Isticmaal macluumaadka iyo adeegyada Kooxda NEJM si aad ugu diyaargarowdo inaad noqoto dhakhtar, urursato aqoonta, hogaamiso urur daryeel caafimaad oo aad kor ugu qaaddo horumarkaaga shaqo.
Intii lagu jiray masiibada Covid-19, horumarka degdega ah ee telemedicine wuxuu dib u saaray dareenka cusub ee doodda ku saabsan shatiga dhakhaatiirta.Faafida ka hor, gobolladu guud ahaan waxay bixiyeen shatiyada dhakhaatiirta iyadoo lagu salaynayo siyaasadda lagu qeexay sharciga ku dhaqanka caafimaadka ee gobol kasta, kaasoo qeexaya in dhakhaatiirtu ay tahay inay shati ka haystaan gobolka uu bukaanku joogo.Dhakhaatiirta doonaya inay u isticmaalaan telemedicine si ay ugu daaweeyaan bukaanada meel ka baxsan gobolka, shuruudan waxay u abuurtaa caqabado waaweyn oo maamul iyo maaliyadeed.
Marxaladihii hore ee masiibada, caqabado badan oo la xidhiidha shatiga ayaa meesha laga saaray.Gobolo badan ayaa soo saaray bayaanno ku meel gaar ah oo aqoonsan shatiyada caafimaadka ee ka baxsan gobolka.1 Heer federaal, Medicare iyo Adeegyada Medicaid waxay si ku meel gaar ah uga tanaasuleen shuruudaha Medicare ee helitaanka shatiga daawaynta ee gobolka bukaanka.2 Isbeddelladan ku meel gaadhka ah waxay awood u siiyeen daryeelka ay bukaanno badani ku heleen telemedicine intii lagu jiray masiibada Covid-19.
Dhakhaatiir gaar ah, aqoonyahanno, iyo siyaasad dejiyayaal ayaa rumeysan in horumarinta telemedicine ay rajo u tahay masiibada, Koongarasku wuxuu tixgelinayaa biilal badan si kor loogu qaado isticmaalka telemedicine.Waxaan aaminsanahay in dib-u-habaynta shatiga ay noqon doonto furaha kordhinta isticmaalka adeegyadan.
In kasta oo ay gobolladu dhawreen xaqa ay u leeyihiin in ay ku shaqeystaan shatiyada caafimaadka laga soo bilaabo dabayaaqadii 1800-meeyadii, horumarinta nidaamyada caafimaadka heer qaran iyo heer gobol iyo kororka isticmaalka telemedicine-ka ayaa ballaariyay baaxadda suuqa daryeelka caafimaadka ee ka baxsan xuduudaha qaranka.Mararka qaarkood, nidaamyada dawlad-goboleedka ku salaysan ma waafaqsana caqli-galnimada.Waxaan maqalnay sheekooyin ku saabsan bukaanno dhowr mayl ku dhex maray khadka gobolka si ay uga qaybqaataan booqashooyinka telemedicine ee daryeelka aasaasiga ah ee baabuurtooda.Bukaan-socodkan si dhib leh ugama qaybqaadan karaan isla ballan guriga sababtoo ah dhakhtarkoodu ma haysto shatiga goobta degenaanshaha.
Muddo dheer, dadku waxay sidoo kale ka welwelayeen in Guddiga Shatiyada Dawlad-goboleedyadu ay aad ugu fiirsanayaan inay xubnahooda ka ilaaliyaan tartanka, halkii ay u adeegi lahaayeen danta guud.Sannadkii 2014-kii, Guddiga Ganacsiga ee Federaalka ayaa si guul leh u dacweeyay Guddiga Kormeerayaasha Ilkaha ee Waqooyiga Carolina, iyaga oo ku doodaya in mamnuucidda sharci-darrada ah ee Guddiga ee ka dhanka ah kuwa aan ilkaha ahayn inay bixiyaan adeegyada caddaynta ay ku xad-gudbeen sharciyada lidka ku ah kalsoonida.Later, kiiskan Maxkamadda Sare waxaa laga gudbiyay Texas si ay uga doodaan xeerarka shatiga ee xaddidaya isticmaalka telemedicine ee gobolka.
Sidoo kale, Dastuurku wuxuu siinayaa dowladda federaalka mudnaanta koowaad, iyadoo la raacayo sharciyada dowlad-goboleedyada ee farageliya ganacsiga dowlad goboleedyada.Koongarasku ma sameeyey waxyaabo ka reeban gobolka?Sharci gaar ah oo shati u leh, gaar ahaan barnaamijyada caafimaadka federaalka.Tusaale ahaan, Sharciga Hawlgalka VA ee 2018 wuxuu u baahan yahay gobolada inay u oggolaadaan dhakhaatiirta ka baxsan gobolka inay ku dhaqmaan telemedicine gudaha nidaamka Arrimaha Veterans (VA).Horumarinta daawooyinka isgaadhsiinta ee dawlad-goboleedka ayaa fursad kale siinaya dawladda federaalka inay soo farageliso.
