Koresha amakuru na serivisi bya NEJM Itsinda kugirango witegure kuba umuganga, gukusanya ubumenyi, kuyobora umuryango wita ku buzima no guteza imbere umwuga wawe.
Mu cyorezo cya Covid-19, iterambere ryihuse rya telemedisine ryongeye kwibanda ku mpaka zerekeye impushya z’abaganga.Mbere y’icyorezo, ibihugu muri rusange byatangaga impushya z’abaganga hashingiwe kuri politiki ivugwa mu itegeko ry’ubuvuzi bwa buri gihugu, ryateganyaga ko abaganga bagomba guhabwa uruhushya muri leta umurwayi aherereyemo.Ku baganga bifuza gukoresha telemedisine kugira ngo bavure abarwayi hanze ya Leta, iki cyifuzo kibateza inzitizi zikomeye mu buyobozi n’imari.
Mugihe cyambere cyicyorezo, inzitizi nyinshi zijyanye nimpushya zavanyweho.Ibihugu byinshi byatanze ibyemezo by'agateganyo byemeza impushya zo kwivuza hanze.1 Ku rwego rwa federasiyo, Serivise y’ubuvuzi n’ubuvuzi yaretse by'agateganyo ibisabwa na Medicare kugira ngo umuntu abone uruhushya rwo kwa muganga muri leta y’umurwayi.2 Izi mpinduka zigihe gito zatumye ubuvuzi abarwayi benshi bahabwa binyuze kuri telemedisine mugihe cyorezo cya Covid-19.
Bamwe mu baganga, intiti, n'abafata ibyemezo bemeza ko iterambere rya telemedisine ari urumuri rw'icyizere kuri iki cyorezo, kandi Kongere irimo gusuzuma imishinga myinshi yo guteza imbere ikoreshwa rya telemedisine.Twizera ko ivugurura ryimpushya rizaba urufunguzo rwo kongera imikoreshereze yizi serivisi.
Nubwo leta zakomeje uburenganzira bwo gukora impushya zo kwivuza kuva mu mpera za 1800, iterambere rya sisitemu nini y’ubuzima n’igihugu n’akarere ndetse no kongera ikoreshwa rya telemedine byaguye isoko ry’ubuvuzi kurenga imipaka y’igihugu.Rimwe na rimwe, sisitemu ishingiye kuri leta ntabwo ihuye nubwenge busanzwe.Twumvise inkuru zivuga ku barwayi batwaye ibirometero byinshi bambukiranya umurongo wa leta kugira ngo bitabira gusura ubuvuzi bwibanze bwa telemedine bivuye mu modoka zabo.Aba barwayi ntibashobora kwitabira gahunda imwe murugo kuko umuganga wabo atabifitiye uburenganzira aho atuye.
Kuva kera, abantu bafite impungenge ko komisiyo ishinzwe gutanga impushya za leta yitaye cyane kurinda abanyamuryango bayo amarushanwa, aho gukorera inyungu rusange.Mu mwaka wa 2014, komisiyo ishinzwe ubucuruzi n’ubucuruzi yareze mu majyaruguru y’inama y’abagenzuzi b’amenyo ya Carolina y’Amajyaruguru, ivuga ko kuba Komisiyo yarabujije abadafite amenyo gutanga serivisi z’abazungu binyuranyije n’amategeko abuza kwishyiriraho ibiciro.Nyuma, uru rubanza rw’Urukiko rw’ikirenga rwatanzwe muri Texas kugira ngo rwamagane amabwiriza y’impushya abuza ikoreshwa rya telemedine muri leta.
Byongeye kandi, Itegeko Nshinga rishyira imbere guverinoma ihuriweho na Leta, hashingiwe ku mategeko ya Leta abangamira ubucuruzi bw’ibihugu.Kongere yakoze bimwe bidasanzwe kuri leta?Uruhushya rwihariye, cyane cyane muri gahunda zubuzima bwa leta.Kurugero, itegeko ryubutumwa bwa VA ryo muri 2018 risaba ibihugu kwemerera abaganga bo hanze y’igihugu gukora imiti ya telemedine muri sisitemu y’abasirikare (VA).Iterambere rya telemedicine ihuza ibihugu ritanga andi mahirwe guverinoma ihuriweho na leta.
