Mbiri Yakale ya Maprogramu a Zaumoyo a Boma

Maziko a bungwe la United Kingdom a kukhazikitsa bungwe la National Health Service (NHS) mu 1948, limene cholinga chake chinali chopereka chithandizo cha mankhwala a anthu osoŵa chithandizo popanda kusowa kwa ndalama. Nkhondo yachiŵiri yapadziko lonse, Kugwa kwa Chuma Kwakukulu, ndi kukonzanso pambuyo pa nkhondo zonse zoyendetsera masinthidwe aakulu a malamulo. Mwachitsanzo, Beveridge Report ya mu 1942 ku United Kingdom inatsogolera mwachindunji ku kupangidwa kwa National Health Service (NHS) mu 1948, imene cholinga chake chinali chopereka chithandizo cha thanzi popanda kusoŵa kwa anthu okalamba ndi opeza ndalama zambiri. Zimenezi zinaimira kusintha kwa boma la anthu apansi pa makampani osoŵa thandizo ndi olemba ntchito.

Maiko ena anatsatira njira zosiyanasiyana. Canada anakhazikitsa njira yake yosamalira zaumoyo yonse kupyolera m'Chilamulo cha Medical Care Act cha 1966, chimene chinapereka ndalama za boma kaamba ka makonzedwe a inshuwalansi ya zaumoyo ya m'chigawo. Ku Germany, dongosolo la malamulo a zaumoyo (Gesetzliche Krainenversicherung) limatsata mizu yake ya Otto von Bismark'sck, malamulo a kakhalidwe ka anthu mu 1880, kuipanga kukhala imodzi ya makampani akale kwambiri a boma odziŵa zaumoyo.

Maprogramu Aakulu a Boma Osonkhezera Kupeza Zaumoyo wa Anthu Lerolino

Maprogramu a zaumoyo a boma amakono amasiyanasiyana malinga ndi dziko koma amagawana zolinga zazikulu: kuwonjezera kupenda, kuchepetsa mtengo, ndi kuwongolera thanzi.

Medicare ndi Medicaid (United States)

Medicare imafalitsa zaumoyo kwa Aamereka a zaka 65 ndi kuposapo, limodzinso ndi achichepere okhala ndi matenda opunduka ndi amene ali ndi madesiki a maselo. Medicaid, ochirikizidwa ndi maboma a boma ndi akuluakulu opeza ndalama zochepa, ana, akazi apakati, achikulire, ndi anthu olumala.

  • [[FLT: 0] Kulembetsa: Pakali 2023, pafupifupi anthu 65 miliyoni amadalira Medicare kuti apereke chithandizo cha thanzi. Programuyi imakhudza chisamaliro cha m’chipatala (Palaneti A), inshuwalansi ya zamankhwala (Pateni B), ndi mankhwala operekedwa ndi boma (Palati ya D). Kuyambira kuyambika kwake, Medicare yachepetsa kwambiri ndalama zowonongera achikulire ndi kuwongolera mautumiki otetezera ku matenda a kansa ndi zigaŵenga.
  • [[FLT: 0] Kufutukuka kwa Medicaid : Act Affordble Care (ACA) inalola maboma kuwonjezera kuthekera kwa Medicaid kwa achikulire okhala ndi ndalama kufikira 138% ya mlingo wa umphaŵi wa boma. Monga 2024, maboma 40 ndi Chigawo cha Columbia akulitsa. Zimenezi zagwirizanitsidwa kuchepetsa chiŵerengero cha imfa, kuwonjezeka kwa kutulukira kansa, ndi kuyang'anira bwino mikhalidwe ya moyo. Kufufuza kofalitsidwa mu Funsoth Kufunza kwapezedwa kuti kuwonjezereka kunawona kuti kuwonjezereka kwachitika kwa mlingo wotsika pakati pa achikulire, poyerekezera ndi kuchepa kwa anthu achikulire, kuwonjezeka kwa mathero ena osafikapo.
  • Mwezi wosatsimikizirika: Chiyambukiro chophatikizapo cha Medicare, Medicaid, ndi machitachita a ACA chinapangitsa Zambia yosatsimikizirika kukhala ndi mlingo wapamwamba wa mbiri wa 8.6% mu 2021, ngakhale kuti chakhala chikuonekera pang'ono kuyambira pamene kutsatiridwa kosalekeza kwa zofunikira pa ngozi ya zaumoyo wa anthu onse ya ku COVID-19.

Njira Yosamalira Anthu Odwala Mosavuta (ACA)

ACA ndi njira yoyendetsera kwambiri zaumoyo ya United States kuyambira pamene Medicare ndi Medicaid . Malamulo ake aakulu amaphatikizapo lamulo la munthu aliyense (tsopano lochotsedwa ndi Tcooxs ndi Jobs Act), misika ya inshuwalansi ya zaumoyo (kusinthana), kuwonjezera ngongole ndi kutsika kwa mtengo, zofunika za thanzi, ndi makonzedwe odalirana olola achinyamata achikulire kukhalabe ndi cholinga cha makolo mpaka zaka 26.

