya anthu popanda mautumiki angozi, mabedi odwazika, kapena malaboratory ndi mphamvu zojambula. Kwa awo amene atsala, chipatala chapafupi chingakhale ola kapena kuposapo, chimene chingaphe m’nthaŵi ya kudwala mtima, sitiroko, kapena kusokonezeka maganizo kwakukulu. Maboma avomereza mwa kupanga maprogramu a boma kuti asunge malo ovutikira ndi kuyang'anira zithunzi zotsalira zina zonga [[FL:]] kulowa m'chipatala chapafupi, ndi zipatala zamwadzi, zimene zimalandira MeLPractived tration (maungwe) m'mautumiki ochepa.

Kupereŵera kwa Ntchito m’Madera a Kumidzi

Kupereŵera kwa akatswiri a zaumoyo m’madera akumidzi kuli kwakukulu. The Health Resources and Service Administration (HRSA) imatchula zikwi za odwala matenda a zamaganizo, ndi akatswiri a zaumoyo m'madera akumidzi. Madera akumidzi ali ndi madokotala 13.5 pa anthu 10,000 alionse, poyerekezera ndi 30.9 m’madera a m’matauni. Olamulira a m’madera akumidzi alibenso madokotala: anthu akumidzi ali ndi madokotala, ana odwala matenda a maganizo, ana, ngongole za ophunzira, malipiro apamwamba, malipiro aukatswiri, kulekana kwa akatswiri, ndi kuchepa kwa madokota onse oletsa kusankha machitidwe akumidzi. Olamulira onse asintha zisonkhetso zotero zonga ngati kulipira ndalama za boma zolipirira za boma zoperekedwa ndi owonjezereka m'masukulu akwanitsa ndalama zokwanira $200,000 m’maphunziro atatu m’zaka zisanu zisanu kuti ayese kuzoloŵera. Omwenso anapanga maprogramungwe a sukulu a zapamwamba a maphunziro a za m’makolo akumidzi, omwe ali ndi opita m’dziko, omwe ali ndi odziŵa kuti

Zoyendera ndi Zopinga za Malo Ozungulira Dziko

Ngakhale pamene mautumiki alipo, kuyenderako kungaletsedwe. Anthu akumidzi kaŵirikaŵiri alibe zoyendera za onse zodalirika, ndipo mtunda wa kumudzi kwa operekera chithandizo chapafupi ungapose makilomita 30 imodzi. Mtolo umenewu ukuvuta kwambiri kwa okalamba, mabanja olandira ndalama zochepa, ndi amene ali ndi mavuto aakulu ofuna kuyendera. Mwachitsanzo, wodwala matenda a shuga m’dera lakutali angafunikire kuyenda ulendo wa makilomita 60 ku njira iliyonse kuti apimidwe, kusoŵa ntchito ndi kutaya mafuta. Maboma ena aika maprogramu a zoyendera [[FLT: 0] ndi magulu a odzifunira kuyendetsa galimoto, monga ngati woyenda ulendo waung'ka, mautumiki osayenda, wopita kuchipatala, ndi magalimoto a zaulendo a zaumoyo amene amabweretsa kumudzi. Mayi ena ayambanso kukhazikitsa maprogramungwe a za chikhulupiriro ndi magulu a oyendetsa galimoto.

Kukula kwa Matenda Osachiritsika ndi Kusagwirizana kwa Thanzi

Anthu a m’midzi akukhala okalamba, osauka, ndipo ali ndi ziŵerengero zowonjezereka za matenda osatha monga ngati matenda a mtima, matenda a shuga, ndi matenda osatha a m’mapapo (COPD). Kuwonjezera apo, anthu akumidzi ali othekera kwambiri kuchita nawo makhalidwe a thanzi monga kusuta fodya ndi kukhala ndi moyo wochepa. Zinthu zimenezi zimaphatikizapo kuyambitsa mavuto a thanzi loipa ndi chiŵerengero cha anthu akufa. Mabungwe a za matenda a matenda ndi kuteteza (CDC) akumidzi akumidzi akumidzi amafa ndi zinthu zotchinga zotetezeka kwambiri kuposa anthu a m’mizinda yawo. Maboma ayankha mwa kulangiza madipatimenti a zaumoyo kuti ayambe kuukira ndi kuyang'anira ntchito zauyang'a ntchito zaumoyo, kuphatikizapo zothandizira zaumoyo wa anthu odziŵa za sukulu, ndi malo odzitetezera a za matenda aakulu. Maprogramulowa amaperekedwa kaŵirikaŵiri kudzera mwa ndalama ndi ma CD Opereka chithandizo chaku

Mabungwe Odziŵa Kufikira Ayamba Kugwiritsa Ntchito Njira Zosavuta Kupeza

Bwanamkubwa ali ndi zipangizo zambiri zoyendetsera ntchito. Zimadalira pa ndale zadziko zawo, mphamvu ya zachuma, ndi zinthu zofunika kwambiri, iwo atsatira njira zosiyanasiyana zotsatirazi.

