Sebenzisa ulwazi kunye neenkonzo zeQela le-NEJM ukulungiselela ukuba ngugqirha, ukuqokelela ulwazi, ukukhokela umbutho wezempilo kunye nokukhuthaza uphuhliso lwakho lomsebenzi.
Ngexesha lobhubhani we-Covid-19, uphuhliso olukhawulezayo lwe-telemedicine luphinde lwajolisa ingqalelo entsha kwingxoxo malunga nelayisenisi yoogqirha.Phambi kobhubhane, amazwe aye akhupha iilayisensi zoogqirha ngokusekwe kumgaqo-nkqubo ochazwe kuMthetho wokuSebenza ngoNyango welizwe ngalinye, owawuchaza ukuba oogqirha kufuneka babe nelayisensi kurhulumente apho isigulana sikuyo.Oogqirha abanqwenela ukusebenzisa i-telemedicine ukunyanga izigulana ezingaphandle korhulumente, le mfuno idala imiqobo enkulu yolawulo kunye neyemali kubo.
Kwinqanaba lokuqala lobhubhane, imiqobo emininzi enxulumene nelayisenisi yasuswa.Amazwe amaninzi akhuphe iziteyitimenti zethutyana eziqaphela iilayisensi zonyango zangaphandle.1 Kwinqanaba le-federal, i-Medicare kunye neeNkonzo ze-Medicaid ziye zarhoxisa okwethutyana iimfuno ze-Medicare zokufumana ilayisenisi yonyango kwimeko yesigulana.2 Olu tshintsho lwexeshana lwenze ukuba ukhathalelo olwafunyanwa ngabaguli abaninzi nge-telemedicine ngexesha lobhubhani we-Covid-19.
Oogqirha abathile, abaphengululi, kunye nabenzi bomgaqo-nkqubo bakholelwa ukuba uphuhliso lwe-telemedicine lukukhanya kwethemba lo bhubhani, kwaye iCongress ithathela ingqalelo amatyala amaninzi ukukhuthaza ukusetyenziswa kwe-telemedicine.Sikholelwa ukuba ukulungiswa kweelayisensi kuya kuba ngundoqo ekwandiseni ukusetyenziswa kwezi nkonzo.
Nangona i-states igcine ilungelo lokusebenzisa iilayisensi zonyango ukususela ekupheleni kwe-1800s, ukuphuhliswa kweenkqubo zempilo yelizwe kunye neyengingqi kunye nokunyuka kokusetyenziswa kwe-telemedicine kuye kwandise umda wemarike yokhathalelo lwempilo ngaphaya kwemida yelizwe.Ngamanye amaxesha, iinkqubo ezisekelwe kurhulumente azihambelani nengqiqo.Sivile amabali malunga nezigulana eziqhube iimayile ezininzi ngaphaya komgca karhulumente ukuba zithathe inxaxheba kutyelelo oluphambili lwe-telemedicine kwiimoto zabo.Aba baguli abanakuthatha inxaxheba kwidinga elifanayo ekhaya kuba ugqirha wabo akanalayisenisi kwindawo yokuhlala.
Kwangexesha elide, abantu baye banexhala lokuba iKomishoni yeLayisensi kaRhulumente inika ingqwalasela enkulu ekukhuseleni amalungu ayo kukhuphiswano, kunokuba isebenzele uluntu.Kwi-2014, iKhomishini yoRhwebo ye-Federal yamangalela ngempumelelo iBhodi yeNorth Carolina yabahloli bamazinyo, iphikisa ukuba ukuvinjelwa kweKhomishini ngokungekho mthethweni ngokuchasene nabangezona bamazinyo ekuboneleleni ngeenkonzo ezimhlophe kwaphula imithetho ye-antitrust.Emva kwexesha, eli tyala leNkundla ePhakamileyo lafakwa eTexas ukucela umngeni kwimimiselo yelayisenisi ethintela ukusetyenziswa kwe-telemedicine kurhulumente.
Ukongeza, uMgaqo-siseko unika urhulumente wobumbano kuqala, ngokuxhomekeke kwimithetho karhulumente ephazamisana norhwebo lwamazwe ngamazwe.ICongress yenze iimeko ezithile kurhulumente?Ulawulo olukhethekileyo olunelayisensi, ngakumbi kwiinkqubo zempilo zomanyano.Umzekelo, uMthetho we-VA Mission ka-2018 ufuna ukuba amazwe avumele oogqirha abangaphandle kwelizwe ukuba basebenzise i-telemedicine ngaphakathi kwenkqubo ye-Veterans Affairs (VA).Uphuhliso lwe-interstate telemedicine lunika elinye ithuba lokuba urhulumente wobumbano angenelele.
