NgoSeptemba 5, i-Bureau eKhuselekileyo yoNyango ikhuphe isaziso se-Ofisi yoNyango yoNyango esenza umsebenzi olungileyo kulawulo lwe-inshurensi yezezonyango (ebizwa ngokuba yi-4 enkulu amalungu kunye namanqaku ayi-15. Iziko lezonyango ekubhekiswe kulo kwisaziso ngabo babhalisiweyo okanye befayilishwe ngabaphathi besixhobo sezonyango, banikwe inqanaba lokudweliswa kwaye banokuhlawuliswa ngokwahlukeneyo.
Ngokwesaziso, ukusukela kumhla wokukhutshwa kwesi saziso, amaphondo kufuneka anike ingxelo kwi-Inshurensi yeinshurensi yonyango lwerekhodi ngaphambi kokuba ingenise ikhathalogu yezonyango ukuze isebenze. Amasebe e-Inshurensi yePhondo ayakhuthazwa ukuba athathe uhlobo lwelinye ilizwe okanye intsebenziswano yokuphonononga ukusekwa kwenqanaba lekhathalogu lekhathalogu kunye nentlawulo ngaphakathi kwe-Alliance okanye kwingingqi. I-NHPA iya kuqalisa ukuphuculwa kwekhathalogu yeSizwe yoNyango lweSizwe kwi-inshurensi yezonyango kungekudala.
Amanqaku aphambili ashwankathelwe apha ngezantsi:
Inqaku loku-1: Ukukhuthaza umanyano lwesizwe lokwahlulahlula kunye nekhowudi yokutya
Isaziso sichaza ukuba ukwahlulahlulwa kunye nekhowudi yokusebenza yezonyango kufuneka imanyene. Ukukhuthaza ngokuqinileyo ukusetyenziswa kwekhowudi ye-Inshurensi yeSizwe yezeNjongo yeSizwe, ngexesha elifanelekileyo ngokuhambelana ne-Inshurensi ye-Inshurensi yezeMpilo yeSizwe yokuphuhlisa ikhowudi yokuziqhelanisa nezonyango ukuze ufumane ikhowudi elungileyo yokuphucula i Ukusetyenziswa kokuchaneka kwekhowudi yokuthengiswa kwezempilo ukufezekisa izinto ezinokuthengwa kwezonyango ngempahla yokuthengwa kwekhowudi, kunye nekhowudi yokusetyenziswa, kunye nokuqinisekisa ukuba ukwenziwa kwekhowudi yezonyango kunye nekhowudi ye Umanyano lweSizwe.
Yahlulahlula-hlula kabini: Ukusetyenziswa kwetekhnoloji, olu hlobo lwezinto ezinokuthethwa kwi-inshurensi yeinshurensi yezonyango
Isaziso sibonisa ukuba ubungakanani bezinto ezinokuthengiswa ukuba zibandakanywe kwintlawulo yeinshurensi yezonyango. Ukuziqhelanisa neenkonzo zobugcisa zenkonzo zenkonzo "kunye nokusetyenziswa kwezinto ezahlukeneyo ezahlukileyo" uMgaqo weProjekthi yeNkonzo yoNyango loLawulo, kwaye ngokuthe ngcembe akasayi kubandakanywa kwi-Intanethi yenkonzo yezonyango ngokwe-A Izibonelelo zoMgangatho weinshurensi yoLawulo lweTyalo leInshurensi.
Inqaku lesithathu: Ezi zinto zingcono aziyi kubandakanywa kumgaqo kwintlawulo yeinshurensi yezonyango
Ngokuphathelele ukufikelela kwi-inshurensi yezonyango, "Isaziso" zibonelela ukuba unamathele "ngokusisiseko". Ukufikelela kunye nolawulo lwe-inshurensi yonyango olusisiseko yezonyango kufuneka lubambelele ngokuqinileyo kwindalo "esisiseko", zenza konke okusemandleni abo, kwizenzo zabo, ugxininiso kwindima yokuthenga Ingxowa-mali ye-Inshurensi, iya kuba yimfuneko yekliniki, ikhuselekile kwaye isebenza, isenexabiso lezonyango elinexabiso lezonyango kumgangatho wokuhlawula i-inshurensi yezonyango ngokuhambelana neenkqubo. Izinto ezinokuthengiswa kwezonyango ziya kubandakanywa kubungakanani bentlawulo yeinshurensi yezonyango ngokungqinelana nenkqubo.
Kwimigaqo, izinto ezinokuthengiswa kwezonyango ngexabiso eliphantsi leklinikhi, amaxabiso okanye iindleko kude kuse ekusweleni kweNgxowa-mali kunye nezigulana, kunye nezixhobo, kunye nezixhobo zokubuyisela kwimeko yesiqhelo aziyi kubandakanywa kwintlawulo yeinshurensi yeinshurensi yezonyango. Kuba urhulumente akafuneki ukuba angafakwanga kwinqanaba le-inshurensi yeinshurensi yezonyango, inamathela kwizibonelelo zentsusa.
