Njengoba iziguli ziya ngokuya zithembela kubaxhumanisi kanye nezinsizakalo zabo, ukunakekelwa kwezempilo kwase-US kuthuthukise lokho uDkt Robert Pearl akubiza ngokuthi "umqondo ophakathi".
Phakathi kwabakhiqizi nabathengi, uzothola iqembu lochwepheshe abaqhuba ukuthengiselana, abasizayo futhi bathumele izimpahla namasevisi.
Baziwa njengabalamuli, bayachuma cishe kuyo yonke imboni, kusukela kwezindawo ezithengiswayo kanye nezokudayisa kuye kwezezimali nezokuvakasha.Ngaphandle kwabaxhumanisi, izindlu namahembe bekungeke kudayiswe.Angeke abe khona amabhange noma amasayithi okubhukha ku-inthanethi.Ngenxa yabalamuli, utamatisi otshalwa eNingizimu Melika ulethwa ngomkhumbi uyiswe eNyakatho Melika, udlule esikweni, uphelele esitolo esikhulu sendawo bese uphelela kubhasikidi wakho.
Abalamuli bakwenza konke ngentengo.Abathengi kanye nosomnotho abavumelani mayelana nokuthi abaxhumanisi bayizilokazane eziwuhlupho ezibalulekile empilweni yesimanje, noma kokubili.
Inqobo nje uma impikiswano isaqhubeka, kunento eyodwa eqinisekile: abaxhumanisi bezokunakekelwa kwezempilo e-US baningi futhi bayachuma.
Odokotela neziguli bagcina ubudlelwano bomuntu siqu futhi bakhokhe ngokuqondile ngaphambi kokuthi kungene abalamuli.
Umlimi wangekhulu le-19 owayenezinhlungu zamahlombe wacela ukuvakashelwa udokotela womkhaya wakubo, owahlola umzimba, waxilonga, nemithi yezinhlungu.Konke lokhu kungashintshwa ngenkukhu noma imali encane.Umlamuli akadingeki.
Lokhu kwaqala ukushintsha engxenyeni yokuqala yekhulu lama-20, lapho izindleko nokuba yinkimbinkimbi kokunakekelwa kwaba yinkinga kwabaningi.Ngo-1929, lapho imakethe yamasheya iphahlazeka, iBlue Cross yaqala njengobudlelwane phakathi kwezibhedlela zaseTexas nabafundisi bendawo.Othisha bakhokha ibhonasi nyanga zonke ka-50 cents ukuze bakhokhele ukunakekelwa kwesibhedlela abakudingayo.
Abadayisi bomshwalense bangabaxhumanisi olandelayo kwezokwelapha, beluleka abantu ngezinhlelo zomshwalense wezempilo ezihamba phambili nezinkampani zomshwalense.Ngenkathi izinkampani zomshwalense ziqala ukunikeza izinzuzo zemithi kadokotela ngeminyaka yawo-1960, ama-PBM (Abaphathi Benzuzo Yekhemisi) bavela ukuze basize ukulawula izindleko zemithi.
Abalamuli bakhona yonke indawo endaweni yedijithali kulezi zinsuku.Izinkampani ezifana neTeledoc neZocDoc zadalelwa ukusiza abantu bathole odokotela imini nobusuku.Amahlumela e-PBM, afana ne-GoodRx, angena emakethe ukuze axoxisane nabakhiqizi namakhemisi ngezintengo zezidakamizwa egameni leziguli.Izinsizakalo zezempilo yengqondo ezifana ne-Talkspace ne-BetterHelp seziqhamuke ukuze zixhumanise abantu nodokotela abanelayisensi yokunikeza imithi yengqondo.
Lezi zixazululo zamaphuzu zisiza iziguli ukuthi zizulazule kangcono kumasistimu okunakekelwa kwezempilo angasebenzi, zenze ukunakekelwa nokwelashwa kube lula, kufinyeleleke, futhi kuthengeke.Kodwa njengoba iziguli ziya ngokuya zithembela kubaxhumanisi nasezinkonzweni zabo, lokho engikubiza ngokuthi ukucabanga komlamuli kuye kwavela ekunakekelweni kwezempilo kwaseMelika.