Ubuncinci zine iintlobo zohlaziyo ezicetyisiweyo okanye zaziswa ukukhuthaza i-interstate telemedicine.Indlela yokuqala yakhela kwinkqubo yangoku yemvume yonyango esekelwe kurhulumente, kodwa yenza kube lula ukuba oogqirha bafumane iipemethe ezingaphandle kwelizwe.Isivumelwano selayisenisi yezonyango phakathi kwamazwe saphunyezwa ngo-2017. Sisivumelwano phakathi kwamazwe angama-28 kunye neGuam ukukhawulezisa inkqubo yemveli yoogqirha abafumana iilayisenisi zikarhulumente zemveli (jonga imephu).Emva kokuhlawula umrhumo we-franchise yee-$700, oogqirha banokufumana iilayisensi kwamanye amazwe athatha inxaxheba, ngemirhumo eqala kwi-75 yeedola e-Alabama okanye eWisconsin ukuya kwi-790 yeedola eMaryland.Ukusukela ngoMatshi ka-2020, kuphela ngama-2,591 (0.4%) oogqirha kumazwe athatha inxaxheba abaye basebenzisa ikhontrakthi ukuze bafumane ilayisensi kwelinye ilizwe.ICongress inokuwisa umthetho wokukhuthaza amazwe aseleyo ukuba ajoyine ikhontrakthi.Nangona izinga lokusetyenziswa kwenkqubo liphantsi, ukwandisa ikhontrakthi kuwo onke amazwe, ukunciphisa iindleko kunye nomthwalo wolawulo, kunye nokukhangisa okungcono kunokukhokelela ekungeneni okukhulu.
Enye inketho yomgaqo-nkqubo kukukhuthaza ukulingana, apho amazwe abona ngokuzenzekelayo iilayisensi ezingaphandle kwelizwe.ICongress igunyazise oogqirha abasebenza kwinkqubo ye-VA ukufumana izibonelelo ezifanayo, kwaye ngexesha lo bhubhani, uninzi lwamazwe luphumeze okwethutyana imigaqo-nkqubo yokuphindaphinda.Kwi-2013, umthetho we-federal ucebise ukuphunyezwa ngokusisigxina kokuphindaphinda kwisicwangciso se-Medicare.3
Indlela yesithathu kukuqhelisela iyeza ngokusekelwe kwindawo yogqirha endaweni yesigulane.NgokoMthetho wokuGunyanyiswa koKhuseleko lweSizwe ka-2012, oogqirha ababonelela ngokhathalelo phantsi kwe-TriCare (iNkqubo yeMpilo yoMkhosi) kufuneka banikwe ilayisenisi kuphela kurhulumente apho bahlala khona, kwaye lo mgaqo-nkqubo uvumela ukusetyenziswa kwezonyango phakathi kwamazwe.I-Senators u-Ted Cruz (R-TX) kunye noMartha Blackburn (R-TN) basandul 'ukuzisa "uMthetho wokuFikelela ngokuLingana kwiiNkonzo zezoNyango", oya kusebenzisa okwethutyana le modeli kwimisebenzi ye-telemedicine kwilizwe lonke.
Isicwangciso sokugqibela -?Kwaye esona siphakamiso sineenkcukacha phakathi kwezindululo ezixoxwe ngononophelo - ilayisenisi ye-federal practice iya kuphunyezwa.Kwi-2012, uSenator u-Tom Udall (i-D-NM) ucebise (kodwa engaziswanga ngokusesikweni) ibhilikhwe yokuseka inkqubo yelayisenisi ye-serial.Kule modeli, oogqirha abanomdla kuqeqesho lwamazwe ngamazwe kufuneka bafake isicelo selayisensi karhulumente ukongeza kwilayisenisi karhulumente4.
Nangona ngokombono kunomtsalane ukuthathela ingqalelo ilayisenisi enye yomanyano, umgaqo-nkqubo onjalo usenokungasebenzi kuba awuhoyanga amava angaphezu kwenkulungwane yeenkqubo zonikezelo mvume ezisekelwe kurhulumente.Le komiti ikwadlala indima ebalulekileyo kwimisebenzi yoluleko, ithatha amanyathelo ngamawaka oogqirha nyaka ngamnye.5 Ukutshintshela kwinkqubo yelayisenisi yomanyano kunokujongela phantsi amagunya oluleko karhulumente.Ukongeza, bobabini oogqirha kunye neebhodi zonyango zikarhulumente ezibonelela ngokuyintloko ngononophelo lobuso ngobuso banomdla wokuxhasa inkqubo yelayisenisi esekwe kurhulumente ukunciphisa ukhuphiswano kubaboneleli abangaphandle kwelizwe, kwaye banokuzama ukujongela phantsi uhlengahlengiso olunjalo.Ukunika iilayisenisi zonyango olusekwe kwindawo kagqirha sisisombululo esilumkileyo, kodwa ikwacela umngeni kwinkqubo yexesha elide elawula ukusebenza kwezonyango.Ukuguqula isicwangciso esisekwe kwindawo kusenokudala imingeni kwibhodi?Imisebenzi yoluleko kunye nomda.Ukuhlonitshwa kohlaziyo lwesizwe Ngoko ke, ulawulo lweemvume ngokwembali lunokuba yeyona ndlela iphambili.
