Iingingqi zasemaphandleni kulo lonke elaseUnited States ziye zazama kade ukufikelela kwimimandla yezonyango ehlala imimandla yasezidolophini nasemadolophini. Ukwahlukaniswa kwemimandla, ukuhla kwezicombululo, ukuhla kweziko lonyango, kunye nokungaqiniseki kwemali kubangela ungquzulwano olugqibeleleyo kwizigidi zabantu baseMerika abahlala kude nezibhedlele, iingcali, kunye neenkonzo zokuthintela. Abalawuli belizwe, abakwindawo yokudibana kwemigaqo-nkqubo yolawulo kunye nokuphuhliswa kwemisebenzi yasekuhlaleni, baye bavela njengeentloko-zakhi zolwazi olutsha. Ngoomthetho, izinto eziphambili, ezona zinto ziphambili, kunye nohlahlolo-mali, abalawuli balwayo balwanisa iingxaki ezingapheliyo zempilo, kwaye abakhange bakhusele impumelelo yempilo yasekuhlaleni, kwaye abancedisi butho bebutho.

Ucelomngeni Oluqhubekayo Lokufumana Unyango Lwasemaphandleni

Iingxaki ezijongene nabemi basemaphandleni azinto intsha, kodwa ziye zakhuthazwa kukutshintsha-tshintsha kwamanani, iingcinezelo zezoqoqosho, kunye neengxaki zempilo kawonke-wonke ezifana nesifo se-COVID-19. Ukuqonda ezi ngxaki kubalulekile ekuqondeni iimpendulo zenkqubo eziye zenziwa ngabalawuli.

Izivalo zokwaluleka kwempilo nokuqiniswa

Ukususela ngo-2010, izibhedlele zasemaphandleni ezingaphezu kwe- 130 ziye zavalwa eUnited States, ngokwenkcazelo evela kwiCecil G. Sheps Center for Health Services Research kwiYunivesithi yaseMntla Carolina. Ezi zivalwayo zishiya abemi bengekho nkonzo yongxamiseko, iibhedi ezilaphu, okanye iigumbi zonyango lwezamayeza kunye namandla okuhlola. Kwabo baseleyo, isibhedlele esikufuphi, zinokuba yiyure okanye ngaphezulu, ezinokuba yingozi kwisiganeko sohlaselo lwentliziyo, isibetho, okanye impazabalazo ezinzima. Iinkokeli ziye zasabela ngokwenza iinkqubo zelizwe ezinika iinkqubo zokuzimonza imigudu enzima nokuhlola ezinye izibhedlele ezingoneli ezingokwakhenkenezo [[FLT:] [FLD1] kunye nezibhedrela zexesha likaxakeka kaxakekayo, ezifumana iMedictacity kwiinkonzo ezithenwayo ezithenjiweyo.

Ukunqongophala komsebenzi kwiindawo ezisemaphandleni

Inkcitho yezempilo ekhoyo kumaphandle emimandla yasemaphandleni inkulu. ISebe lezezimali kunye neSebe lezempilo (HRSA) lichaza amawaka ee-Ofisi ze-Healm Professional Shortages (HPSS) kumaphandle. Imimandla yasemakhaya inabo oogqirha abali-13,5 kubantu abali-10 000 abahlala ezidolophini, xa kuthelekiswa nama-30,9 ekwimimandla yasedolophini. Iimali ezithe zidlulela ngapha nanga koogqirha: abantu basesemaphandleni abaswele amazinyo, asebe lengqondo, abongi, kunye nooogqirha bezempilo abadipoli bemali eninzi. Imali ehlawulwa yimali encinane, ingeniso encinane, inkcitho, inkcitho engo engolwazini engolwazini engondleni, kwaye ilinganiselwe amathuba okunga amathuba eninzi kubantwana abatshana nabo bonke abangafuni ukuzikhethela ukuqhelisa ukusetyenziswa kwemibutho yezo yemfundo yoqeqesho yezonyango kumazwe asekuhlaleni.

