Yi amfani da bayanan ƙungiyar NEJM da sabis don shirya don zama likita, tara ilimi, jagoranci ƙungiyar kiwon lafiya da haɓaka haɓaka aikinku.
Yayin bala'in cutar ta Covid-19, saurin haɓakar telemedicine ya sake mai da hankali kan muhawara game da lasisin likitoci.Kafin barkewar cutar, gabaɗaya jihohi sun ba da lasisi ga likitocin bisa tsarin da aka tsara a cikin Dokar Kula da Lafiya ta kowace Jiha, wadda ta tanadi cewa dole ne a ba likitoci lasisi a jihar da majinyacin yake.Ga likitocin da ke son yin amfani da telemedicine don kula da marasa lafiya a wajen jihar, wannan buƙatar ta haifar musu da cikas na gudanarwa da kuɗi.
A farkon matakan cutar, an kawar da cikas masu alaƙa da lasisi.Jihohi da yawa sun ba da sanarwar wucin gadi waɗanda suka amince da lasisin likitancin waje.1 A matakin tarayya, Sabis na Medicare da Medicaid sun yi watsi da buƙatun Medicare na ɗan lokaci don samun lasisin likita a jihar majiyyaci.2 Waɗannan canje-canje na ɗan lokaci sun ba da damar kulawar da yawancin marasa lafiya suka samu ta hanyar telemedicine yayin bala'in Covid-19.
Wasu likitoci, masana, da masu tsara manufofi sun yi imanin cewa haɓakar telemedicine wani ƙyalli ne na bege ga cutar, kuma Majalisa na yin la'akari da kudade da yawa don haɓaka amfani da telemedicine.Mun yi imanin cewa sake fasalin lasisi zai zama mabuɗin haɓaka amfani da waɗannan ayyuka.
Duk da cewa jihohi sun kiyaye hakkin yin lasisin likitanci tun daga karshen shekarun 1800, ci gaban manyan tsare-tsare na kiwon lafiya na kasa da na shiyya da karuwar amfani da hanyoyin sadarwa na telemedicine sun kara fadada kasuwar kiwon lafiya fiye da iyakokin kasa.Wani lokaci, tsarin tushen jihohi ba sa bin hankali.Mun ji labarai game da marasa lafiya waɗanda suka yi tafiya mil da yawa a cikin layin jihar don shiga cikin ziyarar farko ta telemedicine daga motocinsu.Da kyar waɗannan marasa lafiya za su iya shiga alƙawari ɗaya a gida saboda likitansu ba shi da lasisi a wurin zama.
Tun da dadewa jama’a kuma sun damu da yadda hukumar ba da lasisi ta jiha ta maida hankali sosai wajen kare mambobinta daga gasa, maimakon biyan bukatun jama’a.A cikin 2014, Hukumar Ciniki ta Tarayya ta yi nasarar gurfanar da Hukumar Kula da Haƙori ta Arewacin Carolina, tana mai cewa haramcin da Hukumar ta yi wa marasa aikin haƙori na ba da sabis na farar fata ya saba wa dokokin hana amincewa.Daga baya, an shigar da wannan ƙarar Kotun Koli a Texas don ƙalubalantar ƙa'idodin lasisi da ke hana amfani da telemedicine a cikin jihar.
Bugu da kari, Kundin Tsarin Mulki ya baiwa gwamnatin tarayya fifiko, bisa la’akari da dokokin jahohin da ke yin katsalandan a harkokin kasuwanci tsakanin jihohin.Majalisa ta yi wasu keɓancewa ga jihar?Ikon keɓantacce mai lasisi, musamman a cikin shirye-shiryen kiwon lafiya na tarayya.Misali, Dokar Ofishin Jakadancin VA na 2018 tana buƙatar jihohi don ba da izinin likitocin da ke waje don yin aikin telemedicine a cikin tsarin Harkokin Veterans (VA).Samar da hanyoyin sadarwa na intanet ya sake ba gwamnatin tarayya damar shiga tsakani.
