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I-Medicaid izakha kanjani izindleko nokusatshalaliswa eMelika

I-Medicaid izakha kanjani izindleko nokusatshalaliswa eMelikaInkampani

AbaseMelika bakhokha isilinganiso cishe $ 1,200 ngonyaka ngemiyalelo — futhi lelo nani limele izindleko ezingaphandle kwezikhwama zodwa.

liyini izinga likashukela elihle lohlobo 2 sikashukela

Wonke amanye amanani entengo kadokotela awela kubaqashi nakwabahlinzeki bomshuwalense, kufaka phakathi izinhlelo zombuso nezikahulumeni ezifana I-Medicaid , ehlanganisa abantu abangaphezu kwezigidi ezingama-70. Abanye baphikelela ukuthi abaphathi beMedicaid kumele xoxisana nabakhiqizi bezidakamizwa , besebenzisa amandla abo okuthenga ukwehlisa amanani entengo. Kalula nje, ukusetshenziswa kwemali kweMedicaid emithini kadokotela kuyaphikisana futhi kuyinkimbinkimbi. Sizimisele ukutadisha imininingwane engempikiswano.



Sihlaziye iMedicaid’s Idatha Yokusebenzisa Izidakamizwa Kahulumeni , irekhodi eliphelele lokuthi abahlomuli beMedicaid ezweni lonke bathenga kanjani imiyalo. Okutholakele kwethu kukhombisa ukuthi yiziphi izinhlelo ezisebenzisa kakhulu nokuthi iziphi izidakamizwa ezisetshenziswa kakhulu. Ukuqonda ngokweqiniso ukusetshenziswa kweMelika ngemibhalo ebizayo, qhubeka ufunde.



Amanani entengo yeMedicaid nokuthandwa

Inombolo encane yemithi i-akhawunti yamaphesenti amakhulu wokubuyiselwa kwemali kweMedicaid, kufaka phakathi imiyalo ehambisana nokwelashwa kwezifo ezivamile. Phakathi kuka-2009 no-2018, iMedicaid imboze imiyalo engama-212,663,453 amokfillin , i-antibiotic esetshenziselwa ukwelapha izimo ezisukela ku-pneumonia kuya kwizifo zomgudu womchamo. Imiyalo ye-Ibuprofen zazivame ngokufanayo, yize lo muthi ubuye utholakale ekhawunteni. IHydrocodone, umuthi osetshenziselwa ukwelapha ubuhlungu, yanikezwa izikhathi eziyi-191,159,584 phakathi nesikhathi esifundwayo.

inani-le-scatterplot



Ngokuya ngezindleko eziphelele zokubuyiselwa kwemali, noma kunjalo, izikweletu ezinkulu kakhulu zeMedicaid zivela emithini ebiza kakhulu eyenzelwe ukwelapha izifo ezingamahlalakhona. ITruvada, ecindezela izimpawu ze-HIV futhi evimbela ukudluliswa kwaleli gciwane, ibize iMedicaid $ 5.8 billion (abagxeki bathi amacala omenzi wezidakamizwa intengo yokuxhaphaza ngomkhiqizo wayo). Ngokufanayo, iSuboxone yabiza iMedicaid $ 6.7 billion phakathi kuka-2009 no-2018, noma leyo mali ikhokhele imiyalo engaphansi kwezigidi ezingama-30. Umuthi, owenzelwe ukwelapha ukuncika kwe-opioid, uhlala ulawulwa kakhulu.