Izinto Zokuhamba Nemiqobo Yejiyografi

Naxa kukho iinkonzo, ukufikelela kuzo kusenokuthintela. Abemi basemaphandleni basoloko bengenazo izinto zokuhamba ezithembekileyo, kwaye imigama ukuya kumgcini-khaya okufutshane ingagqitha kwiikhilomitha ezingama-30. Lo mthwalo unzima kakhulu kwiintsapho ezikhulileyo, ezifumana imali ephantsi, kunye nezineemeko ezinganyangekiyo ezifuna ukutyelelwa rhoqo. Umzekelo, isigulana esinesifo seswekile kwingingqi ekude ekude kufuneka sihambe umgama oziikhilomitha ezingama-60 ukuze sihlolwe, ukulahleka komsebenzi kwaye sifumane iindleko-petroli. Ezinye iirhuluneli ziye zafaka iinkqubo zezithuthi zothutho , ezifana nohambo oluncinci oluhambayo, iinkonzo zezothutho lwezamayeza olungekho meyanga-meter, kunye neeyunithi ze-traydrey ezizisa iindleko zoncedo ezizisa ngokuthe ngqo kwiingingqingqi. Amanye amazwe amaqela anxibe iintlanganiso zobugropu ezihamba-omati.

Umlinganiselo Ophakamileyo Wezifo Ezingamachiza Neengxaki Zempilo

Abemi basemaphandleni badla ngokukhula, bahlwempuzekile, yaye baneqondo eliphezulu leemeko ezinganyangekiyo ezifana nesifo sentliziyo, isifo seswekile, kunye nesifo sokuthintela imiphunga esingapheliyo (COPD). Ngaphezu koko, abemi basemaphandleni basengozini yokubandakanyeka kwizenzo zempilo eziphezulu njengokutshaya kwaye bangakwazi ukufunda kakhulu. Ezi zinto zidityaniswa ukuze zibangele iziphumo zempilo ezimandundundu kunye nomlinganiselo ophezulu wokufa kwabantu abafayo. Ii-Ziko zokuLawula ne-Dawulayo (CDC) zinikela ingxelo yokuba amaMelika asemaphandleni afa ngenxa yeziphumo ezingenakuthintelwa zizinto ezingaphezulu kuneedolophu. IiRhuluneli ziye zasabela ngokuyalela imibutho yezo yempilo enzelwe ukuhlasela ukuhlasela nokulawula iinkqubo zempilo, kuquka nezikomishini zempilo yemfundo yemfundo yemfundo yezemfundo yezemfundo yezemfundo yezemfundo yezemfundo yezemfundo yezemfundo yezemfundo yezemfundo yezemfundo yezemfundo yezemfundo yezemali, ii-CDC.

IGarhente ezicwangcisiweyo zisebenzisa ukuphucula indlela yokufikelela

Irhuluneli zinezixhobo ezininzi zenkqubo ezisetyenziswayo. Kuxhomekeke kwilizwe lazo lezobupolitika, umbilini wemali, kunye nezinto eziphambili, ziye zalandela intsalela eyahlukeneyo yezi ndlela zilandelayo.

Ukwandisa iMali

ITelehealth yadubula ngexesha lesifo se-COVID-19, kwaye iinkokeli ezininzi zephondo zakhawuleza ukwenza izinto ezisisigxina ezisisigxina. ITelehealth ivumela izigulana ukuba zidibane noogqirha abangamakhulu eekhilomitha ngaphandle kokushiya amakhaya azo.

  • ukusasaza ufikelelo lwe-intanethi ye- ngombuso wee-ofisi ezibanzi ezivaliweyo, amaqabane kawonke-wonke, kunye nemali ye-ovential ye-Infrapublic Resultmentmentation kunye noMthetho weSebe.
  • Imigaqo-nkqubo yeMedicaid yesizwe ukugquma utyelelo lwe-telekhthi ukwenzela ulwahluko oluninzi lweenkonzo, kuquka impilo yengqondo, ulawulo lwezifo ezinganyangekiyo, kunye nokunqanda.
  • Imithetho ephosa umthetho efuna abangenisi bemali babucala ukubuyisa i-telehealth xa ilingana notyelelo olugqithisileyo.
  • [[NT.0] Ukudibanisa kwizikhulu ze-telehealth ezivumela iikliniki zasemaphandleni zidibane namaziko amayeza emfundo ukudibana kweminye imiba ekude njenge cadiology, i-smatology, kunye nenzululwazi ngemithambo-luvo.

