Njengoko izigulane zithembela ngakumbi kubameli kunye neenkonzo zabo, ukhathalelo lwezempilo lwase-US luye lwavelisa oko uDkt Robert Pearl abiza ngokuthi "ingqondo ephakathi".
Phakathi kwabavelisi kunye nabathengi, uya kufumana iqela leengcali eziququzelela ukuthengiselana, ziququzelele kwaye zithumele iimpahla kunye neenkonzo.
Eyaziwa ngokuba ngabalamleli, bayachuma phantse kuwo onke amashishini, ukusuka kwi-real estate kunye nokuthengisa ukuya kwiinkonzo zemali kunye nezohambo.Ngaphandle kwabameli, izindlu neehempe bezingayi kuthengiswa.Akuyi kubakho zibhanki okanye iindawo zokubhukisha kwi-intanethi.Ndiyabulela kubalamleli, iitumato ezikhule eMzantsi Melika zihanjiswa ngenqanawa ukuya eNyakatho Melika, zidlule kumasiko, ziphelele kwivenkile enkulu yasekhaya kwaye ziphelele kwibhaskithi yakho.
Abalamli benza konke ngexabiso.Abathengi kunye nabezoqoqosho abavumelani malunga nokuba abalamli zizifunxi-gazi eziyimfuneko kubomi banamhlanje, okanye zombini.
Logama nje impikiswano iqhubeka, inye into eqinisekileyo: Abameli bezempilo base-US baninzi kwaye bayachuma.
Oogqirha kunye nezigulana zigcina ubudlelwane bomntu kwaye zihlawula ngokuthe ngqo phambi kokuba abalamli bangene.
Umlimi wenkulungwane ye-19 owayeqaqanjelwa ngamagxa wacela ukutyelelwa ngugqirha wentsapho yakhe, owamxilonga umzimba, wamxilonga waza wafumana iyeza leentlungu.Konke oku kungatshintshwa ngenkukhu okanye imali encinci.Umthetheli akafuneki.
Oku kwaqala ukutshintsha kwisiqingatha sokuqala senkulungwane yama-20, xa iindleko kunye nobunzima bokunyamekela kwaba ngumcimbi kwabaninzi.Kwi-1929, xa i-stock market yaphuka, i-Blue Cross yaqala njengentsebenziswano phakathi kwezibhedlele zaseTexas kunye nabafundisi bendawo.Ootitshala bahlawula ibhonasi yenyanga ye-50 yeesenti ukuze bahlawulele unyango olufunekayo esibhedlele.
Abarhwebi be-inshorensi ngabangeneleli abalandelayo kwezamayeza, becebisa abantu ngezona zicwangciso ze-inshurensi yezempilo kunye neenkampani zeinshorensi.Xa iinkampani ze-inshorensi zaqala ukubonelela ngeenzuzo zamayeza amiselweyo ngoo-1960, ii-PBMs (Abaphathi beNzuzo ye-Pharmacy) bavela ukunceda ukulawula iindleko zamachiza.
Abalamli bakho yonke indawo kwindawo yedijithali kule mihla.Iinkampani ezifana neTeledoc kunye neZocDoc zenzelwe ukunceda abantu bafumane oogqirha imini nobusuku.Amahlumela e-PBM, afana ne-GoodRx, angena emarikeni ukuze athethathethane ngamaxabiso amachiza nabavelisi kunye neekhemesti egameni lezigulana.Iinkonzo zempilo yengqondo ezifana ne-Talkspace kunye ne-BetterHelp ziye zavela ukuze zidibanise abantu kunye noogqirha abanelayisensi yokumisela amayeza engqondo.
Ezi zisombululo zamanqaku zinceda izigulana zijonge ngcono iinkqubo zokhathalelo lwempilo ezingasebenziyo, ukwenza ukhathalelo kunye nonyango lube lula ngakumbi, lufikeleleke kwaye lufikeleleke.Kodwa njengoko izigulana zithembela ngakumbi kubalamli kunye neenkonzo zabo, into endiyibiza ngokuba yingqondo ephakathi iye yavela kukhathalelo lwezempilo lwaseMelika.
