Mu gihe abarwayi bagenda bashingira ku bahuza na serivisi zabo, ubuvuzi bwo muri Amerika bwateje imbere icyo Dr. Robert Pearl yita “imitekerereze yo hagati”.
Hagati yabatunganya n’abaguzi, uzasangamo itsinda ryinzobere zorohereza ibikorwa, kuborohereza no kohereza ibicuruzwa na serivisi.
Azwi nk'abunzi, batera imbere hafi yinganda zose, uhereye kumitungo itimukanwa no kugurisha kugeza serivisi zimari ningendo.Hatabayeho abahuza, amazu n'amashati ntibyagurishwa.Nta banki cyangwa imbuga zo gutumaho kumurongo.Ndashimira abahuza, inyanya zihingwa muri Amerika yepfo zitangwa nubwato muri Amerika ya ruguru, zinyura muri gasutamo, bikarangirira muri supermarket yaho bikarangirira mu gitebo cyawe.
Abahuza babikora byose kubiciro.Abaguzi n'abashinzwe ubukungu ntibavuga rumwe niba abahuza ari parasite ya pesky mubuzima bwa none, cyangwa byombi.
Igihe cyose impaka zikomeje, ikintu kimwe ntakekeranywa: Abahuza ubuzima muri Amerika ni benshi kandi baratera imbere.
Abaganga n'abarwayi bakomeza umubano wabo kandi bishyura mbere yuko abahuza binjira.
Umuhinzi wo mu kinyejana cya 19 ufite ububabare ku rutugu yasabye umuganga w’umuryango we, wasuzumye umubiri, asuzuma, n’imiti y’ububabare.Ibi byose birashobora guhanahana inkoko cyangwa amafaranga make.Umuhuza ntabwo asabwa.
Ibi byatangiye guhinduka mugice cya mbere cyikinyejana cya 20, igihe ibiciro no kugorana byitaweho byabaye ikibazo kuri benshi.Mu 1929, igihe isoko ryimigabane ryangirika, Blue Cross yatangiye nkubufatanye hagati yibitaro bya Texas nabarezi baho.Abarimu bishyura buri kwezi amafaranga 50 yo kwishyura ibitaro bakeneye.
Abahuza ubwishingizi ni umuhuza utaha mu buvuzi, agira inama abantu kuri gahunda nziza y’ubwishingizi bw’ubuzima hamwe n’amasosiyete y’ubwishingizi.Igihe ibigo byubwishingizi byatangiraga gutanga inyungu zibiyobyabwenge byandikirwa mu myaka ya za 1960, PBMs (Pharmacy Benefit Managers) zagaragaye kugirango zifashe kugenzura ibiciro byibiyobyabwenge.
Abahuza bari hose mubice bya digitale muriyi minsi.Ibigo nka Teledoc na ZocDoc byashizweho kugirango bifashe abantu kubona abaganga amanywa n'ijoro.Offshoots za PBM, nka GoodRx, zinjira ku isoko kugirango zumvikane ku biciro by’ibiyobyabwenge n’abakora na farumasi mu izina ry’abarwayi.Serivisi z'ubuzima bwo mu mutwe nka Talkspace na BetterHelp zavutse kugirango zihuze abantu n'abaganga bafite uburenganzira bwo kwandika imiti yo mu mutwe.
Ibi bisubizo bifasha abarwayi kuyobora neza sisitemu yubuzima idakora neza, bigatuma ubuvuzi no kuvurwa byoroha, byoroshye, kandi bihendutse.Ariko nkuko abarwayi bagenda bishingikiriza ku bahuza na serivisi zabo, icyo nita imitekerereze yo hagati cyahindutse mubuzima bwabanyamerika.
Tekereza ko wabonye igikonjo kirekire hejuru yumuhanda wawe.Urashobora kuzamura asfalt, gukuramo imizi munsi hanyuma ukuzuza ahantu hose.Cyangwa urashobora guha akazi umuntu kugirango atange inzira.
Tutitaye ku nganda cyangwa ikibazo, abahuza bakomeza imitekerereze ya "gukosora".Intego yabo ni ugukemura ikibazo gito utitaye kubibazo bijyana (mubisanzwe byubatswe) inyuma yacyo.
Iyo rero umurwayi adashobora kubona umuganga, Zocdoc cyangwa Teledoc barashobora gufasha kubonana.Ariko aya masosiyete yirengagije ikibazo kinini: Kuki bigoye ko abantu babona abaganga bahendutse mbere?Mu buryo nk'ubwo, GoodRx irashobora gutanga ama coupons mugihe abarwayi badashoboye kugura imiti muri farumasi.Ariko isosiyete ntiyitaye ku mpamvu Abanyamerika bishyura inshuro ebyiri ibyo banditse kurusha abantu bo mu bindi bihugu bya OECD.
Ubuvuzi bwabanyamerika bugenda bwangirika kubera ko abunzi badakemura ibyo bibazo bikomeye, bidakemuka.Gukoresha ikigereranyo cyubuvuzi, umuhuza arashobora kugabanya ibibazo byangiza ubuzima.Ntibagerageza kubakiza.
Byumvikane neza, ikibazo cyubuvuzi ntabwo ari abahuza.Kubura abayobozi bafite ubushake kandi bashoboye kugarura urufatiro rwangiritse rwubuvuzi.
