Kutshanje, i-Inshurensi ye-Inshurensi yezeMpilo yeSizwe ikhuphe isaziso esivakalisa ukuba kususela kwi-Okthobha 1, 2023, iya kuphumeza ukupheliswa kwelungelo lezibhedlele libuyele kwilizwe liphela.
Lo mgaqo-nkqubo uthathwa njengelinye inyathelo eliphambili le-Inshurensi yezeMpilo, ejolise ekuqiniseni ukhathalelo lwezempilo, khuthaza ukuphuculwa kwe-inshurensi kunye nolawulo lweshishini, ukuphucula ukusebenza kweNgxowa-mali ye-Inshurensi yezeMpilo , ukunciphisa iindleko zokujikeleza kwamayeza, kwaye usombulule ingxaki yobunzima bokuhlawulwa kwamashishini amayeza.
Ke, kuthetha ntoni ukucima ilungelo lesibhedlele lokubuya? Luya kuzisa luphi utshintsho olutsha kwishishini lezonyango? Nceda undijoyine ngokungaveliyo le mfihlakalo.
** Ukupheliswa kwamalungelo okuthatha isaphulelo sesibhedlele? **
The abolition of the hospital's right of return refers to the abolition of the dual role of public hospitals as purchasers and settlers, and the settlement of payments to pharmaceutical enterprises by medical insurance organizations on their behalf.
Ngokukodwa, iintlawulo zomanyano lweSizwe, kwiPhondo, ukuthengwa okumiselweyo kwiPhondo eziKhethekileyo kwiiMveliso zeZibhedlele zikaRhulumente ziya kuhlawulwa ngokuthe ngqo kwiNgxowa-mali ye-Inshurensi yeNyango yezeMveliso yePhondo Imirhumo kwinyanga elandelayo.
Umgangatho wokupheliswa kwelungelo lokubuya igubungela zonke izibhedlele zikarhulumente kwaye zonke izinto zikazwelonke, zamaphondo, kunye neqela le-Bute
Iimveliso ezikhethiweyo kwi-band the the the the band band band band band band band band band band band band band bangevation babhekisa kumachiza avunyiwe ngabasemagunyeni bokulawulwa kweziyobisi, kunye nezatifikethi zobhaliso lweziyobisi okanye izatifikethi zokubhaliswa kweziyobisi ezingeniswayo okanye zephondo.
Iimveliso zokuthengwa kwempahla ezidwelisiweyo zibhekisa kwizinto ezinokuthethwa zizinto ezivunyiweyo zolawulo lweziyobisi kunye nesatifikethi sobhaliso lwezixhobo zonyango, kunye neKhowudi yeKhathalogu yeXesha eliSebenzayo kwinqanaba likazwelonke okanye lephondo, kunye neemveliso ze-VITROOstic Remogents ilawulwa ngokuhambelana nolawulo lwezixhobo zonyango.
** Yintoni inkqubo yokususa ilungelo lesibhedlele lokubuya? **
Inkqubo yokurhoxisa ilungelo lokubuyiselwa kwesibhedlele ikakhulu libandakanya amakhonkco amane: Idatha ilayisha, uphononongo lwe-Bill, uphononongo lovavanyo kunye nokuhlawulwa kwentlawulo.
Okokuqala, izibhedlele zikarhulumente ziyacelwa ukuba zigcwalise idatha yokuthenga nge-protheredotion yenyanga edluleyo kunye neebhili ezinxulumene neziyobisi ezimiliselweyo zoMthetho oMiselweyo kwiNkqubo yokuLawulwa kweMpahla. Ngomhla we-5 wenyanga nganye. Ngaphambi komhla wesi-8 wenyanga nganye, izibhedlele ziya kuqinisekisa okanye zenze idatha ye-Interventring yenyanga ephelileyo.
Ke, ngaphambi komhla we-15 wenyanga nganye, inkampani iya kugcwalisa uphicotho kunye nesiqinisekiso sedatha yokuthenga inyanga ephelileyo kunye neebhili ezinxulumene noko
Emva koko, phambi kwentsimbi yesi-8 kwinyanga nganye, amashishini ezemidlalo egcwalisa ulwazi olufanelekileyo kwaye afake iindleko zentengiselwano ngokweemfuno ezizenzele ulwazi lokuthenga kunye nokuhanjiswa kwezibhedlele zikarhulumente.
Ulwazi oluYilwayo kufuneka luhambelane nedatha yenkqubo, njengesiseko sezibhedlele zikarhulumente ukuba uphicotha indawo yokuhlala.