Yalatha amane: Ukuphunyezwa kancinci konyango lwe-inshurensi ye-inshurensi eqhelekileyo
Isaziso sibonisa ukuba i-Inshurensi ye-Inshurensi yoMhlaba yeLizwe iya kufunda ukusekwa kwenkqubo yegama eliqhelekileyo lezinto ezinokuhlelwa kwe-inshurensi, ngokusekwe kwi-inshurensi yezonyango, ichonge imilinganiselo yokufumana i-neaming efanelekileyo kulawulo lwe Intlawulo yeinshurensi yezonyango, ngokuthe ngcembe yenza imigaqo yokufumana amagama aqhelekileyo eendidi ezinokuthengiswa kwezonyango, kwaye uqokelele igama eliqhelekileyo le-inshurensi yonyango njengesiseko sentlawulo yeinshurensi yezonyango.
Ngezinto ezinokuthengiswa kwezonyango ngamagama aqhelekileyo asele etshisiwe, kufuneka sikhuthaze ngolawulo lolawulo lwentlawulo yeinshurensi yezonyango yokutya kwezonyango ngokwamagama aqhelekileyo. Ngezinto ezinokusetyenziswa kwezonyango ezingekaphuhlise igama eliqhelekileyo, ukwahlukana okwangoku kunye nekhowudi kuya kusetyenziswa ixesha lolawulo lwe-inshurensi yeinshurensi yezonyango.
Inqaku lesi-5: "Ixesha le-14 leminyaka eli-14 ubudala, ukusekwa kwe-Inshurensi yoNyango yePhondo
Isaziso siyenza icace into yokuba ulawulo lokufikelela lwekhathalogu oluqhelekileyo. Ukukhuthaza ukusekwa kwenkqubo yokufikelela ngokungekhoyo kwezonyango, "ixesha leminyaka emihlanu, kufuneka ligqitywe ngokomthetho wokufikelela ukuze kuphuhliswe iphondo (imimandla yokuziqhelanisa ne-inshurensi yezonyango.
Kweli nqanaba liseke i-Inshurensi yoNyango lweThongo loNyango lwePhondo, ngokusekwe okwethutyana kwi-Inshurensi yezoNyango yeSizwe yokuSebenza kunye neKhowudi, kwaye ngokuthe ngcembe kwi-inshurensi yolawulo lwegama eliqhelekileyo. Okwangoku okwangoku akakasungulili i-Loofic lonyango ibonelela ngolawulo lwePhondo lengingqi ukwandisa iinzame zeminyaka emihlanu yeminyaka yokuseka iphondo lezonyango.
Ukuze ulawulo oluqhelekileyo lwezinto ezinokuqina, urhulumente uya kuphuhlisa ikhathalogu yoNyango lweSizwe yeLizwe, kwaye ngokuthe ngcembe wandisa ubungakanani bekhathalogu yeSizwe egutyungelwe ludidi lweziselo.
Inqaku lesi-6: Seka indlela yohlengahlengiso oguqukayo kwaye uphonononge ukuba kuphonononge indlela yokuxoxwa ngayo
Ngokwesaziso, iphondo ngalinye lifanele lilungelelanise ukutya kwezonyango, ulawulo lwe-inshurensi, uvavanyo lwetekhnoloji, uvavanyo olunxulumene nomzi-mveliso kunye nenkqubo yovavanyo oluhambelana nommiselo, kunye ne Iziphumo zovavanyo ziya kuchazwa kuluntu ngendlela yexesha elifanelekileyo. Khuthaza ukufakelwa kwekhathalogu yekhathalogu yezicelo ezikhethiweyo ezivela kwi-band yokuthenga i-band ehambelana nomgaqo-nkqubo wentlawulo yangoku. Jonga ukufikelela kwiimveliso ezizodwa okanye zexabiso eliphezulu ngokuthetha-thethano kunye nezinye iindlela.
Ukongeza, indlela yokulungelelanisa isandi kufuneka isungulwe. Cinga ngokuqonda ngenkqubela phambili kwezonyango, ukusetyenziswa kweklinikhi, amaxabiso kunye namanqanaba eendleko, kunye nokufikeleleka kweNgxowa-mali yeInshurensi kunye ne-inshurensi, ukufezekisa uhlengahlengiso oluguqukayo ngaphakathi nangaphandle. Ukubuyiselwa kwakhona kwemveliso yetekhnoloji entsha, ukurhoxiswa kwekliniki kunokutshintshwa ngcono, uvavanyo lwezoqoqosho olugwenxa, ngamasebe afanelekileyo aquka uluhlu lweemveliso ze-inshurensi yezonyango.
