NHIS က တာဝန်ယူထားတဲ့ ဝန်ဆောင်မှုတွေသိပြီးတဲ့နောက် အဲသည်ဝန်ဆောင်မှုတွေကို ဘယ် သူကပေးနေကြသလဲဆိုတာကို ဆွေးနွေးဖို့ဖြစ်ပါတယ်။ ရပ်ကွက်ထဲမှာ ဖွင့်ထားတဲ့ ဂျီပီဆေးခန်းက ဆရာဝန်တွေ၊ သွားဆေးခန်းလေး တွေက ဆရာဝန်တွေ၊ ကျေးလက် ကျန်းမာရေးဌာနတွေကစလို့ အဆင့်မြင့်အစိုးရဆေးရုံကြီးတွေအထိ NHIS မှာ မှတ်ပုံတင်ပြီး အဖွဲ့ဝင်အဖြစ် ကျန်းမာရေးဝန်ဆောင်မှုပေးလို့ရပါတယ်။
၂၀၁ရခုနှစ် ဩဂုတ်လမှာ အခြေခံကျန်းမာရေးဆရာဝန် သို့ မဟုတ် ဂျီပီ နှစ်သောင်းကျော်၊ အစိုးရဆေးရုံ ၉ဝရရုံ၊ ပုဂ္ဂလိက ဆေးရုံ ၁၁၀၆ ရုံတို့ဟာ SSAH နဲ့ စာချုပ်ချုပ်ဆိုထားကြပါတယ်။ အမျိုးသားကျန်းမာရေးအာမခံစနစ် နဲ့ ပူးပေါင်းဆောင်ရွက်နေတဲ့ အခြေအနေပါ။
ဒါတင်မကပါဘူး။ ဆေးဝါး ကျွမ်းကျင်ပညာရှင်တွေ၊ ဆေးဆိုင် တွေ၊ ဓာတ်ခွဲခန်းနဲ့ ပုံရိပ်ဖော်နည်း ပညာဓာတ်မှန်ဌာနများစွာဟာ SSAH စနစ်မှာ ပူးပေါင်းပါဝင်နေ ကြတာပါ။ UHC အောင်မြင်ဖို့၊ အမျိုးသားကျန်းမာရေး အာမခံစနစ် အောင်မြင်ဖို့၊ တစ်နည်းအားဖြင့် NHIS နဲ့ SSAH တို့ အောင်မြင်ဖို့ ဒေသခံ၊ နယ်မြေခံထွေကုဆရာဝန်တွေရဲ့ “အား” ကို ရယူထားတဲ့ သဘောပါပဲ။
နယ်မြေခံ ထွေကုဆရာဝန်တွေရဲ့ အားကိုယူသလို တစ်ဖက်က လည်း အရည်အသွေးပြည့်မီတဲ့ ကျန်းမာရေးစောင့်ရှောက်မှုကိုပေး
နိုင်ဖို့စီမံရတာတွေရှိတယ်။ ထွေကုဆရာဝန်တစ်ယောက်ဆီမှာ NHIS အောက်မှတ်ပုံတင်ထားတဲ့ လူနာ ၅ဝဝဝပဲ တာဝန်ပေးပါတယ်။ လူနာတွေအများကြီးဆိုရင် မနိုင်ဝန်ဖြစ်ပြီး အရည်အသွေးကျမှာ စိုး ရိမ်လို့ပါ။ အင်ဒိုနီးရှားဆေးကောင်စီက ထွေကုဂျီပီဆရာဝန်များ အတွက် မသိမဖြစ်သိရမဲ့ ရောဂါ ၁၄၄မျိုးနဲ့ မကုမနေရအရေးပေါ် ကုပေးရမယ့် ရောဂါ ၁၁မျိုးကို သတ်မှတ်ပေးထားတယ်။သင်တန်း တွေလည်း ပေးထားပါတယ်။ ဂျီပီ ဆရာဝန်တစ်ယောက်ဟာ သူ့ဆီ လာပြတဲ့ လူနာတွေထဲက ၅ ရာခိုင်နှုန်းအထိပဲ အထူးကုဆရာဝန်ဆီ လွှဲပြောင်းပြသဖို့ ကန့်သတ် ချက်တစ်ခုလည်း ထူးထူးဆန်းဆန်း ရှိနေပါတယ်။ သဘောက ဂျီပီ ဆရာဝန်က လူနာမကြည့်တော့ဘဲ ထိုင်လွှဲနေမှာကို ထိန်းချုပ်ချင်တာ လို့ သုံးသပ်ရပါတယ်။