Emva koko, ngaphambi kwenyanga engama-20 kwinyanga nganye, i-Arhente ye-Inshurensi yezeMpilo ivelisa isitetimenti sokuxolelaniswa kwenyanga edluleyo kwinkqubo yokuthenga ngokusekwe kwiziphumo zophicotho-zincwadi zikarhulumente.
Phambi kosuku lwe-25 lwenyanga nganye, izibhedlele zikawonke-wonke kunye neenkampani zamachiza ziphonononge kwaye ziqinisekise ngengxelo yonxibelelwano lokuhlawulwa kwempahla nezinto zokuthenga. Emva kokuphononongwa kunye nesiqinisekiso, idatha yokuhlaliswa kuvunyelwene ukuba ihlawulwe, kwaye ukuba ayiqinisekiswanga ngexesha, kuvunyelwene ukuba ihlawulwe ngokungagqibekanga.
Kwidatha yokuhlaliswa kweenkcaso, izibhedlele zikarhulumente kunye namashishini ezenziwa ngamayeza aya kugcwalisa izizathu zokuchasa kwaye azibuyisele omnye komnye, kwaye aqalise isicelo sokuqhutywa kwe-8 kwinyanga elandelayo.
Okokugqibela, malunga nokuhlawuliswa kwentlawulo yempahla, umbutho ophetheyo uvelisa ii-odolo zentlawulo zokuhlala ngenkqubo yokuhlawulwa kwe-Inshurensi yezeMpilo yeNdawo yeSpecient.
Inkqubo yonke yokuhlawula intlawulo iya kugqitywa ukuphela kwenyanga nganye ukuqinisekisa ukuba iintlawulo zexesha elifanelekileyo zenziwa kwiinkampani ze-Inshurensi yezeMpilo zezeMpilo ehambelanayo kwinyanga elandelayo.
** Luluphi utshintsho olutsha oluya kususwa kwilungelo lokuhlawula ilungelo lokuhlawula ubuyisele kwishishini lezempilo? **
Ukupheliswa kwelungelo lokubuya kweZibhedlele linyathelo lenguqulelo elinokubaluleka okungapheliyo, okuya kuthi ngokusesikweni kwendlela yokusebenza kunye nendlela yokwenza ishishini lemveliso yezempilo, kwaye iya kuba nefuthe elibonakalayo kuwo onke amaqela. Iboniswe ngqo kule miba ilandelayo:
Okokuqala, kwizibhedlele zikarhulumente, ukupheliswa kwelungelo lokubuya kuthetha ukulahleka kwelungelo lokuzimela kunye nomthombo wengeniso.
Kwixa elidlulileyo, izibhedlele zikarhulumente zinokufumana ingeniso eyongezelelweyo ngokuxoxisana namashishini amachiza okanye amashishini okukhaba. Nangona kunjalo, le ntshukumo ikwakhokelele ekungqubeni kwemidla kunye nokhuphiswano olungalunganga phakathi kwezibhedlele zikarhulumente kunye namashishini amachiza, ukubeka emngciphekweni ulungelelwano lwentengiso kunye nemidla yabaguli.
Ngokupheliswa kwelungelo lokuhlawula umva, izibhedlele zikarhulumente aziyi kuthatha ingeniso okanye izaphulelo ukusuka kwintlawulo yempahla, okanye ingayisebenzisa intlawulo yempahla yokugcina iimpahla okanye ukwala ukuhlawula amashishini ezemidlalo.
Oku kuya kunyanzela izibhedlele zikarhulumente ukutshintsha indlela abasebenza ngayo yokusebenza kunye nolawulo, ukuphucula ukusebenza kwangaphakathi kunye nomgangatho wenkonzo, kunye nokuxhomekeka ngakumbi kwinkxaso-mali kaRhulumente kunye neentlawulo zonyango.
Kwiinkampani zamachiza, ukupheliswa kwelungelo lokubuya kuthetha ukusombulula ingxaki emide kakhulu yokuhlawula umva.
Kwixa elidlulileyo, izibhedlele zikarhulumente zibambe inyathelo lokuqala kunye nelungelo lokuthetha kwiindawo zokuhlawula, rhoqo ngenxa yezizathu ezahlukeneyo zokungagqibeki okanye ukunciphisa intlawulo yempahla. Rhoxisa ilungelo lokubuya, iinkampani zamayeza ziya kuba ngqo kwingxowa yeinshurensi yezonyango ukuze ihlawulwe, ayisasebenzi kwimpembelelo yezibhedlele zikarhulumente kunye nokuphazamiseka.