Khawufane ucinge ukuba ufumene ukuqhekeka okude kumphezulu wendlela yakho.Unako ukuphakamisa i-asphalt, susa iingcambu ngaphantsi kwaye uphinde uzalise yonke indawo.Okanye ungaqesha umntu ukuba ahlahlele indlela.
Nokuba yeyiphi na ishishini okanye umba, abalamli bagcina “ukulungisa” ukucinga.Injongo yabo kukusombulula ingxaki emxinwa ngaphandle kokuqwalasela iingxaki ezihamba kunye (ngokuqhelekileyo zesakhiwo) emva kwayo.
Ke xa isigulana singamfumani ugqirha, iZocdoc okanye iTeledoc inokunceda ukwenza idinga.Kodwa ezi nkampani ziyawuhoya umbuzo omkhulu: Kutheni kunzima kangaka ukuba abantu bafumane oogqirha abafikelelekayo kwasekuqaleni?Ngokufanayo, i-GoodRx inokubonelela ngamakhuphoni xa izigulane zingakwazi ukuthenga amachiza kwikhemesti.Kodwa inkampani ayikhathali ukuba kutheni abantu baseMelika behlawula kabini imigqaliselo njengabantu abakwamanye amazwe e-OECD.
Ukhathalelo lwempilo lwaseMelika luwohloka ngenxa yokuba abalamli abajongi ezi ngxaki zinkulu, ezingasonjululwanga.Ukusebenzisa isifaniso sonyango, umlamli unokunciphisa iimeko ezisongela ubomi.Abazami ukubaphilisa.
Ukucaca, ingxaki ngamayeza ayikobukho babalamleli.Ukunqongophala kweenkokeli ezizimiseleyo nezikwaziyo ukubuyisela iziseko ezonakalisiweyo zokhathalelo lwempilo.
Umzekelo wolu kungabikho kobunkokeli ngumzekelo wokubuyisela "umrhumo-ngenkonzo" oxhaphakileyo kwinkathalo yezempilo yase-US, apho oogqirha kunye nezibhedlele zihlawulwa ngokusekelwe kwinani leenkonzo (uvavanyo, unyango, kunye neenkqubo) ababonelela ngazo.Le ndlela yokuhlawula "ingeniso njengoko usebenzisa" iyavakala kumashishini amaninzi.Kodwa kukhathalelo lwempilo, iziphumo ziye zaba yindleko kwaye zichasene.
Kwi-pay-per-service, oogqirha bahlawulwa ngaphezulu ngokunyanga ingxaki yezonyango kunokuthintela.Banomdla wokubonelela ngononophelo olungakumbi, nokuba yongeza ixabiso.
Ukuxhomekeka kwelizwe lethu kwimirhumo kunceda ukucacisa ukuba kutheni iindleko zokhathalelo lwezempilo zase-US zinyuke ngokuphindwe kabini ngokukhawuleza njengokunyuka kwamaxabiso kule minyaka ingamashumi amabini idlulileyo, ngelixa ixesha lokuphila lingazange litshintshe ngexesha elifanayo.Okwangoku, i-US isemva kwawo onke amanye amazwe aphuhlileyo kumgangatho wezonyango, kwaye amazinga okusweleka kwabantwana kunye nomama aphindwe kabini kunamanye amazwe atyebileyo.
Unokucinga ukuba abaqeqeshi bezempilo baya kuba neentloni ngolu kusilela - baya kugxininisa ekutshintsheni le modeli yentlawulo engasebenziyo kunye neyona nto igxininise kwixabiso lenkathalo enikezelwayo kunokuba inani lokhathalelo olunikezelwayo.Awukho right.