Aƙalla nau'ikan gyare-gyare guda huɗu an gabatar da su ko gabatar da su don haɓaka maganin telemedicine na jaha.Hanya ta farko ta ginu ne kan tsarin ba da izinin likita na tushen jihar a halin yanzu, amma yana sauƙaƙa wa likitoci samun izini daga waje.An aiwatar da yarjejeniyar lasisin likita a cikin 2017. Yarjejeniya ce tsakanin jihohi 28 da Guam don hanzarta tsarin gargajiya na likitocin samun lasisin jihar na gargajiya (duba taswira).Bayan biyan kuɗin dalar Amurka 700, likitoci za su iya samun lasisi daga wasu ƙasashe masu shiga, tare da kudade daga $75 a Alabama ko Wisconsin zuwa $790 a Maryland.Tun daga Maris 2020, kawai 2,591 (0.4%) na likitoci a cikin jihohin da suka yi amfani da kwangilar don samun lasisi a wata jiha.Majalisa na iya zartar da doka don ƙarfafa ragowar jihohin su shiga kwangilar.Ko da yake yawan amfani da tsarin ya yi ƙasa da ƙasa, faɗaɗa kwangilar zuwa duk jihohi, rage farashi da nauyin gudanarwa, da ingantacciyar talla na iya haifar da shigar da ƙara.
Wani zaɓi na manufofin shine ƙarfafa juna, wanda a ƙarƙashinsa jihohi ke gane lasisin waje ta atomatik.Majalisa ta ba likitocin da ke aiki a cikin tsarin VA izinin samun fa'idodin juna, kuma yayin bala'in, yawancin jihohi sun aiwatar da manufofin juna na ɗan lokaci.A cikin 2013, dokokin tarayya sun ba da shawarar aiwatar da daidaituwa na dindindin a cikin shirin Medicare.3
Hanya ta uku ita ce yin aikin likita bisa ga wurin da likitan yake maimakon wurin da majiyyaci yake.Bisa ga Dokar Izinin Tsaro ta ƙasa na 2012, likitocin da ke ba da kulawa a ƙarƙashin TriCare (Shirin Kiwon Lafiyar Soja) kawai suna buƙatar lasisi a cikin jihar da suke zaune a zahiri, kuma wannan manufar tana ba da damar yin aikin likita na tsaka-tsaki.Sanatoci Ted Cruz (R-TX) da Martha Blackburn (R-TN) kwanan nan sun gabatar da "Dokar Samun Dama ga Likitanci", wanda zai yi amfani da wannan samfurin na ɗan lokaci zuwa ayyukan telemedicine a duk faɗin ƙasar.
Dabarar ƙarshe -?Kuma mafi cikakken tsari a cikin shawarwarin da aka tattauna a hankali - za a aiwatar da lasisin aikin tarayya.A cikin 2012, Sanata Tom Udall (D-NM) ya ba da shawarar (amma ba a gabatar da shi a hukumance ba) daftarin doka don kafa tsarin ba da lasisi.A cikin wannan ƙirar, likitocin da ke da sha'awar aikin tsaka-tsaki dole ne su nemi lasisin jiha ban da lasisin jiha4.
Ko da yake yana da ban sha'awa a ra'ayi don yin la'akari da lasisin tarayya ɗaya, irin wannan manufar na iya zama mai amfani saboda ta yi watsi da ƙwarewar fiye da karni na tsarin lasisi na tushen jihohi.Har ila yau, kwamitin yana taka muhimmiyar rawa a ayyukan ladabtarwa, yana daukar matakai kan dubban likitoci a kowace shekara.5 Canja zuwa tsarin ba da lasisi na tarayya na iya lalata ikon ladabtarwa na jihohi.Bugu da kari, duka likitocin da hukumomin kiwon lafiya na jihohi wadanda a farko ke ba da kulawa ta ido-da-ido, suna da sha'awar ci gaba da kiyaye tsarin ba da lasisi na jihar don iyakance gasa daga masu ba da sabis na waje, kuma suna iya ƙoƙarin lalata irin waɗannan sauye-sauye.Ba da lasisin kula da lafiya dangane da wurin da likitan yake shine mafita mai wayo, amma kuma yana ƙalubalantar tsarin da ya daɗe yana daidaita aikin likita.Gyara dabarun tushen wuri kuma na iya haifar da ƙalubale ga hukumar?Ayyukan horo da iyaka.Mutunta gyare-gyare na ƙasa Saboda haka, sarrafa izini na tarihi na iya zama hanya mafi kyaun ci gaba.
