Ngomhla zi-5 kuMandulo, Ihhovisi Lokuvikeleka Kwezempilo Lombuso lakhipha Isaziso Sehhovisi Lokuvikeleka Kwezempilo Lombuso Ngokwenza Umsebenzi Omuhle Ekuphathweni Kwenkokhelo Yezinto Zokusetshenziswa Zezokwelapha Zomshwalense Oyisisekelo Wezokwelapha (ozobizwa kamuva ngokuthi “Isaziso”), esihlanganisa izinto ezi-4 ezinkulu. izingxenye kanye nezihloko eziyi-15.Izinto ezisetshenziswayo kwezokwelashwa okukhulunywe ngazo eSaziso yilezo ezibhalisiwe noma ezifakwe iziphathimandla zemishini yezokwelapha, ezinikezwe isimo sokufakwa ohlwini futhi zingakhokhiswa ngokuhlukile.
NgokweSaziso, kusukela ngedethi yokukhishwa kwalesi Saziso, izifundazwe kufanele zibike ku-State Medical Insurance Bureau ngerekhodi ngaphambi kokwethula ikhathalogi yezinto ezisetshenziswayo zezokwelapha ukuze zisetshenziswe.Iminyango yesifundazwe yomshwalense wezokwelapha iyakhuthazwa ukuthi ithathe uhlobo lomfelandawonye wesifunda noma ukubambisana ukuze ihlole ukusungulwa kwekhathalogi ehlangene esetshenziswayo kanye namazinga okukhokha ngaphakathi komfelandawonye noma isifunda.I-NHPA izokwethula ukuthuthukiswa kwekhathalogi kazwelonke yezinto ezisetshenziswayo zezokwelapha zomshuwalense wezokwelapha ngokuhamba kwesikhathi.
Amaphuzu abalulekile afingqiwe ngezansi:
Iphuzu loku-1: Khuthaza ukuhlanganiswa kukazwelonke kokuhlukaniswa kanye nekhodi yezinto ezisetshenziswayo
Isaziso sithi ukuhlukaniswa kanye nekhodi yezinto ezisetshenziswayo kwezokwelashwa kufanele kuhlanganiswe.Ukukhuthaza ngokuqinile ukusetshenziswa kwekhodi kazwelonke yezinto ezisetshenziswayo zokwelashwa komshwalense wezempilo, ngesikhathi esifanele ngokuhambisana ne-National Health Insurance Bureau ukuthuthukisa ukuhlukaniswa kwezinto ezisetshenziswayo zezokwelapha kanye nesizindalwazi sekhodi ukuze kwenziwe umsebenzi omuhle wokubuyekeza ikhodi yezinto ezisetshenziswayo zokwelashwa ukuze kuthuthukiswe ukusetshenziswa kokunemba kanye nokumiswa kwekhodi yezinto ezisetshenziswayo kwezokwelashwa ukuze kuzuzwe okusebenzisekayo kwezokwelapha ngekhodi yokuthengwa kwempahla, ngekhodi okufanele isetshenziswe, nekhodi yokukhokhiswa, ngokugadwa kwekhodi, kanye nokuqinisekisa ukuthi ukuhlukaniswa kwezimpahla zokwelashwa kanye nekhodi ubunye besizwe.
Iphuzu lesibili: ukuhlukaniswa kokusetshenziswa kobuchwepheshe, lolu hlobo lwezinto ezidlekayo zibe inkokhelo yomshwalense wezokwelapha
Isaziso sibonisa ukuthi ububanzi bezinto ezisetshenziswayo okufanele zifakwe ekukhokhweni komshwalense wezokwelapha.Ukuze uvumelane nesimiso sokushintsha amanani esevisi yezokwelapha “amasevisi obuchwepheshe nokusetshenziswa okuhlukile okuhlukile”, qinisa iphrojekthi yamanani esevisi yezokwelapha kanye nokuxhumana kokuphathwa kwenkokhelo yempahla yezokwelapha, futhi kancane kancane ngeke kufakwe ekwakhiweni kwentengo yesevisi yezokwelashwa yezimpahla zokwelashwa ezilahlwayo ngokuvumelana izinhlinzeko zobubanzi bokuphathwa kwenkokhelo yomshwalense wezokwelapha.