Imodeli yokuhlawula ixabiso lifuna oogqirha kunye nezibhedlele ukuba bathathe ingozi yemali kwiziphumo zeklinikhi.Kubo, ukutshintshela kwi-prepayment igcwele umngcipheko wemali.Ke endaweni yokuba balixhakamfule elo thuba, bamkela isimo sengqondo somntu ophakathi, bekhetha utshintsho oluncinci oluncinci ukunciphisa umngcipheko.
Njengoko oogqirha kunye nezibhedlele besala ukuhlawula iindleko, iinkampani zeinshorensi zabucala kunye norhulumente womanyano babhenela ekuhlawuleni-ukusebenza iinkqubo ezimele i-middleman mindset egqithisileyo.
Ezi nkqubo zenkuthazo zivuza oogqirha ngeedola ezimbalwa ezongezelelweyo ngexesha ngalinye zibonelela ngenkonzo ethile yothintelo.Kodwa ngenxa yokuba kukho amakhulu eendlela ezisekelwe kubungqina bokuthintela izifo (kwaye kuphela isixa esilinganiselweyo semali yenkuthazo ekhoyo), amanyathelo okuthintela angenayo inkuthazo ahlala engahoywa.
Ingqondo yomntu ophakathi ikhula kakuhle kumashishini angasebenziyo, iinkokeli ezibuthathaka kunye nokuthintela utshintsho.Ke ngoko, ngokukhawuleza ishishini lezempilo lase-US libuyela kwingqondo yalo yobunkokeli, kungcono.
Iinkokeli zithatha inyathelo eliya phambili kwaye zisombulule iingxaki ezinkulu ngezenzo ezinesibindi.Abantu abaphakathi basebenzisa iibhendi ukuze bazifihle.Xa kukho into engahambi kakuhle, iinkokeli zithatha uxanduva.Ingqondo yomlamli ibeka ityala komnye umntu.
Kuyafana namayeza aseMelika, abathengi bamayeza batyhola iinkampani zeinshorensi ngeendleko eziphezulu kunye nempilo enkenenkene.Kwelinye icala, inkampani yeinshorensi igxeka ugqirha ngayo yonke into.Oogqirha bagxeka izigulane, abalawuli kunye neenkampani zokutya okukhawulezayo.Abaguli batyhola abaqeshi babo norhulumente.Sisangqa esikhohlakeleyo esingenasiphelo.
Ngokuqinisekileyo, kukho abantu abaninzi kwishishini lezempilo-ii-CEO, izitulo zeebhodi zabalawuli, abongameli bamaqela ezonyango, kunye nabanye abaninzi-abanamandla kunye nokukwazi ukukhokela utshintsho lwenguqu.Kodwa isimo sengqondo somlamli siyabazalisa uloyiko, sinciphise ukugxila kwabo, kwaye sibatyhalele kuphuculo oluncinci.
Amanyathelo amancinci awanele ukoyisa iingxaki zempilo eziya zisiba mandundu kunye nezixhaphakileyo.Ngethuba nje isisombululo sezempilo sihlala sincinci, iziphumo zokungasebenzi ziya kunyuka.
Ukhathalelo lwezempilo lwaseMelika lufuna iinkokeli ezinamandla zokwaphula ingqondo yomntu ophakathi kwaye zikhuthaze abanye ukuba bathathe inyathelo elinesibindi.
Impumelelo iya kufuna ukuba iinkokeli zisebenzise intliziyo, ingqondo, kunye nomqolo-imimandla emithathu (ngokomfanekiso) ye-anatomical efunekayo ukuzisa utshintsho lwenguqu.Nangona i-anatomy yobunkokeli ingafundiswanga kwizikolo zonyango okanye zabahlengikazi, ikamva leyeza lixhomekeke kuyo.
Amanqaku amathathu alandelayo kolu ngcelele aza kuphonononga olu didi lwendalo kwaye achaze amanyathelo anokuthi athathwe ziinkokeli ukuguqula ukhathalelo lwempilo lwaseMelika.Inyathelo 1: Yahlukana nemeko yengqondo yomntu ophakathi.