Kufutukuka kwa Matelehealth

Telehealth inaphulika mkati mwa mliri wa Chovid-19, ndipo atsogoleri ambiri a boma anasamuka mwamsanga kupanga zinthu zosatsimikizirika zachikhalire. Telehealth imalola odwala kukaonana ndi akatswiri a makilomita mazana ambiri popanda kuchoka kwawo. Bwanamkubwa apititsa patsogolo njira imeneyi mwakuti:

  • Kufalikira kwa kupezeka kwa nkhanu pa Internet kupyolera m'maofesi a boma opapatiza, mayanjano a anthu onse, ndi kugwiritsa ntchito ndalama za boma kuchokera ku Infrapublicament Investment and Jobs Act.
  • Malamulo a boma a Medicaid kukwaniritsa maulendo a patelefoni kaamba ka mautumiki osiyanasiyana, kuphatikizapo thanzi la maganizo, kusamala matenda osatha, ndi chisamaliro chakuchinjiriza.
  • [[MLT:0] Kukhazikitsa lamulo limene limafuna makampani a insurensi kuti abwezere ndalama za foni pamlingo wofanana ndi maulendo apadera.
  • Kuloŵetsa m'magubo a magetsi amene amalola zipatala zakumidzi kugwirizana ndi malo a zachipatala kuti zipezeretu m'minda monga cadiology, dermatology, ndi ubongo.

Mwachitsanzo, boma la Arkansas, pansi pa Bwanamkubwa Asa Hutchinson, linayambitsa Arkansas Telehealth Network, yomwe imagwirizanitsa malo a kumidzi oposa 400 ndi akatswiri pa University of Arkansas for Medical Sciences. Mofananamo, Kazembe wa Virginia Ralph Northam anasaina lamulo la mkulu la boma lokhazikitsa gulu la ntchito la boma lowonjezera magetsi, lotsogolera ku lamulo lachikhalire la stelehealth . Kuyesayesa kumeneku kwachepetsa mokulira zothotho za ntchito za kudera la kumidzikumidzi ndi kuyembekezera nthaŵi kwa odwala akumidzi.

Ndalama Zothandiza Opereka

Kuti athetse kusoŵa kwa antchito, akazembe aika ndalama zambiri za boma m’maprogramu olemba ntchito ndi osunga ntchito.

  • [[FLT: 0] Kulipira ndi maprogramu a maphunziro operekedwa kupyolera mwa madipatimenti a boma a umoyo kapena maphunziro apamwamba. Mwachitsanzo, Texas Physician Education Loan Refullence Program imapereka ndalama zokwana $1600,000 kwa madokotala amene akutumikira m'madera akumidzi HPS
  • Malo okhala otchuka a dziko ku zipatala ndi zipatala za kumidzi, kulimbikitsa madokotala atsopano kukhala m'deralo pambuyo pophunzira.
  • Thrini ndi majonasi kwa osamalira amene amayeserera kumadera akumidzi kwa zaka zochepa chabe.
  • Makompati a Malicensivetive ndi makoma apakati pa dziko amene amapangitsa kukhala kosavuta kwa osamalira kudutsa mizera ya boma, imene ili yofunika kwambiri kwa anthu a m'malire ndi telemedicine . Interstamential Medical Licenfis Convention Conct, yovomerezedwa ndi maboma ambiri, imatsanulira njira yoletsera mankhwala oletsa matenda kwa madokotala ofuna kugwiritsa ntchito m'mayiko ambiri.

“ Komiti ya DOUTH , ya ku Mike Parson, yoyang'anira ntchito zaumoyo, inawonjezera malipiro a osamalira a poyamba m’madera akumidzi, kupangitsa kukhala kopindulitsa kwambiri kuvomereza odwala a Medicaid. North Dakota, pansi pa Bwanam, Doug Burgum, anayambitsa programu ya kukhongoletsa ndalama zaumoyo zimene zimapatsa ngongole ya $500,000 ya odziŵa zaumoyo amene amayeserera m'magawo a m’midzi.