Urugero rwo kubura ubuyobozi ni uburyo bwo kwishyura "amafaranga-kuri-serivisi" yiganje mu buvuzi bwo muri Amerika, aho abaganga n'ibitaro byishyurwa hashingiwe ku mubare wa serivisi (ibizamini, ubuvuzi, n'inzira) batanga.Ubu buryo bwo "kwinjiza nkuko ukoresha" uburyo bwo kwishyura bwumvikana mubikorwa byinshi byamasosiyete.Ariko mubuvuzi, ingaruka zarahenze kandi zitanga umusaruro.
Muri buri mushahara, abaganga bahembwa menshi yo kuvura ikibazo cyubuvuzi kuruta kukirinda.Bashishikajwe no gutanga ubwitonzi bwinshi, bwaba butongera agaciro.
Kuba igihugu cyacu gishingiye ku mafaranga bifasha gusobanura impamvu amafaranga yo kwivuza muri Amerika yazamutse inshuro ebyiri ugereranije n’ifaranga mu myaka 20 ishize, mu gihe icyizere cyo kubaho cyahindutse mu gihe kimwe.Kugeza ubu, Amerika iri inyuma y'ibindi bihugu byose byateye imbere mu nganda mu bijyanye n'ubuvuzi, kandi umubare w'abana bapfa bapfa babyara n'ababyeyi wikubye kabiri ibyo mu bindi bihugu bikize.
Urashobora gutekereza ko inzobere mu buvuzi zagira ipfunwe kubera ibyo byananiranye - bakomeza gutsimbarara ku gusimbuza ubu buryo bwo kwishyura budahwitse n’ubundi bwibanda ku gaciro k’ubuvuzi butangwa aho kuba amafaranga yatanzwe.Ntabwo uvuze ukuri.
Icyitegererezo cyo kwishyura-gaciro gisaba abaganga nibitaro gufata ibyago byamafaranga kubisubizo byubuvuzi.Kuri bo, inzibacyuho yo kwishyura mbere yuzuyemo ingaruka zamafaranga.Aho kugirango babone umwanya, bahisemo imitekerereze yo hagati, bahitamo impinduka ziyongera kugirango bagabanye ingaruka.
Mugihe abaganga nibitaro banze kwishyura ikiguzi, ibigo byubwishingizi bwigenga hamwe na reta ya reta bifashisha gahunda yo kwishyura-ibikorwa byerekana imitekerereze ikabije yo hagati.
Izi gahunda zo gutera inkunga zihembera abaganga amadorari make yinyongera igihe cyose batanze serivise yihariye yo gukumira.Ariko kubera ko hariho inzira zibarirwa mu magana zishingiye ku bimenyetso byo gukumira indwara (kandi umubare muto w'amafaranga yo gutera inkunga uraboneka), ingamba zo gukumira zidashishikarizwa akenshi zirengagizwa.
Imitekerereze ya muntu-hagati itera imbere mu nganda zidakora neza, guca intege abayobozi no kubangamira impinduka.Kubwibyo, byihuse inganda zita kubuzima muri Amerika zisubira mubitekerezo byubuyobozi, nibyiza.
Abayobozi batera intambwe kandi bakemure ibibazo bikomeye nibikorwa bitinyutse.Abunzi bakoresha band-infashanyo kugirango babahishe.Iyo hari ibitagenda neza, abayobozi bafata inshingano.Imitekerereze y'abunzi ishyira amakosa kuwundi muntu.
Ni kimwe nubuvuzi bwabanyamerika, hamwe nabaguzi biyobyabwenge bashinja ibigo byubwishingizi kubiciro byinshi nubuzima bubi.Na none, isosiyete yubwishingizi ishinja umuganga kubintu byose.Abaganga bashinja abarwayi, abagenzuzi n’amasosiyete yihuta.Abarwayi bashinja abakoresha babo na guverinoma.Numuzingi mubi utagira iherezo.
Birumvikana ko hari abantu benshi mubikorwa byubuzima - abayobozi bakuru, intebe yinama yubuyobozi, abaperezida b’amatsinda yubuvuzi, nabandi benshi - bafite imbaraga nubushobozi bwo kuyobora impinduka.Ariko imitekerereze y'abunzi ibuzuza ubwoba, igabanya ibitekerezo byabo, kandi ibasunikira ku iterambere rito ryiyongera.
Intambwe nto ntizihagije kugirango tuneshe ibibazo bibi byubuzima.Igihe cyose igisubizo cyubuzima gikomeje kuba gito, ingaruka zo kudakora ziziyongera.
Ubuvuzi bwabanyamerika bukeneye abayobozi bakomeye kugirango bace imitekerereze yo hagati kandi bashishikarize abandi gufata ingamba zitinyutse.
Intsinzi izasaba abayobozi gukoresha umutima wabo, ubwonko bwabo, numugongo - uturere dutatu (mu buryo bw'ikigereranyo) uturere dukenewe kugirango tuzane impinduka.Nubwo anatomiya yubuyobozi itigishwa mumashuri yubuvuzi cyangwa ubuforomo, ahazaza h'ubuvuzi biterwa nayo.
Ingingo eshatu zikurikira muri uru ruhererekane ziziga kuri anatomiya kandi zisobanure intambwe abayobozi bashobora gutera kugirango bahindure ubuzima bwabanyamerika.Intambwe ya 1: Kuraho imitekerereze yo hagati.