Ngokomzekelo, iphondo laseArkansas, phantsi kweRhuluneli uAsa Hutchinson, lasungula i-Arkansas Telehealth Network, edibanisa amangingqi asemaphandleni angaphezu kwama-400 neengcali kwiYunivesithi yaseArkansas yenzululwazi yezamayeza. Ngokufanayo, iRhuluneli yaseVirginia uRalph Northam yatyisa imiyalelo yegunya elilawulayo ekwandiseni umsebenzi we-telehealth, nto leyo ekhokelela kumthetho osisigxina. Ezi zinyathelo zithe zanciphisa kakhulu imithwalo yokuhamba kwaye zilinde amaxesha kubaguli basemaphandleni.

Inkxaso yemali yabalungiseleli

Ukulungisa ukunqongophala kwabasebenzi, abalawuli baye babeka ulawulo oluphezulu kwiinkqubo zokubhaliswa nokugcinwa kweenkqubo. Ezi ziquka:

  • [[FLT: 0] Imali ehlawulwayo kunye neenkqubo zemfundo ezinikezelwa ngamasebe karhulumente empilo okanye emfundo ephezulu. Umzekelo, iTexas Physician Education Loant Refunger Program inikezela nge-R160 000 kuogqirha abakhonza kumazwe asemaphandleni e-HPSA.
  • Izindlu ezifunyanisiweyo zesizwe kwizibhedlele nakwiikliniki zasemaphandleni, ikhuthaza oogqirha abatsha ukuba bahlale kummandla emva koqeqesho.
  • amatyala etyala neebhonasi zabanikezeli abaqhelisela kwiindawo zasemaphandleni kangangeminyaka embalwa.
  • Ukubonelela ngamacala asekhohlo kunye nezixhobo eziphakathi kwelizwe ezikwenza kube lula ngabanikezeli ukuqhelisela ukunqumla imigca yesizwe, ebaluleke kakhulu kuluntu olusemideni kunye ne-telemedine. INterstamentical Medical Licenfisure Compative Compation, eyamkelwa ngamazwe amaninzi, ikhupha imigaqo yokukhupha iintwala ezintsomi kuogqirha abanqwenela ukuqhelisela kumazwe amaninzi.

“ Inkqubo ye-MO HealthNet” kaMike Parson, phantsi kweRhuluneli, yandisa imbuyekezo yokuhlawula abanyamekela abasebenzi abaphambili kwiindawo zasemaphandleni, ikwenza kube luncedo kakhulu ngokwemali ukwamkela izigulana ezikwi-Medicaid. Umntla Dakota, phantsi kweRhuluneli uDoug Burgum, wasungula inkqubo yokuhlawula imali ebolekwayo yezonyango ehlawula ii-$50 000 ngokuhlawulelwa iingcali zezonyango eziqhuba iziko lonyango lwasemaphandleni.

Ukuphanda Kwizinto Ezifundisa Ukungakhuli Kwamakhaya

Ngaphandle kokugcina izibhedlele zivulekile, abalawuli baxhasa izibonelelo ezintsha kunye neziphelelwe lixesha. Oku kuquka ukuphuculwa kwemali yezixhobo, ulwando, kunye nobugcisa. Izwe laseKhalifoniya, phantsi kweGawulam Newsom, bavumile izibhedlele ezincinane “Izibhedlele zeLoan Program" ukunceda izibhedlele ezilwayo ezizilwayo ekuphepheni ukuvalekeka. Ngaphezu koko, irhuluneli ezininzi ziye zaxhasa i-Emetertentenment Hospital [RET] imodelity [[FLT]], evumela izibhedlele ezincinane ukuba ziguqulelwe kwinkonzo yexesha likaxabisi ngaphandle kwemingxube-24, ukuhlawulwa kwemali ekhuselwayo. EMedicareareads.

Kwakhona abalawuli abaliqela baye baxhasa ukuveliswa kwamaziko ezempilo asemaphandleni, apho abaphandi kunye neekliniki basebenzisana ngezicombululo ezinxulumene neemfuno zasekuhlaleni. Ngokomzekelo, iYunivesithi yeNebraska Medical Center ifumana inkxaso yemali karhulumente yokuvavanya iimodeli zokuhambisa iimodyuli ezintsha, kuquka iikliniki ezihambayo, ukunceda abantu abanoncedo lokuqala oluphezulu, kunye nokuhlolwa kwezigulana ezikude.