Cabanga ukuthi uthole ukuqhekeka okude ebusweni bomgwaqo wakho.Ungakwazi ukuphakamisa i-asphalt, ususe izimpande ngaphansi futhi uphinde ugcwalise yonke indawo.Noma ungaqasha umuntu ozovula indlela.
Ngaphandle kwemboni noma udaba, abaxhumanisi bagcina isimo sengqondo "sokulungisa".Umgomo wabo uwukuxazulula inkinga encane ngaphandle kokucabangela izinkinga ezihambisanayo (imvamisa yesakhiwo) ngemuva kwayo.
Ngakho uma isiguli singamtholi udokotela, i-Zocdoc noma i-Teledoc ingasiza ukwenza i-aphoyintimenti.Kodwa lezi zinkampani aziwunaki umbuzo omkhulu: Kungani kunzima kangaka kubantu ukuthola odokotela abathengekayo kwasekuqaleni?Ngokufanayo, i-GoodRx inganikeza amakhuphoni lapho iziguli zingakwazi ukuthenga izidakamizwa ekhemisi.Kodwa inkampani ayinandaba ukuthi kungani abantu baseMelika bekhokha imali ephindwe kabili yemithi kunabantu bakwamanye amazwe e-OECD.
Ukunakekelwa kwezempilo kwaseMelika kuyawohloka ngoba abalamuli ababheki lezi zinkinga ezinkulu zesistimu ezingaxazululeki.Ukuze asebenzise isifaniso sezokwelapha, umlamuli angadambisa izimo ezisongela ukuphila.Abazami ukubalapha.
Ukuze kucace, inkinga ngemithi akukhona ukuba khona kwabaxhumanisi.Ukushoda kwabaholi abazimisele nabakwaziyo ukubuyisela izisekelo ezonakele zokunakekelwa kwezempilo.
Isibonelo salokhu kuntuleka kobuholi imodeli yembuyiselo “yenkokhelo yesevisi” evame kakhulu ekunakekelweni kwezempilo kwase-US, lapho odokotela nezibhedlela bekhokhelwa khona ngokusekelwe enanini lezinsizakalo (ukuhlolwa, ukwelashwa, nezinqubo) abazihlinzekayo.Le ndlela yokukhokha “yomholo njengoba usebenzisa” inengqondo ezimbonini eziningi zezinkampani.Kodwa ekunakekelweni kwezempilo, imiphumela iye yabiza kakhulu futhi yaba nemiphumela engemihle.
Emsebenzini okhokhelwayo, odokotela bakhokhelwa kakhulu ekwelapheni inkinga yezempilo kunokuyivimba.Banentshisekelo yokuhlinzeka ngokunakekelwa okwengeziwe, kungakhathaliseki ukuthi kwengeza inani noma cha.
Ukuthembela kwezwe lethu ezinkokhelweni kusiza ekuchazeni ukuthi kungani izindleko zokunakekelwa kwezempilo zase-US zikhuphuke ngokuphindwe kabili njengokwehla kwamandla emali kule minyaka engamashumi amabili edlule, kuyilapho isikhathi sokuphila asikashintshi kangako esikhathini esifanayo.Njengamanje, i-US isalele ngemuva kwawo wonke amazwe anezimboni ngekhwalithi yomtholampilo, futhi amazinga okufa kwezingane nomama aphindwe kabili kunawamanye amazwe acebe kakhulu.
Ungase ucabange ukuthi ochwepheshe bezokunakekelwa kwempilo bangaba namahloni ngalokhu kwehluleka - bazophikelela ekushintsheni le modeli yokukhokha engasebenzi ngendlela egxile enanini lokunakekelwa okunikezwayo kunenani lokunakekelwa okunikezwayo.Awulungile.