Har ila yau, da alama dabarun ba su da tasiri a sa ran jihohi za su dauki mataki da kansu don fadada zabin bayar da lasisin fita daga jihar.Daga cikin likitocin da ke cikin kasashe masu shiga, amfani da kwangilar tsakanin jihohi ba shi da yawa, yana mai nuni da cewa shingen gudanarwa da na kudi na iya ci gaba da kawo cikas ga maganin telemedicine na jihohin.Idan aka yi la'akari da tsayin daka na cikin gida, da wuya jihohi su kafa dokokin juna na dindindin da kansu.
Wataƙila dabarar da ta fi dacewa ita ce amfani da hukumomin tarayya don ƙarfafa juna.Majalisa na iya buƙatar izini don daidaitawa a cikin mahallin wani shirin tarayya, Medicare, bisa ga dokokin da suka gabata da ke tsara likitoci a cikin tsarin VA da TriCare.Muddin suna da ingantacciyar lasisin likita, za su iya ƙyale likitoci su ba da sabis na telemedicine ga masu cin gajiyar Medicare a kowace jiha.Irin wannan manufar za ta iya hanzarta aiwatar da dokokin kasa game da juna, wanda kuma zai shafi marasa lafiya da ke amfani da wasu nau'ikan inshora.
Kwayar cutar ta Covid-19 ta tayar da tambayoyi game da fa'idar tsarin lasisin da ke akwai, kuma ya ƙara bayyana cewa tsarin da ke dogaro da telemedicine sun cancanci sabon tsarin.Samfura masu yuwuwa suna da yawa, kuma matakin canjin da ke tattare da shi ya bambanta daga ƙari zuwa rarrabuwa.Mun yi imanin cewa kafa tsarin ba da lasisi na ƙasa da ke akwai, amma ƙarfafa haɗin kai tsakanin ƙasashe shine hanya mafi dacewa ta ci gaba.
Daga Harvard Medical School da Bet Israel Deaconess Medical Center (AM), da Tufts University School of Medicine (AN) -?Dukansu suna cikin Boston;da Makarantar Shari'a ta Jami'ar Duke (BR) a Durham, North Carolina.
1. Ƙungiyar Majalisar Likitoci ta ƙasa.Jihohi da yankuna na Amurka sun sake duba buƙatun lasisin likitansu dangane da COVID-19.Fabrairu 1, 2021 (https://www.fsmb.org/siteassets/advocacy/pdf/state-emergency-declarations-licensures-requirementcovid-19.pdf).
2. Inshorar likita da cibiyar sabis na taimakon likita.An keɓe bargon sanarwar gaggawa ta COVID-19 don masu ba da lafiya.Disamba 1, 2020 (https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf).
3. Dokar TELE-MED ta 2013, HR 3077, Satoshi 113. (2013-2014) (https://www.congress.gov/bill/113th-congress/house-bill/3077).
4. Magoya bayan Norman J. Telemedicine sun yi sabon ƙoƙari don aikin ba da lasisin likita a kan iyakokin jihohi.New York: Asusun Tarayya, Janairu 31, 2012 (https://www.commonwealthfund.org/publications/newsletter-article/telemedicine-supporters-launch-new-effort-doctor-licensing-across).
5. Ƙungiyar Majalisar Likitoci ta ƙasa.Matsalolin Kula da Lafiya ta Amurka da Ayyuka, 2018. Disamba 3, 2018 (https://www.fsmb.org/siteassets/advocacy/publications/us-medical-regulatory-trends-actions.pdf).
Lokacin aikawa: Maris-01-2021