Muva nje, i-National Health Insurance Bureau ikhiphe isaziso esimemezela ukuthi kusukela ngo-Okthoba 1, 2023, kuzosebenzisa ukuqedwa kwelungelo lokubuyela ezibhedlela ezweni lonke.
Le nqubomgomo ibhekwa njengenye indlela enkulu ye-Health Insural Reform, ehlose ukujulisa ukuguquguquka kwempilo yezempilo, ukukhuthaza ukuthuthukiswa kwempilo kanye nokuphathwa komshuwalense wezempilo, ukunakekelwa kwezokwelapha kanye nomuthi, kuthuthukisa ukusebenza kahle kokusetshenziswa kwesikhwama somshuwalense wezempilo , Yehlisa izindleko zokujikeleza kwezokwelapha, futhi futhi uxazulule inkinga yobunzima bokukhokha kwamabhizinisi amakhambi.
Ngakho-ke, kusho ukuthini ukukhansela ilungelo lesibhedlela lokubuya? Yiziphi izinguquko ezintsha ezizoletha embonini yezokwelapha? Ngiyacela uhlanganyele nami ngokwambula le mfihlakalo.
** Okuqediwe kwamalungelo esaphulelo esibhedlela? Jike
Ukuqedwa kwelungelo lesibhedlela lokubuya kubhekisele ekuqedweni kwendima emibili yezibhedlela zikahulumeni njengabathengi kanye nabahlali, kanye nokuxazululwa kwezinkokhelo kumabhizinisi womshuwalense wezokwelapha ngenxa yabo.
Ngokuqondile, izinkokhelo ze-Alliance kaZwelonke, eziphakathi nendawo, imikhiqizo esetshenzisiwe ye-Bamber Ehlanganisiwe Yesifundazwe kanye nemikhiqizo yokuthengwa kwempahla ethengiwe ethengiwe izibhedlela zomshuwalense wezokwelapha kumabhizinisi womshuwalense womphakathi ahambisanayo imali yenyanga elandelayo.
Ububanzi balokhu kuqedwa kwelungelo lokubuya kuhlanganisa zonke izibhedlela zikahulumeni kanye nakho konke ubudlelwano bezwe lonke, phakathi kwezifundazwe, kanye nemikhiqizo ekhethiwe ekhethiwe yezifundazwe kanye nemikhiqizo yokuthenga esezingeni lesifundazwe.
Imikhiqizo ekhethiwe ekuthengeni okuhlanganisiwe okubhekiswe ezidakamizweni ezivunyelwe yiziphathimandla zokulawula izidakamizwa, nezitifiketi zokubhaliswa kwezidakamizwa noma izitifiketi zokubhaliswa kwezidakamizwa ezingenisiwe, kanye namakhodi wekhathalogi lesifundazwe noma lesifundazwe.
Imikhiqizo yokuthengwa kwempahla efakwe kuhlu ibhekiswe kumikhiqizo evunyelwe nguMnyango Wezokuphethwa Kwezidakamizwa kanye Nesitifiketi Sokubhaliswa kwamadivayisi wezokwelapha noma isitifiketi sokubhaliswa kwamadivayisi wezokwelapha angenisiwe, kanye nekhodi yekhathalogu yeZagalodi Lezinga Ezivamile, Kanye nemikhiqizo ye-Vitro Diagnostic reagents ephethwe ngokuhambisana nokuphathwa kwamadivayisi wezokwelapha.
** Iyini inqubo yokususa ilungelo lesibhedlela lokubuya? Jike
Inqubo yokukhansela ilungelo lesibhedlela lokubuya ikakhulukazi kufaka phakathi izixhumanisi ezine: Ukulayishwa kwedatha, ukubuyekezwa kwe-BIL, ukubuyekeza ukubuyekeza nokukhokhelwa kokukhokha nokubuyiselwa kwemali.
Okokuqala, izibhedlela zikahulumeni kuyadingeka ukuqeda ukulayishwa kwedatha yenyanga yenyanga edlule kanye nezikweletu ezihlobene ezinhlelweni "ezihlangene" ezihlangene zohlelo lokuphathwa kwezidakamizwa "ngenyanga ngayinye. Ngaphambi kosuku lwe-8 lwenyanga ngayinye, izibhedlela zizoqinisekisa noma zenzele idatha yokusungula yenyanga edlule.
Ngemuva kwalokho, ngaphambi kosuku lwe-15 lwenyanga ngayinye, inkampani izoqedela ukucwaningwa kanye nokuqinisekiswa kwedatha yokuthenga ngenyanga edlule kanye nezikweletu ezihlobene, futhi ibuye noma yiziphi izikweletu ezingathandeki kumabhizinisi wezemithi ngesikhathi esifanele.