Ukuqhuma kokubhaliswa kweMedicaid

Eminyakeni eyalandela ukudluliswa koMthetho Wokunakekelwa Okungabizi, amazwe angama-37 akhethwa ukwamukela Izinhlelo zokunwetshwa kweMedicaid , enweba ukumbozwa kwezigidi zabantu baseMelika abebengafaneleki ngaphambilini. Ngenxa yalokho, ukubamba iqhaza kweMedicaid kukhuphuke kakhulu phakathi kuka-2013 no-2017, kusuka kubantu abangu-56,533,472 kuya kwabangu-74,775,710. Ngaleso sikhathi, izindleko zokubuyiselwa kwemali zohlelo zikhuphuke ngama- $ 17 billion futhi. Noma kunjalo, zombili lezi zinyathelo zehle kancane ku-2018, intuthuko abanye ochwepheshe bathi emnothweni oqinile. Njengoba abasebenzi behola ngaphezulu, badlula imikhawulo yemali engenayo yokutholakala kweMedicaid, kunciphisa ama-rolls wohlelo. Enye imbangela yokwehliswa kokubamba iqhaza kungaba izidingo zomsebenzi ezintsha, abaphathi bakaTrump abanxuse amazwe ukuthi azisebenzise eminyakeni yamuva.

ukubhaliswa-ukubuyiselwa kwemali



Eziningi zesizwe izifundazwe ezinabantu abaningi ube namanani amakhulu kunawo wonke okubuyiselwa kwemali kadokotela. Eqinisweni, umehluko wezindleko zombuso wawumkhulu kakhulu: iNew York, California, neTexas zichithe imali ethe xaxa kunezinye izifundazwe ezingama-47 zihlangene ngesikhathi esifundwayo. Kepha maqondana nokusetshenziswa kwemali kweMedicaid ngomuntu ngamunye, iNew York neCalifornia zazinezindleko eziphansi kakhulu zesizwe — ngaphansi kwamasenti ayi-15 umuntu ngamunye obhalisile. Ngokuphambene nalokho, izifundazwe ezimbalwa zaseNew England zabonakala zinomusa omkhulu: IVermont, Maine, neNew Hampshire bakhokha ngaphezulu kwama- $ 3 ababhalisile ekubuyiselweni kwemali kadokotela.

Ukwanda kwezikripthi zabahlanganyeli beMedicaid

Njengoba ukubhaliswa kweMedicaid kukhula phakathi kuka-2013 no-2017, inani lemiyalo etholwe ngeMedicaid nayo inyuke kakhulu. Ngokwezinga elithile, lokhu okutholakele kunembile: Njengoba abantu abaningi bebamba iqhaza kulolu hlelo, isidingo semithi sikhula ngokufanele. Noma kunjalo, idatha yombuso ingeza ungqimba lobunzima kulokhu kuhlangana okulula. Ezinye zezindawo ezinabantu abaningi besizwe, ezibandakanya iCalifornia, New York, Texas, neFlorida, zilinganiselwe ngaphansi kwemiyalo engu-0.3 kubo bonke ababhalisile abangu-1 000. Ngakolunye uhlangothi lobubanzi, uhlelo lweVermont's Medicaid lumboze cishe imiyalo eyisithupha kubo bonke ababambiqhaza abayinkulungwane. Yini engachaza lokhu kwehlukahlukana okukhulu kwezindawo ngokwesidingo sezokwelapha?

ukugcwaliswa kokubhalisa



Incazelo eyodwa yalezi zinqubo ezichazayo ingahle ihambisane neminyaka yobudala: iMaine, iNew Hampshire, neVermont bane- abantu abadala kunabo bonke besifundazwe ngamaphesenti wabantu bonke, ngakho-ke izakhamuzi ezijwayelekile zingadinga imishanguzo eminingi ngenxa yalokho. Kepha ezifundeni ezingxenyeni zombili zomthamo womuntu ngamunye, izishayamthetho zendawo ziwubonile umthelela wezintengo zemithi ezinhlelweni zazo zeMedicaid. Ngo-2018, iVermont waba umbuso wokuqala ukwenza kube semthethweni ukungeniswa kwemithi kadokotela evela eCanada, ukwenza imali ngentengo eshibhile ngaphesheya komngcele. ECalifornia, uGov Gavin Newsom uqondise iMedicaid ku xoxisana ngentengo kadokotela ngqo nabakhiqizi bezidakamizwa ngenhloso yokuthola amagama angcono.