Kwangaxeshanye, kubonakala isicwangciso esingasebenziyo sokulindela ukuba amazwe athathe amanyathelo ngokwawo ukwandisa iinketho zokukhutshwa kwelayisensi ngaphandle kwelizwe.Phakathi koogqirha kumazwe athatha inxaxheba, ukusetyenziswa kwezivumelwano zamazwe ngamazwe kuphantsi, kugxininisa ukuba izithintelo zolawulo kunye nezemali zingaqhubeka nokuthintela i-telemedicine ye-interstate.Ukuthathela ingqalelo ukuchasana kwangaphakathi, akunakwenzeka ukuba amazwe awise imithetho esisigxina yokubuyisana ngokwawo.
Mhlawumbi esona sicwangciso sithembisayo kukusebenzisa amagunya amanyeneyo ukukhuthaza ukuphindaphindana.ICongress inokufuna imvume yokuphindaphinda kumxholo wenkqubo ye-federal, i-Medicare, ngokusekelwe kumthetho wangaphambili olawula oogqirha kwinkqubo ye-VA kunye ne-TriCare.Ngethuba nje banelayisensi yonyango esebenzayo, banokuvumela oogqirha ukuba babonelele ngeenkonzo ze-telemedicine kubaxhamli be-Medicare kulo naliphi na ilizwe.Umgaqo-nkqubo onjalo unokukhawulezisa ukugqithiswa komthetho wesizwe malunga nokulingana, okuya kuchaphazela izigulane ezisebenzisa ezinye iindlela ze-inshurensi.
Ubhubhani we-Covid-19 uphakamise imibuzo malunga nokuba luncedo kwesakhelo selayisensi ekhoyo, kwaye kuye kwacaca ngakumbi ukuba iinkqubo ezixhomekeke kwi-telemedicine ziyifanele inkqubo entsha.Iimodeli ezinokwenzeka zininzi, kwaye iqondo lotshintsho olubandakanyekayo lusuka kulwandiso ukuya kuhlelo.Sikholelwa ekubeni ukuseka inkqubo ekhoyo yokukhutshwa kweelayisenisi yesizwe, kodwa ukukhuthaza ukulingana phakathi kwamazwe yeyona ndlela ibonakalayo yokuya phambili.
Ukusuka kwiSikolo sezoNyango saseHarvard kunye neBeth Israel Deaconess Medical Centre (AM), kunye neTufts University School of Medicine (AN) -?Bobabini baseBoston;kunye neDuke University School of Law (BR) eDurham, eMntla Carolina.
1. I-Federation of National Medical Councils.Amazwe ase-US kunye nemimandla baye bahlaziya iimfuno zabo zelayisensi yoogqirha ngokusekwe kwi-COVID-19.NgoFebruwari 1, 2021 (https://www.fsmb.org/siteassets/advocacy/pdf/state-emergency-declarations-licensures-requirementscovid-19.pdf).
2. I-inshurensi yezonyango kunye neziko lenkonzo yoncedo lwezonyango.Ingubo yesibhengezo se-COVID-19 engxamisekileyo kubaboneleli bezempilo ikhululiwe.NgoDisemba 1, 2020 (https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf).
3. Umthetho we-TELE-MED ka-2013, i-HR 3077, i-Satoshi 113. (2013-2014) (https://www.congress.gov/bill/113th-congress/house-bill/3077).
4. Abaxhasi bakaNorman J. Telemedicine benze iinzame ezintsha zomsebenzi welayisenisi kagqirha kuyo yonke imida karhulumente.ENew York: I-Federal Fund, ngo-Januwari 31, 2012 (https://www.commonwealthfund.org/publications/newsletter-article/telemedicine-supporters-launch-new-effort-doctor-licensing-across).
5. I-Federation of National Medical Councils.IiNdlela zoLawulo lwezoNyango lwase-US kunye neZinto, 2018. NgoDisemba 3, 2018 (https://www.fsmb.org/siteassets/advocacy/publications/us-medical-regulatory-trends-actions.pdf).
Ixesha lokuposa: Mar-01-2021