Ugu yaraan afar nooc oo dib u habayn ah ayaa la soo jeediyay ama la soo bandhigay si kor loogu qaado telemedicine-ka gobolka.Habka ugu horreeya wuxuu ku dhisan yahay nidaamka oggolaanshaha caafimaadka ee ku salaysan gobolka, laakiin wuxuu u fududeeyaa dhakhaatiirta inay helaan oggolaansho ka baxsan gobolka.Heshiiska shatiga caafimaadka ee dowlad goboleedyada ayaa la hirgeliyay 2017. Waa heshiis ay wada gaareen 28 dowladood iyo Guam si loo dedejiyo habka dhaqanka ee dhakhaatiirta ay ku helaan shatiyada dhaqanka ee gobolka (eeg khariidadda).Ka dib bixinta $700 khidmadda xatooyada, dhakhaatiirtu waxay ka heli karaan shatiga wadamada kale ee ka qaybgalaya, oo leh khidmadaha u dhexeeya $75 Alabama ama Wisconsin ilaa $790 gudaha Maryland.Laga bilaabo Maarso 2020, kaliya 2,591 (0.4%) dhakhaatiirta gobolada ka qaybqaata ayaa u isticmaalay qandaraaska si ay shati uga helaan gobol kale.Koongarasku wuxuu soo saari karaa sharci lagu dhiirigelinayo gobolada hadhay inay ku biiraan qandaraaska.Inkasta oo heerka isticmaalka nidaamku uu yaraa, balaadhinta qandaraaska ee dhammaan gobolada, dhimista kharashyada iyo culaysyada maamulka, iyo xayaysiis wanaagsan ayaa laga yaabaa inay horseeddo dhexgalka weyn.
Ikhtiyaar kale oo siyaasadeed ayaa ah in la dhiirigaliyo isdhaafsiga, kaas oo ay dawladuhu si toos ah u aqoonsanayaan shatiga ka baxsan gobolka.Koongarasku waxa uu u fasaxay dhakhaatiirta ku shaqaynaysa nidaamka VA si ay u helaan faa'iidooyin labada dhinac ah, iyo inta lagu jiro masiibada, gobolada intooda badani waxay si ku meel gaar ah u fuliyeen siyaasadaha isu-celinta.Sannadkii 2013, sharciga federaalku wuxuu soo jeediyay hirgelinta joogtada ah ee dib-u-celinta qorshaha Medicare.3
Habka saddexaad waa in lagu dhaqmo daawada iyadoo lagu salaynayo goobta uu takhtarku joogo halkii uu bukaanku joogo.Marka loo eego Sharciga Ogolaanshaha Difaaca Qaranka ee 2012, daaweeyayaasha bixiya daryeelka ee hoos yimaada TriCare (Barnaamijka Caafimaadka Militeriga) kaliya waxay u baahan yihiin in shati laga siiyo gobolka ay dhab ahaantii ku nool yihiin, siyaasadani waxay ogolanaysaa ku dhaqanka caafimaadka gobolka.Senatarrada Ted Cruz (R-TX) iyo Martha Blackburn (R-TN) ayaa dhowaan soo bandhigay "Sharciga Sinaanta ee Adeegyada Caafimaadka", kaas oo si ku meel gaar ah u dabaqi doona qaabkan dhaqamada telemedicine ee dalka oo dhan.
Xeeladda ugu dambeysa -?Iyo soo jeedinta ugu faahfaahsan ee ka mid ah soo jeedinta si taxadar leh looga hadlay - shatiga ku dhaqanka federaalka waa la hirgelin doonaa.Sannadkii 2012, Senator Tom Udall (D-NM) ayaa soo jeediyay (laakin si rasmi ah looma soo bandhigin) sharci lagu dhisayo habka shati bixinta taxanaha ah.Qaabkan, daaweeyayaasha danaynaya ku dhaqanka dawlad-goboleedka waa in ay codsadaan shatiga gobolka marka lagu daro shatiga gobolka4.
Inkasta oo ay fikrad ahaan soo jiidanayso in la tixgeliyo hal liisan oo federaal ah, siyaasaddan oo kale ayaa laga yaabaa inay noqoto mid aan hirgalayn sababtoo ah waxay iska indhatiraysaa waayo-aragnimada in ka badan qarni ee nidaamyada shatiga ku salaysan ee gobolka.Guddigu wuxuu kaloo door muhiim ah ka qaataa howlaha edbinta, isagoo tallaabo ka qaadaya kumanaan dhakhaatiir ah sannad kasta.5 U beddelashada nidaamka shatiga federaalka waxay wiiqi kartaa awoodaha edbinta ee gobolka.Intaa waxaa dheer, labadaba dhakhaatiirta iyo guddiyada caafimaadka gobolka ee ugu horreyn bixiya daryeelka fool-ka-fool ah waxay leeyihiin dano gaar ah oo lagu ilaalinayo nidaamka shatiga ku salaysan ee gobolka si loo xaddido tartanka ka imaanaya bixiyeyaasha gobolka ka baxsan, waxaana laga yaabaa inay isku dayaan inay wiiqaan dib-u-habayntaas.Bixinta shatiyada daryeelka caafimaadka ee ku salaysan goobta dhakhtarka waa xal caqli-gal ah, laakiin sidoo kale waxay caqabad ku tahay nidaamka muddada dheer ee nidaaminaya ku-dhaqanka caafimaadka.Wax ka beddelka istaraatiijiyadda ku saleysan goobta ayaa sidoo kale caqabad u keeni karta guddiga?Hawlaha edbinta iyo baaxadda.Ixtiraamka dib-u-habaynta qaranka Sidaa darteed, xakamaynta taariikheed ee oggolaanshaha ayaa laga yaabaa inay noqoto jidka ugu wanaagsan ee hore loo maro.