Oku kuya kunciphisa kakhulu uxinzelelo lwezezimali kumashishini ezemali, ukuphucula ukuhamba kwemali kunye nokwenza inzuzo, kunye nokwenza lula utyalomali olunyusiweyo kwi-R & D kunye nokhuphiswano lwemveliso.
Ukongeza, ukupheliswa kwelungelo lokubuya kuthetha ukuba amashishini echiza aya kujongana nokubeka i-vick kunye nokuhlola izinto ezingalunganga, kwaye kufuneka anyuse amaxabiso, kwaye kufuneka axhomekeke kwixabiso- Ukusebenza kwemveliso kunye nenqanaba lenkonzo ukuphumelela abathengi kunye nentengiso.
Abasebenzi beinshurensi yezempilo, ukupheliswa kwelungelo lokubuya kuthetha uxanduva kunye nemisebenzi.
Kwixesha elidlulileyo, abaqhubi beinshurensi yezeMpilo kufuneka baphinde bahlale nezibhedlele zikarhulumente kwaye bekungafuneki bahlangabezane ngqo neenkampani zamayeza.
Emva kokupheliswa kwelungelo lokubuya, i-Inshurensi ye-Inshurensi yezeMpilo iya kuba ngumzimba ophambili wokuhlawula iintlawulo, kwaye kufuneka isebenze nezibhedlele zikarhulumente kunye neenkampani zamachiza ukuze zikwazi ukwenza idatha yedatha, ukuxolelwa kwakhona kunye nentlawulo yempahla kunye njalo.
Oku kuyakonyusa umthwalo womsebenzi kunye nomngcipheko weearhente zeinshurensi zezempilo, kwaye zifuna ukuba ziphucule ulawulo kunye namanqanaba e-Ansical, kunye nokuseka indlela yendlela yokubeka esweni kunye nendlela yokuvavanya ukuqinisekisa indawo yokuhlala echanekileyo nenokhuseleko.
Okokugqibela, ngenxa yezigulana, ukupheliswa kwelungelo lokubuya kuthetha ukonwabela ukubaluleka kunye neenkonzo zonyango ezingabonakaliyo.
Kwixa elidlulileyo, ngenxa yokudluliselwa kwezibonelelo kunye nokukhaba phakathi kwezibhedlele zikarhulumente kunye neenkampani zamachiza, abaguli bahlala bengakwazi ukufumana amaxabiso afanelekileyo okanye ezona mveliso zifanelekileyo.
Ngokupheliswa kwelungelo lokuhlawula umva, izibhedlele zikarhulumente ziya kuphulukana nenkuthazo kunye negumbi lokufumana inzuzo okanye igumbi lokufaka intlawulo kwintlawulo yempahla, kwaye ayiyi kuba nakho ukusebenzisa intlawulo yokusebenzisa iimveliso ezithile okanye ukukhuthaza ezinye iimveliso.
Oku kwenza ukuba abaguli bakhethe ezona mveliso zifanelekileyo kunye neenkonzo ngokweemfuno zabo kunye neemeko zabo kwimo yemakethi efanelekileyo kunye nendawo yentengiso ebonakalayo.
Ngamafutshane, ukupheliswa kwelungelo 'lokubuyela kwimbuyekezo linyathelo eliphambili likahlengahlengiso oluya kuba nefuthe elibonakalayo kwicandelo lezempilo.
Ayizukuphinda isebenze kuphela imowudi yokusebenza yezibhedlele zikarhulumente, kodwa iphinde ilungelelanise imo yophuhliso yamashishini amayeza.
Kwangelo xesha, iphucula inqanaba lolawulo lwemibutho ye-Inshurensi yezeMpilo kunye nenqanaba leenkonzo zoguli. Iya kuphakamisa ukuphuculwa kolwahlulo kunye nolawulo lwe-inshurensi yezempilo, ukhathalelo lwezonyango kunye namayeza, ukuphucula ukusebenza kwemali kwi-Inshorensi yezeMpilo, kwaye ukhusele amalungelo asemthethweni kunye nemidla yezigulana.
Makhe sijonge phambili ekuphunyezweni ngempumelelo kolu hlengahlengiso, oluya kuzisa ingomso elingcono kwishishini lezonyango!
I-HongGuan Care malunga nempilo yakho.
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IXESHA LOKUQALA: UPE-06-2023