Okulandelayo, ngaphambi kwenyanga ngayinye yenyanga, amabhizinisi amakhambi agcwalisa imininingwane efanelekile futhi alayishe izikweletu ngokusho kwezidingo ezisuselwa kwimininingwane ye-oda yokuthengwa kwempahla yangempela.
Imininingwane yoMthethosivivinywa kufanele ihambisane nedatha yohlelo, njengesisekelo sezibhedlela zikahulumeni ukucwaninga indawo yokuhlala.
Lapho-ke, ngaphambi kwenyanga ngayinye yenyanga, i-Ejensi Yomshwalense Wezempilo ikhiqiza isitatimende sokubuyisana kwenyanga edlule ohlelweni lokuthengwa kwezimpahla olususelwa emiphumeleni yokucwaningwa kwamabhuku kaPhezulu.
Ngaphambi kosuku lwe-25 lwenyanga ngayinye, izibhedlela zomphakathi kanye nezinkampani ezenza imithi ziyabuyekeza futhi ziqinisekise isitatimende sokubuyisana sohlelo lokuthengwa kwempahla. Ngemuva kokubuyekezwa nokuqinisekiswa, idatha yokukhokha kuvunyelwe ukuthi ikhokhwe, futhi uma ingaqinisekiswa sikhathi, kuvunyelwe ukuthi ikhokhwe ngokuzenzakalelayo.
Ngemininingwane yokuxazululwa ngezinto eziphikisayo, izibhedlela zikahulumeni kanye namabhizinisi amakhambi zizogcwalisa izizathu zokuphikisa futhi zibuyisele komunye nomunye, futhi ziqale uhlelo lokusebenza lokucutshungulwa ngaphambi kwenyanga elandelayo.
Ekugcineni, ngokwesigaba sokubuyiselwa kwemali ekhokhelwayo izimpahla, inhlangano yokuphatha ikhiqiza ama-oda wokukhokha wokukhokha ngohlelo lokuthengwa kwempahla futhi iphoqelele imininingwane yokukhokha kwizindawo zezezimali zomshuwalense wezempilo kanye nohlelo lwebhizinisi oluyisisekelo.
Inqubo yonke yokukhokhelwa kwenkokhelo izoqedwa ngasekupheleni kwenyanga ngayinye ukuqinisekisa ukuthi izinkokhelo ezifika ngesikhathi zenziwa ezinkampanini zemithi yezempilo kanye nokususwa kwezinkampani zokuhlala zomshuwalense wezempilo ezihambelana nenyanga elandelayo.
** Yiziphi izinguquko ezintsha ezizosuswa ilungelo lezibhedlela 'lokukhokha emuva zilethe embonini yezempilo? Jike
Ukuqedwa kwelungelo lokubuya kwezibhedlela kuyindlela yokuguqula isinyathelo sokufinyelela okude, okuzokwehlisa kabusha imodi yokusebenza kanye nendlela yentshisekelo yemboni yezempilo, futhi izoba nomthelela omkhulu kuwo wonke amaqembu. Kuboniswa ngokukhethekile kulezi zinto ezilandelayo:
Okokuqala, ezibhedlela zikahulumeni, ukuqedwa kwelungelo lokubuya kusho ukulahleka kwelungelo lokuzimela elibalulekile kanye nomthombo weholo.
Esikhathini esedlule, izibhedlela zikahulumeni zingathola imali eyengeziwe ngokuxoxisana ngezikhathi zokukhokha ngamabhizinisi wezemithi noma ukucela ama-kickbacks. Kodwa-ke, lo mkhuba uholele ekubuthweni kwezintshisakalo kanye nokuncintisana okungafanele phakathi kwezibhedlela zomphakathi namabhizinisi amakhambi, ukubeka i-oda lemakethe nezintshisekelo zeziguli.
Ngokuqedwa kwelungelo lokukhokha emuva, izibhedlela zikahulumeni ngeke zikwazi ukuthola inzuzo noma izaphulelo ekukhokheni izimpahla, futhi ngeke zisebenzise inkokhelo yezimpahla njengezaba zokuzenzakalelayo noma zenqabe ukukhokha amabhizinisi ezenzakade.
Lokhu kuzophoqa izibhedlela zikahulumeni ukuthi zishintshe ukucabanga kwazo kanye nokuphatha kanye nekhwalithi yangaphakathi nekhwalithi yesevisi, futhi zincike kakhulu kuxhaso lukahulumeni kanye nezinkokhelo zeziguli.
Kwezinkampani ezenza imithi, ukuqedwa kwelungelo lokubuya kusho ukuxazulula inkinga emide yokubuyisa okunzima ukubuyisa emuva.