Nibura ubwoko bune bwivugurura bwatanzwe cyangwa bwatangijwe kugirango biteze imbere telemedicine.Uburyo bwa mbere bwubakiye kuri sisitemu yubuvuzi bushingiye kuri leta, ariko byorohereza abaganga kubona ibyangombwa byo hanze.Amasezerano y’ubuvuzi bw’ibihugu yashyizwe mu bikorwa mu 2017. Ni amasezerano hagati y’ibihugu 28 na Guam mu kwihutisha inzira gakondo y’abaganga babona impushya za Leta gakondo (reba ikarita).Nyuma yo kwishyura amadorari 700 y’amadorari, abaganga barashobora kubona impushya mu bindi bihugu bitabiriye, hamwe n’amafaranga kuva 75 $ muri Alabama cyangwa Wisconsin kugeza $ 790 muri Maryland.Kugeza muri Werurwe 2020, abaganga 2,591 (0.4%) bonyine ni bo bakoresheje amasezerano yo kubona uruhushya mu kindi gihugu.Kongere irashobora gutora amategeko ashishikariza ibihugu bisigaye kwitabira amasezerano.Nubwo igipimo cyimikoreshereze ya sisitemu cyabaye gito, kwagura amasezerano muri leta zose, kugabanya ibiciro numutwaro wubuyobozi, hamwe no kwamamaza neza bishobora gutuma umuntu yinjira cyane.
Ubundi buryo bwa politiki ni ugushishikariza gusubiranamo, aho leta zihita zemera impushya zo hanze.Kongre yemereye abaganga bakora imyitozo muri sisitemu ya VA kubona inyungu, kandi mugihe cyicyorezo, leta nyinshi zashyize mubikorwa politiki yo gusubiranamo byigihe gito.Muri 2013, amategeko ya leta yasabye ko hashyirwa mu bikorwa burundu gusubiranamo muri gahunda ya Medicare.3
Uburyo bwa gatatu ni ugukora ubuvuzi bushingiye aho umuganga aherereye aho umurwayi aherereye.Dukurikije itegeko ry’igihugu ryemerera ingabo z’igihugu 2012, abaganga batanga ubuvuzi muri TriCare (Gahunda y’ubuzima bwa Gisirikare) bakeneye gusa uruhushya muri leta batuyemo, kandi iyi politiki yemerera ubuvuzi bw’ibihugu.Abasenateri Ted Cruz (R-TX) na Martha Blackburn (R-TN) baherutse gushyiraho “Kuringaniza uburyo bwo kubona serivisi z’ubuvuzi”, bizakoreshwa by'agateganyo iyi ngero mu bikorwa bya telemedine mu gihugu hose.
Ingamba zanyuma -?Kandi icyifuzo kirambuye mubyifuzo byaganiriweho neza - uruhushya rwo kwimenyereza umwuga ruzashyirwa mubikorwa.Mu mwaka wa 2012, Senateri Tom Udall (D-NM) yatanze umushinga w'itegeko rishyiraho uburyo bwo gutanga uruhushya.Muri iki cyitegererezo, abaganga bashishikajwe n’imikorere ya leta bagomba gusaba uruhushya rwa leta hiyongereyeho uruhushya rwa leta4.
Nubwo ari igitekerezo cyo gusuzuma uruhushya rumwe rwa federasiyo, politiki nkiyi irashobora kuba idahwitse kuko yirengagije uburambe bwikinyejana kirenga ibinyejana bishingiye kuri leta.Iyi komite kandi igira uruhare runini mu bikorwa bya disipulini, ifata ibyemezo abaganga ibihumbi buri mwaka.5 Guhindukira muri sisitemu yo gutanga uruhushya rushobora guhungabanya imbaraga za leta.Byongeye kandi, abaganga ndetse n’inama z’ubuvuzi za Leta zitanga cyane cyane ubuvuzi imbonankubone bafite inyungu mu gukomeza gahunda y’impushya zishingiye kuri Leta kugira ngo bagabanye amarushanwa atangwa n’abatanga serivisi z’igihugu, kandi barashobora kugerageza kubangamira iryo vugurura.Gutanga impushya zo kwivuza ukurikije aho umuganga aherereye ni igisubizo cyubwenge, ariko kandi kirwanya sisitemu imaze igihe igenga imikorere yubuvuzi.Guhindura ingamba zishingiye kumwanya bishobora nanone guteza ibibazo kubuyobozi?Ibikorwa bya disipulini n'urwego.Kubaha ivugurura ryigihugu Kubwibyo, kugenzura amateka yimpushya birashobora kuba inzira nziza yiterambere.