Iphuzu lesithathu: lezi zinto ezisetshenziswayo ngeke zifakwe ngokomgomo enkokhelweni yomshwalense wezokwelapha
Mayelana nokufinyelela kumshwalense wezokwelapha, “Isaziso” sihlinzeka ngokubambelela “esiyisisekelo” sokuma kokusebenza.Ukufinyelela nokuphathwa kwezinto ezisetshenziswayo zokwelashwa eziyisisekelo zomshwalense wezokwelapha kufanele ngaso sonke isikhathi kuhambisane ngokuqinile nokuma kokusebenza “okuyisisekelo”, benze konke okusemandleni abo, ngokwamandla abo, futhi kunqume ngokunengqondo ububanzi bezindinganiso zokukhokha nezinkokhelo, kugxilwe endimeni yokuthenga yesu lezokwelapha. Isikhwama somshwalense, sizodingeka ngokomtholampilo, siphephe futhi siphumelele, izinto ezisetshenziswayo zokwelashwa ezinenani elizwakalayo endaweni yokukhokhwa komshwalense wezokwelapha ngokuhambisana nezinqubo.Izinto ezisetshenziswayo kwezokwelashwa zizofakwa esibalweni senkokhelo yomshwalense wezokwelapha ngokuhambisana nohlelo.
Empeleni, izinto ezisetshenziswayo zokwelapha ezinenani eliphansi lomtholampilo, izintengo noma izindleko ezedlula kude ukufinyeleleka kwesikhwama neziguli, kanye nemishini yokulungisa okungezona ezokwelapha ngeke ifakwe kububanzi benkokhelo yomshwalense wezokwelapha.Ukuze umbuso udinge ngokucacile ukuthi ungafakwa kububanzi benkokhelo yomshwalense wezokwelapha wezinto ezisetshenziswayo, unamathele ezinhlinzekweni zangempela.
Iphuzu lesine: ukuqaliswa kancane kancane kokuphathwa kwegama elivamile lomshwalense wezokwelapha
Isaziso sikhombisa ukuthi i-State Medical Insurance Bureau izocwaninga ngokusungulwa kohlelo lokuphatha amagama afanayo lezinto ezisetshenziswayo zezokwelapha ngaphansi komshwalense wezokwelapha, ngokusekelwe ekuhlukaniseni kanye nesizindalwazi sekhodi sezinto ezisetshenziswayo zezokwelapha ngaphansi komshwalense wezokwelapha, linqume izinkambiso zokuqamba ezifanele ukuphathwa komshuwalense wezempilo. inkokhelo yomshwalense wezokwelapha, kancane kancane yakha imithetho yokuqamba amagama avamile ezigaba ezahlukene zezinto ezisetshenziswayo zezokwelapha, futhi ihlanganise igama elivamile lomshwalense wezokwelapha njengesisekelo sesinyathelo esilandelayo ekuphathweni kwenkokhelo yomshwalense wezokwelapha.
Ezintweni ezisetshenziswayo zezokwelapha ezinamagama avamile asevele akhiwe, kufanele sikhuthaze ngokuqhubekayo ukuphathwa kwenkokhelo yomshwalense wezokwelapha wezinto ezisetshenziswayo zezokwelapha ngokuya ngamagama avamile.Ezintweni ezisetshenziswayo zezokwelapha ezingakaqambi igama elivamile, ukuhlukaniswa kwamanje kanye nekhodi kuzosetshenziswa okwamanje ekuphathweni kwenkokhelo yomshwalense wezokwelapha.
Iphuzu lesi-5: Isikhathi “Seminyaka Eyi-14 Yeminyaka Emihlanu”, ukusungulwa kwekhathalogi yezinto ezisetshenziswayo zomshwalense wezokwelapha wesifundazwe
Isaziso sikwenza kucace ukuthi ukuphathwa kokufinyelela kwekhathalogi yezinto ezidlekayo zezokwelapha kuthuthuka kancane kancane.Ukukhuthaza ukusungulwa kwesistimu yokufinyelela ezintweni ezidliwayo zezokwelapha, isikhathi “seminyaka eyi-14 yeminyaka emihlanu”, kufanele siqedwe ngokuvumelana nomthetho wokufinyelela ukuze kuthuthukiswe isifundazwe (izifunda ezizimele, omasipala ngokuqondile ngaphansi kukaHulumeni Omkhulu) umkhombandlela ohlanganisiwe wezinto ezisetshenziswayo zokwelashwa zomshwalense wezokwelapha.