Esikhathini esedlule, izibhedlela zikahulumeni zibamba isinyathelo kuqala kanye nelungelo lokukhuluma ekuxazululeni izinkokhelo, kaningi ngenxa yezizathu ezahlukahlukene zokuzenzakalelayo noma ukudonsa inkokhelo yezimpahla. Khansela ilungelo lokubuya, izinkampani ezenza imithi zizobe zivela esikhwameni somshuwalense wezokwelapha ukuze sithole inkokhelo, akusekho ngaphansi kwethonya lezibhedlela zomphakathi nokuphazanyiswa.
Lokhu kuzodambisa kakhulu ingcindezi yezezimali emabhizinisini amakhambi, kuthuthukise ukuhamba kwemali kanye nenzuzo, futhi kusiza ukutshalwa kwezimali okukhuphukayo ku-R & D kanye nokwenza izinto ezintsha ukuze uthuthukise ikhwalithi yomkhiqizo nokuncintisana.
Ngaphezu kwalokho, ukuqedwa kwelungelo lokubuya kubuye kusho ukuthi amabhizinisi amakhamithi abhekana nokuqashwa okuqinile futhi okujwayelekile, futhi awasakwazi ukusebenzisa ama-kickbacks kanye nezinye izindlela ezingalungile ukuze akhuphule amanani entengo noma kufanele athembele kwizindleko- Ukusebenza kahle komkhiqizo kanye nezinga lenkonzo ukuwina amakhasimende kanye nemakethe.
Kwabasebenzi be-Health Insurance Operators, ukuqedwa kwelungelo lokubuya kusho ukubolekisa okwengeziwe kanye nemisebenzi.
Esikhathini esedlule, opharetha womshuwalense wezempilo badinga kuphela ukuzinza nezibhedlela zikahulumeni futhi bekungadingi ukubhekana ngqo nezinkampani ezenzakade.
Ngemuva kokuqedwa kwelungelo lokubuya, i-ejensi yomshuwalense wezempilo izoba ngumzimba oyinhloko wokuxazululwa kwezinkokhelo, futhi kudingeka ukuthi isebenze nezibhedlela zomphakathi nezinkampani ezenzakade ukwenza imali yedatha, ukucwaningwa kwamabhuku okubhalwe phansi kanye nokukhokha kwezimpahla kanye kanjalo.
Lokhu kuzokwengeza umthwalo kanye nengozi yezinhlangano zomshuwalense wezempilo, futhi zidinga ukuthi zithuthukise ukuphathwa kwazo kanye nama-informatization amazinga, futhi zisungule indawo yokuhlola nokuhlola okuzwakalayo yokuqinisekisa izindawo zokukhokha ezifanele, ezifika ngesikhathi.
Ekugcineni, ezigulini, ukuqedwa kwelungelo lokubuya kusho ukujabulela izinsizakalo zezokwelapha ezibonakalayo.
Esikhathini esedlule, ngenxa yokudluliselwa kwezinzuzo kanye nokukhahlela phakathi kwezibhedlela zomphakathi kanye nezinkampani ezenza imithi, iziguli zazivame ukungakwazi ukuthola amanani amahle noma imikhiqizo efaneleke kakhulu.
Ngokuqedwa kwelungelo lokukhokha emuva, izibhedlela zikahulumeni zizolahlekelwa yisisusa nekamelo ukuthola inzuzo noma ukukhahlela kusuka ekukhokheni izimpahla, futhi ngeke zikwazi ukusebenzisa inkokhelo yezimpahla njengezaba zokwenqaba ukusebenzisa imikhiqizo ethile noma ukukhuthaza okuthile imikhiqizo.
Lokhu kwenza iziguli zikwazi ukukhetha imikhiqizo nezinsizakalo ezifanele kakhulu ngokuya ngezidingo zazo kanye nezimo endaweni yemakethe ebonakalayo.
Ngamafuphi, ukuqedwa kwelungelo lokubuyisa izibhedlela kuyisinyathelo esikhulu sokuguqula okuzoba nomthelela ofinyelela kude emkhakheni wezokunakekelwa kwempilo.
Akugcini nje ngokuqinisekisa imodi yokusebenza yezibhedlela zikahulumeni, kodwa futhi iguqula indlela yokuthuthuka yamabhizinisi amakhambi.
Ngasikhathi sinye, kuthuthukisa izinga lokuphatha izinhlangano zomshuwalense wezempilo kanye nezinga lezinsizakalo zeziguli. Kuzothuthukisa ukuthuthukiswa kwe-synergistic kanye nokuphathwa komshuwalense wezempilo, ukunakekelwa kwezemithi kanye nemithi, kuthuthukise ukusebenza kahle kwezimali zesikhwama sezempilo, kunciphise izindleko zokujikeleza kwezemithi, futhi kuvikele amalungelo asemthethweni neziguli.
Ake sibheke phambili ekusetshenzisweni ngempumelelo kwalesi singuquko, esizoletha kusasa okungcono embonini yezokwelapha!
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Isikhathi sePosi: Sep-06-2023