Ukutholakala kwezidakamizwa zeMedicaid

Izidakamizwa eziningi ezivame ukunikezwa ababhalisile beMedicaid azizange zenze izindleko zokubuyiselwa. Kepha i-Ventolin HFA (albuterol), i-inhaler yokutakula esetshenziselwa ukwelapha i-asthma, yanciphisa lo mkhuba: Njengomuthi ovame kakhulu ukunikezwa, ibingama- $ 10.5 billion ekubuyiselweni. Imithi yesifuba somoya engathandwa kangako nayo ikhombise ukuthi iyabiza kwaMedicaid, kufaka phakathi iFluticasone neSymbicort. Olunye ucwaningo kukhombisa ukuthi i-asthma ivame kakhulu ezinganeni nakubantu abadala abahlala emakhaya ahola kancane-futhi iMedicaid yenzelwe ngokusobala ukusebenzela la maqembu.

ejwayelekile-ebizayo



Imithi emithathu yesifo sikashukela ibuye ibize izinhlelo zeMedicaid ngaphezulu kwezingu- $ 4 billion lilinye ekubuyiselweni. Lokhu okutholakele kungakhombisa nezimo zezempilo zabantu baseMelika abahola kancane, abane amazinga aphezulu kakhulu esifo sikashukela kunamanye amaqembu ezenhlalo nezomnotho. UHarvoni, umuthi ofakazelwe ukuthi welapha isifo sokusha kwesibindi kohlobo C, ubenze imali engaphezu kwezigidi eziyizinkulungwane ezingama- $ 5 ekubuyiselweni. Abaphathi beMedicaid bakhathazeke kakhulu ukuthi ukubuyiselwa kwemali komuthi kungahle kubonakale kungagcineki. I- Isifundo seviki esingu-12 seHarvoni sibiza u- $ 94,500 , isilinganiso esizothwalisa kanzima izinhlelo zeMedicaid uma wonke umuntu obhaliswe nge-hepatitis C ethola lokhu kwelashwa.

Izindleko zokubuyiselwa eziphakeme kakhulu ze-Medicaid

Ngemithi eyisithupha, ukubuyiselwa kwemali kweMedicaid kudlule u- $ 1,000 ngomthamo ngamunye ngokwesilinganiso. Ingqikithi ebiza kakhulu yi-Synagis, engasiza ukuvimbela ukuvumelanisa kokuphefumula , isimo esivamile ezinganeni nakubantu abadala asebekhulile. I-Epogen, ukwelashwa kwe-anemia, kubiza u- $ 1,857 ngomthamo ngamunye — inani eliphakeme kakhulu uma kubhekwa ukuthi i-anemia imvamisa umphumela ohlangothini kwezinye izindlela zokwelapha ezibizayo, njenge-chemotherapy. Imithi emibili elwa nokwelashwa kwengqondo, i-Invega neRisperdal, nayo ikhombise ukuthi ibiza ngokweqile ngomthamo ngamunye.

hi-umthamo



Njengoba kushiwo ngenhla, iHarvoni yayiphakathi kwemithi ebiza kakhulu ngomthamo ngamunye, njengezinye izindlela ezintathu zokwelashwa kwesifo sokusha kwesibindi kohlobo C. Ama-immunosuppressants amabili, uHumira noRemicade, nawo enza lolu hlu (iHumira nayo ingazilimaza, okungenzeka yehlise izindleko). Khonamanjalo, iMirena, umshini we-intrauterine owenzelwe ukuvimbela ukukhulelwa, wabiza u- $ 758 ngokwesilinganiso — yize le ntengo ingase ibe ngaphansi kwezindleko zokuqoqwa kwamaphilisi okulawula ukubeletha ngokuhamba kwesikhathi. Ukukhishwa kwemithi ye-Medicaid yokulawulwa kokuzalwa ihlala iphikisana kwezinye izifundazwe, kepha abameli bathi kunciphisa izindleko zohlelo ngokuhamba kwesikhathi ngokuvimbela ukukhulelwa okungahleliwe.