Ukunyusa iMedicaid nokunciphisa ukunciphisa

I-inshorensi ye-inshorensi yempilo yeyona nto ingundoqo ekunqandeni ukufikelela. Izinga elingakhutshelwanga kwimimandla yasemaphandleni lidla ngokuphakama kuneedolophana, kwaye abahlali basemaphandleni basengozini yokukhutshelwa. I-Affordible Care Act ye-Medicaid ingumsebenzi ongundoqo wokunciphisa inani labantu abangakhutshelwanga. Ngokwandiswa kwe-2024, amaphondo angamashumi amane ne-Oridilitini yaseColumbia aye andisa iMedicaid. I-od yephondo ekwandiswa kwemali yasemaphandleni kunye nokufikelela komonde ekuthinteleni inkathalo yemoto. Umzekelo, emva kokuba uMontam Medid ekhuliswe kunyaka ka-2016 phantsi kweRhulumente Steve Bullock, izibhedlele zasemakhaya zabona ukuncitshiswa kwemali engakhange i-Mdibi. I-odgertempty, i-odk abaphathi-oth beeageageagee, iqwalasela yeminye yeenkqubo ze-move, i-ogropoog.

Ngaphaya kweMedicaid, abalawuli baye basebenza ukubhalisa abemi basemaphandleni kwiintengiso ze-inshorensi yempilo nokukhuthaza izicwangciso ezifikelelekayo. Imitshintshiswano esekelwe kurhulumente, njengaleyo yaseColorado naseMinnesota, iye yalungisa amaphulo okufikelela kubantu basemaphandleni, ibonelela ngoomatiloshe abahamba ngeenqanawa abaphezulu kunye neenkqubo zokufunda ezilula.

Iimodeli ezitsha kunye nomanyano lwezoburhulumente

Abalawuli abasebenzi bodwa. Balulwalamano oluxhathisayo norhulumente wesizwe necandelo labucala ukuyila iinkqubo ezizinzileyo nezinokusindeka.

Imibutho yokunyamekela abantu ekwimimiselo yasemaphandleni efuna ukuphendula

Abanye abalawuli baye bakhuthaza ukusekwa kwe Intlangano yokunyamekela abaguli ejolise ekuphenduleni ityala [i-ACOs] evumela iikliniki ezincinane nezibhedlele ukuba zingenele ii-glorics ezivuzwayo ezigcina izigulana zisempilweni kunokuba zinikezele nje unyango. Aba ACO basebenzisa abaquququzeleli benkathalo, ugcino-lwazi lwe-alytics, kunye nomonde wokufumana iziphumo zokulawula izifo ezingapheliyo kunye nokunciphisa ukuhlahlela izibhedlele. Urhulumente wase-Io, phantsi kweRhuluneli uKim Reynolders, unika uncedo lobugcisa ukuze asebenze ii-ACOs, okuphumela kwiindleko ezisezantsi kwaye kuphuculwe-mediations zoncedo lwe-Medication.

Abasebenzi Bezonyango Boluntu Nenkxaso Yoontanga

Ekubeni kuqashelwa ukuba ukuthembana kubalulekile kuluntu oluncinane, abalawuli abaninzi baye baxhasa ukuqeqeshwa nokuthunyelwa kwemibutho yezempilo (CHWS) abasoloko behlala kwiindawo ezifanayo. I-CHWS inikela imfundo yempilo, inceda izigulana zihambele phambili kwinkqubo, kwaye inxulumana neenkonzo zoluntu. Amazwe amaninzi, kuquka iNtshona Virginia neKentucky, aye ayila iinkqubo zokuxhasa kunye neendlela zokubuyisela intengiso kwiinkqubo zawo ze-CHWs. Le ndlela iyasebenza ekulawuleni i-heastemic, iswekile, i-swekile, kunye ne-Mayam kwimimandla yasemaphandleni.