Kufufuza Zaumoyo wa Kumidzi

Kuphatikiza pa kutseguka kwa zipatala zomwe zilipo, akazembe akuchirikiza malo atsopano ndi zachikale. Zimenezi zimaphatikizapo kuwongolera ndalama za ndalama za zipangizo, zomangira nyumba, ndi luso la zomangamanga. Boma la California , pansi pa Gavin Newsom, anavomereza kuti zipatala za $200 miliyoni “Loan Program" kuthandiza kumenyera nkhondo m'machipatala akumidzi kupeŵa kutsekeka. Kuwonjezera apo, akazembe ambiri achirikiza boma la za chipatala . [FLT] ASTIGURF] Emetertenthial Hos Hospital (RE) Far Far Farmal Newsom , zimene zimalola zipatala pang'ono kuti zitembenuze ku mautumiki amwaivala opanda maola 24 osoŵa, kulandira ndalama zowonjezereka za Medicare. Mame adafulumira mofulumira mofulumira, zopereka madera ena akupereka chigwirizano cha boma, zowonjezera chigwirizano.

Akuluakulu angapo athandizanso pa ntchito yokonza malo othandizira anthu odwala kumidzi, kumene ofufuza ndi akatswiri a zachipatala agwirizana ndi njira zothetsera mavuto a m’deralo. Mwachitsanzo, yunivesite ya Nebraska Medical Center ya ku Liral Health Innovation Hub amalandira ndalama za boma kuti aone ngati pali anthu atsopano opereka chithandizo, kuphatikizapo zipatala za anthu ovutika, ndiponso anthu odwala.

Kukulitsa Medicaid ndi Kuchepetsa Kusafunika kwa Zinthu

Inshuwalansi ya zaumoyo ndi chida chachikulu choletsa kupezeka. Chiŵerengero chosatsimikizirika m'madera akumidzi kaŵirikaŵiri nchachikulu kuposa m’matauni, ndipo nzika za kumidzi ziri zothekera kusungidwa. Maboma ofutukuka anena za kuwonjezereka kwa ndalama za chipatala cha kumidzi ndi kuthekera kwa kuchepetsa kusamala. Mwachitsanzo, pambuyo pa kufutukuka kwa Montana Mdicaid mu 2016 pansi pa Wolamulira Steve Bullock, zipatala za dzikolo zinaona kutsika 25% ya ndalama zosamalira. Mdisiki wa maboma owonjezereka m'mayiko ena anena za kuwonjezereka kwa ndalama za m'magawo a chipatala ndi kuyang'anira kuyang'anira kutsogolo kwa anthu akumidzi, monga oyendetsa ndege.

Kutali kwa Medicaid, akazembe athandizanso kulembetsa anthu a m’midzi ku misika ya inshuwalansi ya zaumoyo ndi kupititsa patsogolo mapulani otsika. Kusinthana kwa boma, monga kuja kwa ku Colorado ndi ku Minnesota, kwagwirizana ndi ntchito zopitira anthu akumidzi, kugaŵira oyendetsa sitima zapamtunda ndi njira zofeŵetsa zopimira.

Mafanizo Osintha ndi Maulendo a Boma

Mabomawo akugwiritsa ntchito maprogramu odalirika ndiponso odalirika popanga maprogramu.

Mabungwe Odziŵerengera Mlandu M’midzi

Bwanamkubwa ena alimbikitsa kupangidwa kwa Ofesi Yoŵerengera mlandu ya Magulu a Care (ACOS) [AFLT:1] amene amalola zipatala zazing'ono ndi zipatala kugwirizana ndi makampani omwe amafupidwa kaamba ka kusungitsa odwala kukhala athanzi mmalo mwa kungopereka chithandizo. Amenewa amagwiritsira ntchito ogwirizanitsa chisamaliro, chidziŵitso cha analytics, ndi kuchiritsa koleza mtima kuti ayang'ane ndi kuchepetsa kuikidwa m’chipatala. Boma la Iowa, pansi pa Bwana Kim Reynolders, linapereka chithandizo chaukatswiri kuti apange ACHO, zotsatirapo za ndalama zotsika ndi zowongowongolera zothandizira kuthandizira kugawana othandizira ku Medicaundivation.