အဲသည်ရောဂါတွေက ကျော်လာရင်၊ ရောဂါကြီးတွေဆိုရင်တော့ ဆေးရုံကြီးတွေဆီ လွှဲပေးရပါတယ်။ အဲသလိုလွှဲတဲ့အခါမှာလည်း Class A, B,C,D စသဖြင့် သတ်မှတ်ထားသေးတယ်။ Class A ခေါ်တဲ့ ပထမတန်းဆေးရုံကြီး တွေဆီတန်းလွှဲလို့မရပါဘူး။ လူနာ သဘောဆန္ဒအရလည်း အဲသလို ဆေးရုံကြီးတွေဆီ သွားလို့မရဘူး။ အဲ… လူနာက သွားချင်သပဆို ရင်တော့ ကျန်းမာရေးအာမခံ စရိတ်ထဲက မရတော့ဘဲ အိတ်စိုက် ပြီး သွားရောက်ကုသကြရမှာ ဖြစ် ပါတယ်။ အဲ… အရေးပေါ် ဖြစ် တာမျိုးဆိုရင်တော့ ဂျီပီဆရာဝန် က ပထမတန်းဆေးရုံကြီးတွေဆီ လိုအပ်သလို လွှဲခွင့်ရှိပါတယ်။ ဂျီပီ ဆရာဝန်များရဲ့ အခြေခံကျန်းမာ ရေးဆေးခန်းမှာ လိုအပ်တဲ့ ဆေး တွေကိုပုံပေးထားပါတယ်။ အခြေခံ ဆေးတွေပေါ့လေ။ လူနာများအဖို့ ဝယ်စရာမလိုဘဲ အခမဲ့ရရှိကြတာပါ။
ကျန်းမာရေးဝန်ထမ်းတွေကို လစာနဲ့ဆုကြေး ဘယ်လိုပေးသလဲ
ထွေကု၊ ဂျီပီဆရာဝန်များအတွက် NHIS က ပုံစံနှစ်မျိုးနဲ့ လစာငွေကြေးချီးမြှင့်ပါတယ်။ တစ် ခုကတော့ Capitation ခေါ်တဲ့ ကြို ပေးငွေပါ။ ဂျီပီတစ်ယောက်ရဲ့ ဆေးခန်းကိုလာရောက်ပြသမဲ့ ခန့်မှန်းလူနာဦးရေကို တွက်ချက်ပြီး ငွေကြိုထုတ်ပေးထားတာပါ။ သည် ထက်များသွားပြီဆိုရင်တော့ ထပ်မံတင်ပြပြီးတောင်းရတဲ့ Claim ပုံစံပါ။ ကြိုပေးငွေနဲ့ တင်တောင်း ငွေပေါ့လေ။ NHIS နဲ့ စာချုပ်ချုပ်ဆိုထားတဲ့ ဂျီပီဆရာဝန်များဟာ လူနာတစ်လစာအတွက် ကုန်ကျစရိတ်ကို ကြိုတင်ရရှိထားတာပါ။ အဲသည်ငွေတွေထဲမှာ ဆရာဝန်အတွက် ခြြွေကခအပြင် ဓာတ်ခွဲ ခန်းစစ်ဆေးခတွေနဲ့ ဆေးတန်ဖိုး ကုန်ကျစရိတ်တွေပါ ပါဝင်ပါတယ်။ ဆီးချို၊သွေးတိုးလို နာတာ ရှည်ရောဂါများအတွက် ဆေးဝါး တွေကိုတော့ နောက်ထပ်ခေါင်းစဉ် တစ်ခုနဲ့ ထောက်ပံ့ပေးထားပါတယ်။ တချို့ဒေသတွေမှာဆိုရင် ထွေကုဆရာဝန်တွေအတွက် ကိုယ်ဝန်ဆောင်မိခင် ဆေးစစ်ပေးခြင်း ကိစ္စများအတွက်တောင် ငွေကြေးထုတ်ပေးထားတာရှိပါတယ်။
ဂျီပီဆရာဝန်များအတွက် ကြို ပေးငွေနဲ့ တင်တောင်းငွေဟာ အစ ပိုင်းမှာ အဆင်ပြေသလို ရှိပေမဲ့ နောက်ပိုင်းမှာ မလောက်မငှတွေ