Kwangelo xesha, ukusekwa kwendlela yokuthintela umngcipheko ngesandi sokuhlengahlengiswa kwentlawulo ye-inshurensi yezonyango, ukhuseleko lweNgxowa-mali ixesha elide lokubala oluchanekileyo, kwimingcipheko enokubakho Ukuphuhliswa kwesicwangciso, ngakumbi kubandakanya ukutshintshwa komgangatho wokuhlawula iintlobo ezahlukeneyo zendlela enye yokwenza umsebenzi olungileyo wokuqinisekisa ukhuseleko lwamalungelo kunye nemidla yezigulana.
Inqaku lesi-7: Lungisa ngokuthe ngqo umgaqo-nkqubo wokuhlawula kwiphondo
Isaziso sibonisa ukuba umgaqo-nkqubo wentlawulo kufuneka ulungelelaniswe kwaye ilungiselelwe. Ukukhuthaza umgaqo-nkqubo wokuhlawula ukuze ube nesayensi kunye nokucocwa, kwaye kancinci kancinci umgaqo-nkqubo wentlawulo ye-sloppy ngokusekwe kwintlawulo yenqanaba lexabiso, kunye nobungakanani be-quota okanye ukuhlawula umda.
Iindawo ezilungelelanisiweyo zinokuthatha izinto ezifana nokufikelelwa kweNgxowa-mali kunye nomthwalo kwi-inshurensi, kwaye ngokwenyani yexabiso eliphezulu okanye iindleko zokusebenzisa i-Popy-ye-Popy-yepokotho yepokothweni. Amasebe e-Inshurensi yezeMpilo yePhondo afanele ukomeleze imigaqo-nkqubo yokuhlawula kunye nokukhusela amanqanaba okhuselo lwePhondo kwiPhondo, kwaye akhuthaze amanyathelo okufezekisa umanyano kwiphondo kwangoko.
Inqaku lesi-8: Ukusekwa kwe-DRG / DIP Synenergistic Sypenism
Ukukhuthaza imigangatho yokuhlawula ngendlela eqinisiweyo nangocwangco. Khuthaza amaphondo ukuba aphonononge uphuhliso lwemigangatho yokuhlawula enonyango ye-inshurensi yonyango kwaye yenza uhlengahlengiso olunamandla. Ukuphucula indlela yokudibana phakathi kwemigangatho yentlawulo kunye namaxabiso okuthenga ngentloko, kunye nokumisela imigangatho yokuhlawula kwiimveliso ezikhethiweyo kwiCandelo lebhendi elixhonyiweyo ngokwemigaqo efanelekileyo. Jonga iingxoxo zokufikelela kunye nezinye iindlela zokwenza ngokugqibeleleyo imigangatho yentlawulo yexabiso eliphezulu lezonyango. Ngenxa yokungazithembi kwezonyango ngomsebenzi ofanayo kunye nokusetyenziswa, izinto ezifanayo kunye neempawu, ukusebenzisana, ukwenziwa kweklinikhi, kunye nokuhlangana kolawulo lweinshurensi yezonyango, imigangatho yamanyanisa inokwenziwa.
Lungelelanisa utshintsho lwendlela yokuhlawula. Ukuseka indlela yokukhuthaza u-DRG kunye ne-DRG, i-DIP ye-DIP yokuhlawula ye-DIP kunye neminye imigaqo-nkqubo yokwenza isiphumo esifanelekileyo. Qwalasela umda wokuhlawula, umgangatho wentlawulo kunye nomgaqo-nkqubo wokuhlawula ongenakona ngendlela edibeneyo, kwaye uphucule uhlahlo-lwabiwo mali olupheleleyo kunye namaqela entlawulo ngexesha elifanelekileyo.
Inqaku lesithoba: Ezi ngcinga zigxile ekujongeni iliso
Ngokwesaziso, indlela yokubeka esweni novavanyo yentlawulo yeinshurensi yezonyango kufuneka isekwe. Amaphondo ahlala rhoqo kwiphondo lokufikelela kwi-Inshurensi yezeMpilo yePhondo, intlawulo yeNgxowa-mali yeInshurensi, umthwalo wonyango, i-intanethi, i-intanethi, izibalo, igxile ekusetyenzisweni kweklinikhi ngaphezulu kwe Ukusetyenziswa kweNgxowa-mali kunye noMthwalo woMo kaMo kagqirha wokubeka iliso kumthwalo onzima.
I-HongGuan Care malunga nempilo yakho.
Bona ngakumbi i-Honggan Meidlid Imveliso yemveliso yemveliso →https: //www.hgcmed.com/ploves/
Ukuba kukho nayiphi na iimfuno zezinto zonyango, nceda ukhululeke ukunxibelelana nathi.
hongguanmedical@outlook.com
IXESHA LOKUQALA: UPE-11 ukuya ku-1123