Umanyano nezizwe

Kumaphondo anabemi bamaMelika Omthonyama, abalawuli baye basebenza noorhulumente besizwe ukulungelelanisa iinkonzo zonyango kwiinkonzo zolawulo kumacala ommandla. I-Indiyan Health Service (IHS) inceda amalungu amaninzi esizwe, kodwa ubuncwane bayo busoloko bunganele. IiRhuluneli ziye zangena kwizivumelwano zokuthenga izivumelwano, ukudibanisa ugcino-lwazi, kunye nemisebenzi yekliniki edibeneyo ukuchaza. Umzekelo, urhulumente waseAlaska, phantsi kweRhuluneli Mike Duneleavy, osebenzisana nemibutho yezonyango yesizwe ukwandisa ukufikelela kwe-teleheath kunye nokusetyenziswa okukhethekileyo kwemiqathango yephondo, imimandla engangeni melwanga kweendlela.

Imiphumo Emikhulu Neengxaki Eziseleyo

Imigaqo ephunyezwe ngabalawuli iye yavelisa inkqubela-phambili ebonakalayo, kodwa izithuba ezibalulekileyo ziyaqhubekeka. Ukuvavanya impembelelo yokwenene kufuna ukujongwa kwiingcaciso ezininzi.

Amabali Aphumelelayo

  • Ukusetyenziswa kwe-tempelth kwiindawo zasemaphandleni kwande ngama-3000% kwamanye amazwe ukususela ngo-2020, kunye nolwaneliseko lomonde olungaphaya kwama-90%. Abaguli basemaphandleni banikela ingxelo yokulondolozwa kwexesha nemali, kwaye ukugcinwa okungcono kokulandela inkathalo elandelayo.
  • Iinkqubo zokubolekisa ngemali yesizwe zifake amakhulu abanikezeli kuluntu olungaphantsi. Umzekelo, i-Virginia State Loan Refusionment Program ibeke ngaphezu kwe- 150 yabagcini-mdla abaphambili kumaphandle e-HPS njengoko yaqala ukusekwa.
  • Unciphiso kukhuselwe lwezibhedlele ezinokuthintelwa kumazwe anezicwangciso zomsebenzi wempilo woluntu ezinamandla kunye nee-ACOS.
  • Ukuvalwa kwesibhedlele kuthe kwacotha ngokweemeko ezifakelele imali yolwamkelo kunye nokuguqulwa kwimodeli ye-REH. NgokweSps Center, isantya sokuvala siyehla ukusuka ku-avareji yonyaka ye-15 ukuya kweye-9 kwiminyaka emibini emva kokunikezelwa kwegama le-REH.

Imiqobo Eseleyo

Ngaphandle kwezi nzuzo, abantu abaninzi basemaphandleni basajamelana neengxaki ezinkulu zokufikelela. Ukunqongophala komsebenzi kuyaqhubekeka[; urhulumente uqikelela ukuba ii-Infractive Infective Invectorivemental Acts zifuna ama-HPSA iziqu ezingundoqo ezingama-200,000 kwimimandla yasemaphandleni. [ Broadband ukufikelela [[[FLT:]] iknal' ekhoyo: nangona i-Infraclactive Invementation Invementmentmental Imentations is issssssssssssssssss zecreaeaccureat, iindawo ezininzi ezisemaphandleni ezihlala zingagcinwanga zizinto eziphantsi kwezanyalala, zijongene neenko olude lukhulu, [[5] umthamo othe k'okanye, othe wandisa uluntu oluthe , ulwano oluthe , uninzi.[Foffic.]

Indima Yomgaqo-nkqubo Womanyano Noovimba

Abalawuli abanakucombulula unyango lwasemaphandleni kuphela. Inkqubo yomanyano igqiba kwiinketho ezinkulu zobume bukarhulumente.

  • [[NTLA] Amaqondo e-Medicare kunye ne-Medicaid ahlawulelwayo : Amanani aphezulu abanikezeli basemaphandleni aphucula uzinzo lwemali. Iziko leMedicare & Medicaid Services (CMS) liye laqalisa uhlenga-hlengiso oluninzi lokuhlawula kwiindawo zasemaphandleni, kodwa abalawuli baye baxhasa ulwando oluthe lwaya phambili.
  • [[FLT: 0] Iiprojekthi kunye neeprojekthi zokubonisa: Iinkqubo ezifana ne i-HRSA uMatiloshele we-ofisi yezonyango lwasemaphandleni eMasiko-mthetho enikayo [ ibonelela ngenkxaso-mali ye-teleheath, umsebenzi, kunye nonyuselo lweziko. Iijaji ezininzi zisebenzise ezi ngcaciso kwimimiselo yembewu.
  • [[NTLA] Umba othe tye : Iingceba zetelehealth, abasebenzi bezibhedlele, kunye nomgangatho wokuqhelisela ziyingozi. IiRhuluneli ziye zasebenza neCMS kunye neendlu zowiso-mthetho zikarhulumente ukwenza ubhubhani wobuphengululi obungagqibekanga.