Ukwenza imephu imithi

Cishe kuzo zonke izifundazwe, imishanguzo ethile yayihlanganiswa kaningi ngokweqile yiMedicaid. Imvamisa, ukusetshenziswa okungalingani kwemithi ethile kubangelwe yimisebenzi yezempilo kahulumeni. E-Vermont, ngokwesibonelo, imiyalo ye-Suboxone yayiphezulu ngama-805% kunesilinganiso sikazwelonke: Umuthi usuyingxenye ebalulekile yawo hub futhi wakhuluma imodeli yokwelapha ukuncika kwe-opioid. I-New Jersey, enayo wagcizelela ukulwa nesifo sikashukela ngeMedicaid, imibhalo ye-alogliptin embozwe cishe izikhathi eziphindwe kasishiyagalolunye kunenani likazwelonke. Kwezinye izimo, izinqubomgomo zombuso zibonakala zinelungelo lohlobo oluthile lomuthi ojwayelekile. I-Oklahoma, isibonelo, ihlanganise imiyalo engama-562% ngaphezulu ye-Tamiflu kunesilinganiso sikazwelonke. I-Indiana, okwamanje, ibisethubeni elikhulu lokumboza i-738% umabhebhana , okulingana okujwayelekile.

Ukuthambekela kokuchazwa kwezinye izifundazwe kungaphakamisa ukukhathazeka ngezizathu zobungozi bokulutha, noma kunjalo. ENorth Carolina, ngokwesibonelo, iMedicaid imboze imiyalo engama-178% ngaphezulu kwe-morphine kunesilinganiso sikazwelonke. Ngokunjalo, uhlelo lwaseLouisana iMedicaid lumboze iSoma, isidambisi semisipha esingasetshenziswa kabi, 216% ngaphezu kwesilinganiso sikazwelonke. EKentucky, imiyalo ye-benzodiazepine Ativan yayijwayelekile. Ochwepheshe abaningi bakholelwa ukuthi lesi sigaba sezidakamizwa singabonisa usongo olukhulu olulandelayo lwezempilo yomphakathi, nge enquma amanani kukhula kakhulu emashumini eminyaka amuva nje.

Ukuthutheleka kweNaloxone (Narcan) enquma

Njengoba inkinga ye-opioid iqhubeka nokucekela phansi imiphakathi yaseMelika, uhulumeni wobumbano uya ngokuya ephendukela kuye izindlela zokwelashwa ezisizwa ngemithi njengendlela yokunqanda ukufa ngokweqile. Futhi ngenkathi ezinye izinhlelo zikahulumeni zeMedicaid zingabuyiseli ngqo imishanguzo eyenzelwe ukuphatha ukuhoxiswa kwe-opioid, izindawo eziningi ezinenani eliphakeme kakhulu lokufa kwabantu abadlula ngokweqile. I-Buprenorphine, isithako esiyinhloko eSuboxone, sabuyiselwa ngqo ngaphesheya kweNyakatho-mpumalanga, i-Appalachia, nezinqamu ezinkulu zaseMidwest — izifunda zashaya kakhulu ngokomuntu ngamunye.