ဖြစ်လာတယ်လို့ဆိုပါတယ်။ NHIS က ဂျီပီတစ်ယောက် အတွက် လူနာငါးထောင်သတ် မှတ်ထားတယ်ဆိုပေမဲ့ နောက်ပိုင်းမှာ NHIS စနစ်ထဲ ဝင်လာတဲ့ လူနာဦးရေများလာတယ်။ လူနာငါးထောင်ထက်ပိုကြည့်လာရ တယ်။ ကြိုပေးငွေက မလောက်တော့ဘူး။ နောက်ပြီး အရည်အသွေးပြည့်မီ စွာ ကြည့်ရမယ်ဆိုတော့ ကျန်းမာရေးအာမခံစနစ်က ကြိုပေးထားတဲ့ ငွေနဲ့ မလောက်မငှတွေ ဖြစ်လာတယ်။ သည်တော့နောက်ပိုင်းမှာ ထွေကုဆရာဝန်တွေအတွက် ကြည့်သလောက်လူနာဦးရေအလိုက် ငွေထုတ်ပေးဖို့၊ လူနာများများ ကြည့်ရတဲ့သူကို ငွေပိုထုတ်ပေးဖို့ ပြင်ဆင်သတ်မှတ်ခဲ့ရပါတယ်။
NHIS နဲ့ စာချုပ်ချုပ်ဆိုထားတဲ့ ဆေးရုံကြီးတွေအတွက်တော့ ရောဂါအမျိုးအစားအလိုက် ငွေကြို ထုတ်ပေးထားတာပါ။ CBG လို့ အတိုကောက်ခေါ်ပါတယ်။ ဥပမာ နှလုံးသွေးကြောပိတ်လူနာတစ်ဦး လျှင် ဆေးကုသမှုကုန်ကျစရိတ် ဘယ်လောက်ဆိုတာ ခန့်မှန်းပြီး လူနာဘယ်နှယောက်စာအတွက် ကြိုထုတ်ပေးထားတာမျိုးပါ။ DRG လို့ခေါ်တဲ့ ငွေပေးပုံစံတစ်ခုရှိပါသေးတယ်။ Diagnosis related group လို့အရှည်ရေးတယ်။ လူနာတစ်ဦးရောဂါရှာဖွေဖို့ကုန်ကျစရိတ်ကို ကြိုတင်ထုတ်ပေးထားတဲ့ သဘောပါ။ ဆေးရုံကြီးတွေမှာတော့ CBG နဲ DRG ပုံစံများနဲ့ ငွေကြိုထုတ်ပေးထားကြတာပါ။
အမေရိကန်ပြည်ထောင်စုရဲ့ ကျန်းမာရေးအာမခံစနစ်တစ်ခုဖြစ် တဲ့ Medicare စနစ်မှာဆိုရင် ၁၉၈၃ ခုနှစ်ကတည်းက CBG တို့ DRG တို့ကို သုံးနေကြပါပြီတဲ့။ အင်ဒိုနီးရှားကတော့ အဲသည် အခြေခံကို ပုံစံနည်းနည်းပြောင်းပြီး မှီးလိုက်တဲ့သဘောပါ။ လူနာတစ်ဦးအတွက် အထူးကု ကုန်ကျစရိတ်တွေ၊ ရောဂါရှာဖွေရေးဓာတ် မှန်၊ ဓာတ်ခွဲကုန်ကျစရိတ်တွေကို တော့ အင်ဒိုနီးရှားကျန်းမာရေး ဝန်ကြီးဌာနကပဲ ခန့်မှန်း တွက် ချက်ပေးထားတာပါ။
လုပ်ပိုင်ခွင့်သတ်မှတ်ချက်များ
အင်ဒိုနီးရှားရဲ့ UHC စနစ် ကြီးအောက်မှာ အစိုးရ၊ NHIS နဲ့ SSAH အဖွဲ့တွေပါနေကြတယ်။ သည်အဖွဲ့တွေရဲ့ တာဝန်နဲ့လုပ်ပိုင် ခွင့်တွေကို သတ်သတ်မှတ်မှတ် ခွဲခြားထားဖို့လိုတာပေါ့။ အင်ဒို နီးရှား အမျိုးသားကျန်းမာရေး ဥပဒေအမိန့်အမှတ် ၃၆/၂ဝဝ၉မှာ အဲသည်ဌာနတစ်ခုချင်းစီရဲ့ လုပ် ပိုင်ခွင့်တွေကို သတ်မှတ်ပေးထား တာရှိပါတယ်။ အင်ဒိုနီးရှားဗဟို အစိုးရနဲ့ ပြည်နယ်အစိုးရတွေဟာ ပြည်သူ့ကျန်းမာရေးလုပ်ငန်းစဉ်တွေ အတွက် တာဝန်ယူရပါတယ်။ လူ များများကို ကာကွယ်ဆေးထိုး၊ ဆေးတိုက်၊ ပညာပေးလုပ်ငန်းတွေ ကို အစိုးရဌာနတွေက လုပ်မယ်ပေါ့။
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