Kulesi sigaba sekusungulwe umshwalense wezokwelapha ohlangene wesifunda wemibhalo yesifunda, osuselwe okwesikhashana kusigaba nekhodi yomshwalense wezokwelapha kazwelonke, futhi kancane kancane uye ekushintsheni kokuphathwa kwegama lomshwalense wezokwelapha.Okwamanje ayikaqalisi uhla lwemibhalo oluhlangene lwempahla yezokwelapha esifundazweni ukuze kwandiswe imizamo yokuthi “Isikhathi Seminyaka Eyi-14 Yeminyaka Emihlanu” kusungulwe uhla lwemibhalo oluhlangene lwempahla yezokwelapha esifundazweni.
Ukuze uthole ukuphathwa okujwayelekile okwengeziwe kwezinto ezisetshenziswayo, kancane kancane umbuso uzothuthukisa ikhathalogi kazwelonke yomshwalense wezokwelapha obumbene, futhi kancane kancane andise ububanzi bekhathalogi kazwelonke embozwe isigaba sezinto ezisetshenziswayo.
Iphuzu lesi-6: Sungula indlela yokulungisa eguquguqukayo futhi uhlole ukufinyelela okuxoxiwe ngakho ukuze uthole okusebenzisekayo okukhethekile
NgokweSaziso, isifundazwe ngasinye kufanele sihlele izinto ezisetshenziswayo zezokwelapha, ezomtholampilo, zokuphathwa komshwalense wezempilo, ukuhlolwa kobuchwepheshe nabanye ochwepheshe nezinhlangano ezihlobene nomkhakha, ngenqubo yokuhlola esezingeni, izinto ezisetshenziswayo zezokwelapha ezifanele zibe ohlwini lwemibhalo ngokuhambisana nezinqubo, kanye imiphumela yokuhlolwa izodalulwa emphakathini ngesikhathi esifanele.Khuthaza ukufakwa okubalulekile kukhathalogi yezinto ezisetshenziswayo ezikhethiwe kusukela ekuthengeni okuhlanganisiwe okuthobelana nenqubomgomo yokukhokha yamanje.Hlola ukufinyelela kumikhiqizo yekhethelo noma yenani eliphezulu ngokuxoxisana nezinye izindlela.
Ngaphezu kwalokho, kufanele kusungulwe indlela yokulungisa eguquguqukayo yomsindo.Cabangela ngokugcwele inqubekelaphambili yezobuchwepheshe yezinto ezisetshenziswayo zokwelashwa, ukusetshenziswa komtholampilo, amanani namazinga ezindleko, kanye nokufinyeleleka kwesikhwama somshwalense wezokwelapha kanye nabantu abanomshwalense, njll., ukuze kufezeke ukulungiswa okuguquguqukayo kokungena nokuphuma.Ukugcwaliswa ngesikhathi kwemikhiqizo emisha yobuchwepheshe edingekayo, ukuhoxiswa komtholampilo kungashintshwa kangcono, ukuhlolwa kwezomnotho okungalungile, yiminyango efanele efakwe ohlwini olubi kanye neminye imikhiqizo ayihlangabezani nezidingo zomshwalense wezokwelapha.
Ngesikhathi esifanayo, ukusungulwa kwendlela yokuvimbela ubungozi ezwakalayo yokulungiswa kobubanzi bokukhokhelwa komshwalense wezokwelapha osetshenziswayo, ukuphepha kwesikhwama, ukwelashwa kweziguli isikhathi eside sokubala okunembile, ngezingozi ezingaba khona ukuthuthukiswa kohlelo, ikakhulukazi olubandakanya ukudluliswa kobubanzi bokukhokha kwezinhlobonhlobo zezinye izindlela ukwenza umsebenzi omuhle wokuqinisekisa ukuvikelwa kwamalungelo nezintshisakalo zeziguli.