Isla mar ahaantaana, waxay u muuqataa istaraatiijiyad aan waxtar lahayn oo laga filayo in dawlad-goboleedyadu ay iskood u qaadaan tallaabo si ay u ballaariyaan ikhtiyaarrada shatiga ka baxsan gobolka.Dhakhaatiirta wadamada ka qaybgalaya, isticmaalka qandaraasyada dawlad-goboleedka ayaa hooseeya, taas oo muujinaysa in caqabadaha maamul iyo maaliyadeed ay sii wadi karaan inay carqaladeeyaan telemedicine-ka gobolka.Iyadoo la tixgelinayo iska caabinta gudaha, uma badna in gobolladu ay iyagu iskood u dejiyaan sharciyo is-dhaafsi joogto ah.
Waxaa laga yaabaa in istiraatiijiyadda ugu rajo-gelinta badan ay tahay in la isticmaalo mas'uuliyiinta federaalka si loo dhiirrigeliyo isu-celinta.Koongarasku wuxuu u baahan karaa ogolaansho isu-is-dhaafsi marka la eego barnaamij kale oo federaali ah, Medicare, oo ku saleysan sharcigii hore ee nidaaminaya dhakhaatiirta nidaamka VA iyo TriCare.Ilaa iyo inta ay haystaan liisan caafimaad oo sax ah, waxay u oggolaan karaan dhakhaatiirta inay bixiyaan adeegyada telemedicine ka-faa'iideystayaasha Medicare ee gobol kasta.Siyaasaddan oo kale waxay u badan tahay inay dardargeliso ansixinta sharciga qaranka ee is-dhaafsiga, kaas oo sidoo kale saameyn doona bukaannada isticmaala noocyada kale ee caymiska.
Faafida Covid-19 waxay kicisay su'aalo ku saabsan faa'iidada qaabka shati-siinta ee jira, waxayna si isa soo taraysa u caddaatay in nidaamyada ku tiirsan telemedicine ay u qalmaan nidaam cusub.Moodooyinka suurtagalka ah ayaa badan, heerka isbeddelka ku lug lehna wuxuu u dhexeeyaa koror ilaa kala saarid.Waxaan rumeysannahay in sameynta nidaamka shati-siinta qaranka ee jira, laakiin dhiirigelinta isdhaafsiga ka dhexeeya waddammada ayaa ah dariiqa ugu macquulsan ee hore loo maro.
Laga soo bilaabo Dugsiga Caafimaadka Harvard iyo Xarunta Caafimaadka ee Beth Israel Deaconess Medical Center (AM), iyo Tufts University School of Medicine (AN) -?Labaduba waxay joogaan Boston;iyo Dugsiga Sharciga ee Jaamacadda Duke (BR) ee Durham, North Carolina.
1. Xiriirka Golayaasha Caafimaadka Qaranka.Gobolada iyo dhulalka Mareykanka ayaa dib u eegis ku sameeyay sharuudaha shatiga dhaqtarkooda iyadoo lagu salaynayo COVID-19.Febraayo 1, 2021 (https://www.fsmb.org/siteassets/advocacy/pdf/state-emergency-declarations-licensures-requirementcovid-19.pdf).
2. Caymiska caafimaadka iyo xarunta adeegga gargaarka caafimaadka.Bustaha ku dhawaaqida degdega ah ee COVID-19 ee bixiyayaasha daryeelka caafimaadka waa ka reebban yahay.Diseembar 1, 2020 (https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf).
3. Xeerka TELE-MED ee 2013, HR 3077, Satoshi 113. (2013-2014) (https://www.congress.gov/bill/113th-congress/house-bill/3077).
4. Taageerayaasha Norman J. Telemedicine waxay sameeyeen dadaallo cusub oo ku saabsan shaqada ruqsadda dhakhtarka ee xuduudaha gobolka.New York: Maaliyadda Federaalka, Janaayo 31, 2012 (https://www.commonwealthfund.org/publications/newsletter-article/telemedicine-supporters-launch-new-effort-doctor-licensing-across).
5. Xiriirka Golayaasha Caafimaadka Qaranka.Isbeddellada iyo Tallaabooyinka Sharciga Caafimaadka Mareykanka, 2018. Diseembar 3, 2018 (https://www.fsmb.org/siteassets/advocacy/publications/us-medical-regulatory-trends-actions.pdf).
Waqtiga boostada: Mar-01-2021