ukubukwa kwe-opioid

Ukubuyiselwa kwemali kweMethadone bekungajwayelekile kangako kunokumbozwa kwe-buprenorphine, noma kunjalo ucwaningo lukhombisa yomibili le mithi iyasebenza ekwehliseni ukufa kwabantu ngokweqile phakathi kwabebekade besebenzisa i-opioid. Noma kunjalo, omunye umuthi kungenzeka usindise izimpilo ezengeziwe eminyakeni yamuva: naloxone , i-opioid antagonist esetshenziselwa ukubuyisela emuva ukweqisa. Ngokomlando, inani lemiyalelo ye-naloxone phakathi kwababhalisile beMedicaid lenyuke ngokuhambisana nokushona ngokweqile. Kodwa-ke, ngo-2016, inani lemiyalelo ye-naloxone embozwe yiMedicaid lehle kancane, njengoba nokushona ngokweqile kufinyelele emazingeni angakaze abonwe ngalowo nyaka. Lokhu kuthuthukiswa okungekho emthethweni kungaba nencazelo elula: Ezindaweni ezinjengePennsylvania, ezazinenani elikhulu kakhulu lokufa kwabantu ngokweqile ngo-2017, iziphathimandla seziqalile isabalalisa naloxone Mahhala.

Impilo yaseMelika: Intengo ephezulu okufanele uyikhokhe

Okutholakele kwethu kuveza umehluko othakazelisayo ekusetshenzisweni kwemithi kadokotela phakathi kwababhalisile beMedicaid ezweni lonke. Esimweni ngasinye, izindlela ezihlukanisayo ezichaza amaphutha zingavela ezintweni eziningi, kufaka phakathi izinsongo zezempilo zesifunda, izinqubo zokuphatha, kanye nokwakheka kwabantu besifundazwe ngasinye. Kepha ngenkathi imiphumela yethu ingahluka kakhulu, kuvela izingqikithi ezimbili ezibalulekile.

Okokuqala, awukho umbuso ongavikelekile ezindlekweni zokwenyuka kwemithi, kepha ezinye izindawo zithola amanani entengo kadokotela eyinselele enkulu. Okwesibili, imithi ebiza kakhulu futhi enqunyiwe iyizidingo — hhayi ukunethezeka — kulabo abazidingayo. Kwababhalisile beMedicaid nabo bonke abanye abantu baseMelika, lezi zinto ezingqubuzanayo zibaluleke kakhulu ukuthi ungazinaki.

Uma unokutholakala kwezidakamizwa ze-Medicaid kodwa i-copay yakho isephezulu kakhulu, ungahlala useshela i-SingleCare ukuthola umuthi wakho. Nazi ezimbalwa zezinkulungwane zemithi esinganikeza izaphulelo ku:

  • I-Amoxicillin
  • Ibuprofen
  • I-Albuterol
  • I-Loratadine
  • I-Ventolin HFA
  • I-Lisinopril
  • Omeprazole
  • I-Azithromycin
  • I-Fluticasone
  • ICetirizine
  • I-Metformin
  • UGabapentin
  • Amlodipine
  • I-Levothyroxine

Indlela yokusebenza

Yonke imininingwane yale phrojekthi itholwe kuhulumeni wase-U.S Idatha Yokusebenzisa Izidakamizwa ZaseMedicaid State ngokufinyelela kwe-API. Imininingwane iqoqwe ngo-Jan. 2009 kuya kuJulayi 2018 (ukuphela kwe-Q2). Izinhlobonhlobo eziningi zamakhemikhali afanayo asatshalaliswa futhi ahlukaniswa njengezinto ezahlukahlukene kudatha ye-Medicaid zihlelwe (ngokwesibonelo, i-Suboxone, i-Suboxone 1, i-Suboxone 2, i-Suboxone 4, i-Suboxone 8, ne-Suboxone S konke kwahlelwa). Ngemininingwane yango-2018 efingqiwe (kunokulinganiselwa), sinikeze ibanga lokulinganisela elibukwayo lamanani wokugcina ngokuya ngesibalo sesikhawu sokuzethemba. Imininingwane yomdwebo wokugcina (kuma-opiate overdoses) itholwe kuCenters for Disease Control and Prevention (CDC) naseNational Institute on Drug Abuse.

Imithombo