Imodeli ye-pay-for-value idinga odokotela nezibhedlela ukuthi bathathe ingozi yezezimali ngemiphumela yomtholampilo.Kubo, ukushintshela ekukhokheni kusengaphambili kugcwele ubungozi bezezimali.Ngakho esikhundleni sokubamba leli thuba, bathatha isimo sengqondo somuntu omaphakathi, bakhetha izinguquko ezincane ezikhulayo ukuze banciphise ubungozi.
Njengoba odokotela nezibhedlela benqaba ukukhokhela izindleko, izinkampani zomshwalense ezizimele kanye nohulumeni wobumbano baphendukela ezinhlelweni zokukhokhela ukusebenza kahle ezimele umqondo ophakathi ngokwedlulele.
Lezi zinhlelo zenkuthazo ziklomelisa odokotela ngamadola ambalwa engeziwe isikhathi ngasinye lapho benikeza isevisi ethile yokuvimbela.Kodwa ngenxa yokuthi kunamakhulu ezindlela ezisekelwe ebufakazini zokuvimbela izifo (futhi imali elinganiselwe kuphela yemali yokukhuthaza etholakalayo), izindlela zokuvimbela ezingezona ezikhuthazayo ngokuvamile azinakwa.
Ingqondo yomuntu ophakathi ikhula kahle ezimbonini ezingasebenzi, yenza abaholi buthaka futhi ivimbele ushintsho.Ngakho-ke, ngokushesha imboni yezokunakekelwa kwezempilo yase-US ibuyela emcabangweni wayo wobuholi, iba ngcono.
Abaholi bathatha igxathu eliya phambili futhi baxazulule izinkinga ezinkulu ngezenzo ezinesibindi.Abaphakathi basebenzisa amabhande ukuze bawafihle.Uma kukhona okungahambi kahle, abaholi bazibophezela.Umqondo womlamuli ubeka icala komunye umuntu.
Kuyafana nangemithi yaseMelika, lapho abathengi bezidakamizwa besola izinkampani zomshwalense ngezindleko eziphakeme nempilo ebuthaka.Kanti inkampani yomshwalense isola udokotela ngakho konke.Odokotela basola iziguli, abalawuli kanye nezinkampani zokudla okusheshayo.Iziguli zisola abaqashi bazo nohulumeni.Kuyindilinga enonya engapheli.
Yiqiniso, kunabantu abaningi embonini yokunakekelwa kwezempilo-ama-CEO, izihlalo zamabhodi abaqondisi, omongameli bamaqembu ezokwelapha, nabanye abaningi-abanamandla nekhono lokuhola izinguquko zenguquko.Kodwa umqondo womlamuli ubagcwalisa ngokwesaba, unciphise ukugxila kwabo, futhi ubaphushele ekuthuthukisweni okuncane okukhulayo.
Izinyathelo ezincane azanele ukunqoba izinkinga zempilo ezibhebhethekayo nezisabalele.Uma nje ikhambi lezempilo lihlala lincane, imiphumela yokungenzi lutho izokhula.
Ukunakekelwa kwezempilo kwaseMelika kudinga abaholi abaqinile ukuze baphule ingqondo yomuntu ophakathi futhi bakhuthaze abanye ukuthi bathathe isinyathelo esinesibindi.
Impumelelo izodinga ukuthi abaholi basebenzise inhliziyo, ubuchopho, nomgogodla—izifunda ezintathu (ngokomfanekiso) ezidingekayo ukuze kulethe uguquko.Yize i-anatomy yobuholi ingafundiswa ezikoleni zezokwelapha noma zabahlengikazi, ikusasa lemithi lincike kukho.
Izihloko ezintathu ezilandelayo zalolu chungechunge zizohlola lezi zakhi zomzimba futhi zichaze izinyathelo abaholi abangazithatha ukuguqula ukunakekelwa kwezempilo kwaseMelika.Isinyathelo 1: Susa isimo sengqondo somuntu ophakathi.