Sanadihii u dambeeyay, tirada diidmada caymiska ayaa si weyn u kordhaysay dalka Mareykanka, taasoo ugu wacan algoritamyada otomaatiga ah ee ku shaqeeya AI. Qalabyo cusub oo AI ah ayaa soo baxaya si ay u sameeyaan racfaan otomaatig ah oo ka dhan ah diidmahan. Si kastaba ha ahaatee, khubarada caafimaadka ayaa ku dooday in dib-u-habeyn aas-aasi ah loo baahan yahay si loo xalliyo kharashyada caafimaadka ee sarreeya loona hubiyo in la helo caymis wanaagsan. UnitedHealth, Humana, iyo Cigna ayaa haatan wajahayaan dacwado class-action ah oo lagu eedeeyay inay algoritamyada u isticmaaleen in la diido daryeelka caafimaadka ee muhiimka ah. Mid ka mid ah dacwadaha ayaa sheegaya in Cigna ay diidday in ka badan 300, 000 sheegasho muddo laba bilood gudaheed, iyadoo celcelis ahaan la diidday hal sheegasho 1. 2 ilbiriqsi kasta oo dhakhtar dib u eegay. Waxaa la sheegay in algoritamyadu ay leeyihiin heer qalad oo cabsi leh oo gaara 90%, iyadoo laba kamid ah toban sheegasho oo la diiday ay dib loo saxo markii la racfaan sameeyay; hase yeeshee, kaliya qiyaastii 0. 2% bukaannada ayaa racfaan ka gudbiyay diidmahan, badanaa waxaa ka dhalata kharashyo ka madax bannaan ama daryeel la’aanta loo baahan yahay. Mushkiladdan waxaa sii xumeysa habka ogolaanshaha hore, halkaas oo wax ka yar 10% ee codsiyada la diiday ee qorshaha Medicare Advantage la racfaan galiyay sanadkii 2022. Caadooyin badan oo caafimaad ayaa haatan haysta kooxo gaar ah oo ka shaqeeya racfaanadan adag.

Sahaminta ayaa muujisay in ku dhawaad kala badh dadka waaweyn ee Mareykanka ay helan biilal caafimaad aan la filayn, taasoo keentay walwal iyo xanuun xaalado caafimaad oo ka sii daraya sababo la xiriira daryeelka dib u dhac ku yimid, iyadoo inta badan aysan ka warqabin xaqooda racfaan. Sheekada Deirdre O’Reilly, oo ah dhakhtar daryeelka dakhliyada badan, ayaa muujinaysa dhibaatadan. Ka dib markii booqashadii degdegga ahayd ee wiilkeeda lagu diiday caymiska BlueCross BlueShield ee Vermont, O’Reilly waxay la kulantay nidaam racfaan oogu daal badan oo muujiyay waxtar la’aanta iyo caqabadaha ay la xiriiraan bukaannada. Kahor intaan la iska dhaqin dhaleecayn badan, qaar ka mid ah dowladaha ayaa hirgelinaya sharciyo si loo fududeeyo culayska ogolaanshaha hore, halka dowladda federaalka ay soo bandhigayso sharciyo cusub oo ku saabsan ogolaanshaha hore ee Medicare Advantage. Kharashyada racfaanka ee bixiyayaasha waxay gaaraan in ka badan $7. 2 bilyan sanadkii. Waxaa jirta "xildhibaanada bots-ka" oo sii kordhaya iyadoo bukaannada iyo shirkaduhu ay isticmaalaan qalabyada AI si ay u taageeraan racfaannada sheegashada. Inkasta oo qaar ka mid ah khubarada ay arkaan doorka suurtogalka ah ee algoritamyada la hagaajiyay ee nidaamka caafimaadka, kormeerka aadanaha ayaa weli muhiim ah. Walwalka ayaa sii socda iyadoo lagu tiirsan yahay AI kaliya ay xumayn karto dhibaatooyinka jira, oo ay ku jiraan kharashyada caafimaadka ee aadka u sarreeya. Khubarada ayaa adkeysanaya in kharashka caafimaadka Mareykanka, oo ka kooban kalabar GDP, uu baahan yahay isbeddel weyn oo ka baxsan ka hadalka isticmaalka AI ee go’aanada caymiska.