Muri icyo gihe, birasa n’ingamba zidahwitse ziteze ko ibihugu bifata ibyemezo byonyine kugirango byongere uburyo bwo gutanga impushya zo hanze.Mu baganga bo mu bihugu byitabiriye aya mahugurwa, ikoreshwa ry’amasezerano y’ibihugu ni rito, bagaragaza ko inzitizi z’ubuyobozi n’imari zishobora gukomeza kubangamira imiti y’ibihugu.Urebye kurwanya imbere, ntibishoboka ko ibihugu bizashyiraho amategeko yisubiraho wenyine.
Ahari ingamba zitanga ikizere ni ugukoresha abayobozi ba federasiyo kugirango bashishikarize gusubiranamo.Kongere irashobora gusaba uruhushya rwo gusubiranamo murwego rwindi gahunda ya federasiyo, Medicare, ishingiye kumategeko yabanjirije agenga abaganga muri sisitemu ya VA na TriCare.Igihe cyose bafite uruhushya rwubuvuzi rwemewe, barashobora kwemerera abaganga gutanga serivise za telemedine kubagenerwabikorwa ba Medicare muri leta iyo ari yo yose.Politiki nk'iyi irashobora kwihutisha itorwa ry'amategeko y'igihugu yerekeye gusubiranamo, bizagira ingaruka no ku barwayi bakoresha ubundi buryo bw'ubwishingizi.
Icyorezo cya Covid-19 cyateje kwibaza ku kamaro k'urwego ruhari rwo gutanga uruhushya, kandi bimaze kugaragara ko sisitemu zishingiye kuri telemedisine zikwiye sisitemu nshya.Ibishobora kuba byinshi ni byinshi, kandi urwego rwimpinduka rurimo kuva kwiyongera kugeza mubyiciro.Twizera ko gushyiraho uburyo bwo gutanga impushya zigihugu zihari, ariko gushishikariza gusubiranamo hagati y’ibihugu ninzira nyayo yiterambere.
Kuva mu Ishuri Rikuru ry'Ubuvuzi rya Harvard na Beth Isiraheli Ikigo Cy'ubuvuzi (AM), na Tufts University of Medicine (AN) -?Bombi bari i Boston;Ishuri ry'amategeko rya Duke (BR) i Durham, muri Karoline y'Amajyaruguru.
1. Ihuriro ry’inama nkuru y’ubuvuzi.Intara n’intara zo muri Amerika byavuguruye ibyangombwa by’umuganga bishingiye kuri COVID-19.Ku ya 1 Gashyantare 2021 (https: //www.fsmb.
2. Ubwishingizi bw'ubuvuzi n'ikigo gishinzwe ubuvuzi.COVID-19 itangazo ryihutirwa ryabatanga ubuvuzi basonewe.Ku ya 1 Ukuboza 2020 (https://www.cms.gov/files/document/summary-covid-19- byihutirwa- gutangaza-waivers.pdf).
3. Itegeko rya TELE-MED 2013, HR 3077, Satoshi 113. (2013-2014) (https://www.congress.gov/bill/113th-congress/house-bill/3077).
4. Abashyigikiye Norman J. Telemedicine bashyizeho ingufu nshya kubikorwa byo gutanga uruhushya rwa muganga kurenga imbibi za leta.New York.
5. Ihuriro ry’inama z’ubuvuzi z’igihugu.Ibikorwa byo kugenzura ubuvuzi muri Amerika, n'ibikorwa, 2018. Ku ya 3 Ukuboza 2018 (https: //www.fsmb.
Igihe cyo kohereza: Werurwe-01-2021