Iphuzu lesi-7: Kancane kancane bhalansisa inqubomgomo yokukhokha esifundazweni
Isaziso sikhombisa ukuthi inqubomgomo yokukhokha kufanele ididiyelwe futhi ithuthukiswe.Khuthaza inqubomgomo yokukhokha ukuthi ibe yesayensi kakhulu futhi icwengisiswe, futhi kancane kancane uyiqede inqubomgomo yokukhokha ngobudlabha ngokusekelwe kuphela enkokhelweni ehlukene yezinga lezindleko, kanye nesabelo sobukhulu obufanayo noma umkhawulo wokukhokha.
Izindawo ezididiyelwe zingacabangela izici ezinjengokukwazi ukukhokhela isikhwama kanye nomthwalo kulowo onomshwalense, futhi ngokuya ngesimo sangempela samanye amanani aphezulu noma izindleko zezinto ezisetshenziswayo zokwelashwa ukuze kumiswe isilinganiso sokuqala sokukhokha ngaphandle kwephakethe.Iminyango yomshwalense wezempilo ezifundazweni kufanele iqinise ukusebenzisana, ilinganise kancane kancane izinqubomgomo zokukhokha namazinga okuvikela ezifunda ezididiyelwe esifundazweni, futhi ikhuthaze izifundazwe ezinemibandela ukuthi zifeze ubumbano ngokwesisekelo sesifundazwe ngokushesha okukhulu.
Iphuzu lesi-8: Ukusungulwa kwendlela yokukhuthaza i-DRG/DIP ye-synergistic
Nyusa izindinganiso zokukhokha ngendlela enganyakazi nehlelekile.Khuthaza izifundazwe ukuthi zihlole ukuthuthukiswa kwezindinganiso zokukhokha izinto ezisetshenziswayo zezokwelapha zomshuwalense wezokwelapha futhi zenze izinguquko eziguqukayo.Thuthukisa indlela yokusebenzisana phakathi kwamazinga okukhokha nezintengo zokuthenga ezimaphakathi, futhi unqume amazinga okukhokha emikhiqizo ekhethwe ekuthengeni kwebhendi emaphakathi ngokuvumelana nemithetho efanele.Hlola izingxoxo zokufinyelela nezinye izindlela zokunquma ngokunengqondo izindinganiso zokukhokha kwezinye izinto ezisetshenziswayo zokwelapha ezinenani eliphezulu.Ezintweni ezisetshenziswayo zezokwelapha ezinomsebenzi nokusetshenziswa okufanayo, izinto ezifanayo nezici, ukushintshwa komtholampilo, nokuhlangana kokuphathwa komshwalense wezokwelapha, izindinganiso zokukhokha ezihlanganisiwe zingakhiwa.
Vumelanisa ukuguqulwa kwendlela yokukhokha.Ukusungula indlela yokukhuthazwa kwe-synergistic ne-DRG, ukuguqulwa kwendlela yokukhokha ye-DIP nezinye izinqubomgomo ukuze kwakhe umphumela wokunqwabelanisa omuhle.Cabangela ububanzi bokukhokha, izinga lokukhokha kanye nenqubomgomo yokukhokha yezimpahla zezokwelapha ngendlela ehlanganisiwe, futhi uthuthukise isabelomali esiphelele nezinga lokukhokha lezinhlobo/amaqembu ezifo ngesikhathi.
Iphuzu lesishiyagalolunye: lezi zinto ezisetshenziswayo zigxile ekuqapheni
NgokweSaziso, kufanele kusungulwe indlela yokuqapha nokuhlola ukukhokhelwa komshwalense wezokwelapha.Izifundazwe njalo mayelana nokutholakala komshwalense wezempilo wesifundazwe, ukukhokhelwa kwesikhwama somshwalense wezempilo, umthwalo wesiguli, njll., kanye nokuthengwa kwempahla nge-inthanethi, izinga lokuthengwa kwempahla nge-inthanethi, njll., ukuqapha, izibalo, ukuhlaziya, okugxile ekusetshenzisweni komtholampilo okungaphezu kwe ukusetshenziswa kwezimali kanye nomthwalo wesiguli wezinto ezisetshenziswayo zezokwelapha ukuqapha umthwalo osindayo.
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Isikhathi sokuthumela: Sep-11-2023