Antchito ya Zaumoyo ndi Ausinkhu Wawo

Pozindikira kuti kukhulupirirana n’kofunika kwambiri m’midzi yaing’ono, akazembe ambiri athandiza ndi kugwiritsa ntchito maphunziro ndi ntchito za ogwira ntchito zaumoyo a anthu a m'dera limodzi. Ma CHW amaphunzitsa zaumoyo, kuthandiza odwala kuyendetsa zinthu, ndi kugwirizanitsa anthu. Maboma ambiri, kuphatikizapo West Virginia ndi Kentucky, apanga mapulogalamu othandizira kukonza ndi njira zobwezetsera ndalama za CHWs m'maprogramungwe awo a Médicaid. Njira imeneyi yathandiza kwambiri poyang'anira matenda a shuga, ndi kuyendetsa matenda a shuga, ndi a amayi kumadera akumidzi.

Kugwirizana ndi Mitundu ya Mafuko

M'mayiko okhala ndi anthu a Eni America, akazembe agwira ntchito ndi maboma a mafuko awo kugwirizanitsa ntchito zaumoyo ku malire a dziko. Indien Health Service (IHS) imatumikira ziwalo zambiri za mafuko, koma chuma chake kaŵirikaŵiri sichikukwanira. Bwanamkubwa aloŵa m'mapangano, makampani ogulitsa zinthu, ndi maseŵero a zipatala ogwirizana kuti aperekeze. Mwachitsanzo, boma la Alaska, pansi pa Bwanamkunja Mike Dunleavy, logwirizana ndi magulu a zaumoyo a mafuko kuti afutukule teleheath ndi kutumiza ma maofesi apadera kudutsa madera aakulu, osayenda misewu.

Zotsatirapo ndi Zovuta Zimene Zatsala

Malamulo ochitidwa ndi abwanamkubwa atulutsa masinthidwe owonekera, koma nsonga zazikulu zikupitirizabe.

Anthu Amene Anapambana

  • Kugwiritsira ntchito kwamphamvu m'madera akumidzi kwawonjezeka ndi oposa 3,000% m'maiko ena chiyambire 2020, ndi kukhudzika mtima kwa kupitirira 90%. Odwala a m’madera akumidzi akusimba kuti anasunga nthaŵi ndi ndalama, ndipo kumamatira bwinopo kutsatira chisamaliro.
  • Maprogramu a loni yadziko aika mazana ambiri a ndalama zothandizira anthu m'midzi yosafunika. Mwachitsanzo, Virginia State Loan Refungerment Program yaika makampani 150 aakulu osamalira kumidzi ya HPS Kuyambira pamene anakhazikitsidwa.
  • Recuction mu kugoneka kwa chipatala kokhoza kupeŵeka m'maboma okhala ndi maprogramu amphamvu a zaumoyo m'mudzi ndi ACOS.
  • Kutsekedwa kwa chipatala kwachepetsa m'zigawo kuti kwagwiritsira ntchito ndalama zothandizira ndi kutembenuza ku REH . Malinga ndi Sheps Center, chiŵerengero cha kutsekedwa chatsika kuchokera pa avareji ya chaka ya 15 mpaka 9 m'zaka ziŵiri zotsatira kuyambitsidwa kwa dzina la REH.

Zopinga Zimene Zidakalipo

Mosasamala kanthu za mapindu ameneŵa, anthu ambiri akumidzi amayang'anizanabe ndi mavuto aakulu ofikira. Kuperewera kwa ntchito kumapitirizabe; boma limayerekezera kuti zipatala zowonjezereka zothandizira anthu 200,000 zikufunikira kuchotsa matanthauzo a HPSA m'midzi ya kumidzi. [[FLT]] Broadbad kulowa mu ufiki [[FLT:] [3] kusoŵabedirective Infraclactive Instmentation Instmentivementations ndi Actssss amaucroadsssssssssss, madera ambiri akukhalabe osasungidwa kapena ocheperapo, owonjezereka, osalandira anthu ambiri. [kuwonjezera, kuwonjezera, kuwonjezera, kuchuluka kwa maiko akumidzi.]

Ntchito ya Malamulo Oyendetsera Zinthu ndi Chuma

Maboma sangathetseretu zaumoyo wa kumidzi okha.