Umanyano lwezoburhulumente, olunjenge ukudityaniswa kwe-1115 Medicaids wavers, luvumela iimeko ukuba zivavanye iindlela ezintsha. Umzekelo, iOhio yafumana umxhakamfuli wokuqhuba inqwelo-moya yemodeli ye-“mizi yonyango". Imodeli yabaguli abaneemeko ezingapheliyo emaphandleni asemaphandleni, idibanisa impilo yesimilo kunye nenkathalo ephambili.

Khangela Phambili: Izabelo Zeerhuluneli

Umda olandelayo ekufumaneni unyango lwasemaphandleni uza kubandakanya ukusetyenziswa ngokunzulu kobugcisa, ukusetyenziswa kakhulu kwabanikezeli abangengomalungu e-physics, nokujoliswe kuko okuqhubekayo ekunqandeni impilo yabantu.

  • Umboniso woqheliso olunwenwayo kuqheliselo oluphambili lwabongikazi ababhalisweyo (APRNS), amagosa oogqirha (PAS), kunye noosokhemisi bonyango abanokuqhelisela ngaphezulu kwephepha-mvume labo, nto leyo enokuthi yandise ukufikelela kukungabikho koogqirha.
  • Ukusetyenziswa komzilinge okude kunye nezixhobo ezitshayekayo zokulawula iimeko ezinganyangekiyo, ezixhaswe lutyalo-mali lwemeko kwisiseko sempilo IT.
  • Amaziko ezempilo omeleleyo asekelwe kwisikolo anika abantwana iinkonzo ezisisiseko, ezingokwasengqondweni, kunye namazinyo kwiindawo ezisemaphandleni, asoloko ehlawulwa ngenkxaso karhulumente.
  • [[UMTL:0] Intlawulo yexabiso esekelwe kwintlawulo yeenguqu enika iziphumo kunesandi, ivumela abanikezeli basemaphandleni ukuba bafake ingeniso ekuthinteleni nasekucombululeni.

Abalawuli abaninzi bahlola kwakhona ukuqokelelwa okuphakathi komhlaba ukwenzela i-intephalth snactrectory, ukusetyenziswa kwekhemisti, kwanokwabelana ngogcino-lwazi lwempilo kawonke-wonke ukuchaza iimfuno ezivelayo kwiindawo zasemaphandleni. ukusingqongileyo okulawulayo kusoloko kutshintsha, kwaye abalawuli basebenzisa amazwi abo ukubumba ulawulo lwesizwe kunye nokujolisa ngqo kwiNxulumano yeSizwe.

Isiphelo

Ukufikelela konyango lwasemaphandleni akuyongxaki enye kodwa kuqokelelwa kwemiba edityanisiweyo ebandakanya ukuma komhlaba, izoqoqosho, imisebenzi, kunye nenkqubo. Abalawuli baye bahambela phambili ngezixhobo ezibanzi: ukwandisa i-telehealth, ukunikela impembeleko zemali, ukunikezela ngenkxaso-mali, ukunyusa i-inshorensi, nokukhuthaza ukunikezelwa kwee-inshorensi, ukuqokelelwa kwe-inshorensi, kunye nokuphuhlisa inkqubela phambili yokuveliswa kwemiqathango yempilo. Ngoxa le migudu ivelise iinguqu-nkqubo edityatyanisiweyo eninzi, izigula-ethene, i-asethi, i-asemgangathweni yempilo yasekuhlaleni, i-omatilone, i-omatilone, kunye nomanyano lwengingqi olululungele ukusetyenziswa kwabantu basemaphandleni, kodwa umgangatho ophezulu wolawulo oluthe kezempilo othe gqoyo.