  • [[FLT: 0] Mitediare ndi Medicaid infreed revotion : Mitengo yapamwamba ya osamalira a m’midzi imawongolera kukhazikika kwa zachuma. Centers for Medicare & Medicaid Services (CMS) yayambitsa masinthidwe angapo olipira kaamba ka madera akumidzi, koma olamulira achirikiza kaamba ka chiwonjezeko chowonjezereka.
  • Maprojekiti ndi kuonetsa projekiti [1]: Maprogramu onga HRSA Federal Office ya ntchito za Umoyo wa Paral Colic yopereka imapereka ndalama zothandizira pa magetsi, ntchito, ndi kuwongolera malo. Olamulira ambiri agwiritsira ntchito njira zimenezi ku njira za kuyambitsa za mbewu.
  • Kusinthasintha kwa malamulo [1]: Mantha a telehealth, ogwira ntchito m'chipatala, ndi machitachita akhala ovuta. Maboma agwira ntchito ndi CMS ndi mabungwe a boma kupanga miliri yambiri yosatha.

Mayanjano a boma, monga ngati Kusintha 1115 Medicaids ravers , amalola maboma kuyesa njira zatsopano. Mwachitsanzo, Ohio analandira wothandiza kuyendetsa ndege ya “nyumba zochiritsira ” chitsanzo cha odwala odwala odwala odwala odwala matenda aakulu m'midzi, kugwirizanitsa thanzi ndi chisamaliro chachikulu cha khalidwe.

Kuyang’ana Mtsogolo: Malangizo a M’tsogolo a Akuluakulu

Kudera lina la kumidzi kumene anthu amafikirako chithandizo chaumoyo kumakhala ndi luso la zopangapanga, kuchuluka kwa anthu osamalira matenda, ndiponso kupitiriza kulimbikitsa anthu kuti asamadwale.

  • Kuchuluka kwa njira zopitira patsogolo kwa manesi olembetsedwa (APRNS), adokotala (PAS), ndi ogulitsa mankhwala oyesera pamwamba pa laisensi yawo, zimene zingawonjezere kupezeka kwa asing'anga.
  • Kugwiritsira ntchito kwapamwamba kwa kuyang'anira wodwala kwapatali ndi zipangizo zowonongeka zosamalira mikhalidwe yosatha, yochirikizidwa ndi kuikizira kwa boma m'zopereka zaumoyo IT.
  • Malo aakulu kwambiri a zaumoyo a pasukulu [[FL:1] amene amapereka chisamaliro chachikulu, thanzi lamaganizo, ndi mano kwa ana a kumidzi, kaŵirikaŵiri ochirikizidwa ndi boma.
  • Kusintha kwamtengo wozikidwa pa kuwongolera kumene kumatulukapo mmalo mwa kuchuluka, kulola osamalira a kumidzi kuikiza ndalama zawo m'kuchinjiriza ndi kusamala.

Olamulira angapo akufufuzanso zolembedwa za chigawo chapakati pa telehealth inflaming, mankhwala okonzanso, ndipo ngakhale kugawana chidziŵitso cha zaumoyo wa anthu kuti adziŵe zosoŵa zomakula m'madera akumidzi. Malo akwawo ozungulira [[FLT: 0] amasintha nthaŵi zonse, ndipo olamulira akugwiritsira ntchito mawu awo kukonza malamulo a boma kudzera mwa National Bridgers Association ndi kuwongolera kuyendetsa ulamuliro wa boma.

Kumaliza

Kufikira kwa kumidzi sikuli vuto limodzi koma kusonkhanitsa nkhani zogwirizana zophatikizapo malo, chuma, antchito, ndi malamulo. Olamulira ayamba ndi njira zowonjezereka: kufutukulira magetsi, kupereka zikopa za ndalama kuti apereke, kuwonjezera inshuwalansi, ndi kulimbikitsa kukonza zinthu zina zothandizira. Pamene zoyesayesa zimenezi zapanga ziwongoleredwe zabwino kwambiri, odwala ogwirizana kwambiri, njira yaumoyo yolimba kwambiri ya kumaloko imakhala kwa nthaŵi yaitali. [[FLT: 0] Ubwino wa Zaumoyo wa ku kampani, kuwonjezera kusungidwa kwa inshuwalansi, ndi kulimbikitsa kuti anthu akumidzi akumidzi apitirizebe kukhala ndi ziyambukiro zaumphaŵi, ndi mpata wa moyo pakati pa madera akumidzi ndi madera aunika, ndi kugwirizana kwaungwe, kudziko lonse la anthu okhala ndi mgwirizano ku madera akunja, kuwonjezera kuthekera kwa kuyenderana kwa kuntchito kwa anthu akunja, koma kukuwonedwa ndi kutchuka kwa kuyendetsa kwa oyendetsa ntchito.