  • Phindu la kuchuluka: [[FLT :1] Pofika 2016, 20 miliyoni ya anthu amene anali osawadziwa adapezeka ku ACA . Pamene kuli kwakuti kulembetsa kunasintha mkati mwa ulamuliro wa Trump, American Replation Plan ya 2021 ndi yotsatira Indactiation Reduction Act inawonjezera ndalama zothandizira, kupangitsa kulembetsa kugula malonda oposa 21 miliyoni mu 2024.
  • Mapindu a thanzi: The ACA inalamula kuti mapulani onse ogulitsidwa pa misika aphindu khumi la thanzi lofunika, kuphatikizapo mautumiki angozi, kugoneka m’chipatala, kulera ndi kusamalira ana obadwa kumene, mankhwala a maganizo, mankhwala oletsedwa, ndi mautumiki otetezera.
  • Mikhalidwe yomwe ilipo: ACA amaletsa makampani a inshuwalansi kukana kulipira kapena kulipira ndalama zowonjezereka zozikidwa pa mikhalidwe yomwe idakalipo. Makonzedwe ameneŵa akhala ofunika kwa mamiliyoni a Aamereka okhala ndi matenda osatha monga matenda a shuga, matenda a mtima, ndi chifuwa cha mphumu omwe poyamba anayang'anizana ndi zopinga kuti apeze inshuwalansi.
  • Kusintha ndi zitokoso: Mosasamala kanthu za mapindu, ACA sanafikire kufalitsidwa kwa onse. Pafupifupi Aamereka 27 miliyoni osakula omwe akhalabe osawoneredwa, makamaka chifukwa cha mzera wa kuulutsa kwa Medicaid m'zigawo zimene sizinafutukule, ndalama zosaŵerengeka kwa awo osayenerera kaamba ka kuperekedwa, ndi osamukira osalembedwa omwe satchulidwa.

National Health Service (NHS) (United Kingdom)

. . . . . ndi njira yothandiza kwambiri pa zachipatala yomwe imathandizira anthu onse alamulo a ku UK, amene ali ndi ndalama zoyendetsera msonkho wa boma ndi ndalama zoyendetsera Inishuwarensi ya National. Ndiyo ntchito yaikulu kwambiri padziko lonse yoyendetsera ntchito zaumoyo, yomwe ili ndi antchito oposa 1.5 miliyoni.

  • Kukwaniritsa kosagwirizana: NHS imatsimikizira kuti chisamaliro cha umoyo chiripo kwa onse mosasamala kanthu za ndalama, malo a ntchito, kapena mbiri ya zamankhwala. Chitsanzo chimenechi chachotsa kwakukulukulu zopinga zandalama ku chisamaliro chachikulu ndi chipatala. Lipoti la pagalasi la Commonwealth Fund 2021 linaika NHS monga dongosolo lapamwamba la zaumoyo pakati pa maiko 11 ofikapo kaamba ka kukhazikika, kupezeka, ndi kukwaniritsidwa, ndi kuyendetsa bwino kwa ntchito.
  • Kugogomezera kwa chisamaliro chobwezera: Oikizira kwambiri ntchito zaumoyo wa anthu, kuphatikizapo katemera wofala, maprogramu a mtunduwo opimira kansa (chifuwa, chiberekero, mtsempha) ndi zinthu zowopsa za mtima. Maprogramu ameneŵa athandiza kuwongolera utali wa moyo ndi kuchepetsa imfa kuchokera ku mikhalidwe yochiritsika.
  • Chalmentes: A CHHS amayang'anizana ndi mavuto aakulu kuchokera ku chiŵerengero cha okalamba, kukwera kwa kufunidwa, kusoŵa kwa ndalama, ndi kusoŵa kwa ntchito. Pa 2023, nthaŵi zoyembekezera njira zosankhidwira ndi maulendo apadera zakhala zokulirapo, zosonkhezera mikangano yowonjezereka ya ndalama ndi kusintha. Komabe, lamulo lamakhalidwe a dziko lonse lakufikira kukufalikira likupitirizabe kufalikira m'magulu andale zadziko.

Chisamaliro Chachikulu cha Zaumoyo (PHC) m’Kukulitsa Mitundu

Maprogramu a boma m'maiko opeza ndalama zochepa ndi apakati kaŵirikaŵiri amakhala ndi njira zoyambirira za chisamaliro cha thanzi, kaŵirikaŵiri zochirikizidwa ndi mabungwe apadziko lonse onga ngati World Health Organization (WHO) ndi World Bank. Chilengezo cha 1978 Alma- Ata chinaitana "Chichiritso cha Onse pa Chaka cha 2000" kupyolera mwa chisamaliro chachikulu. Zitsanzo zimaphatikizapo:

  • Inishuwansi ya zaumoyo ya chitaganya: Rwanda inakhazikitsa makonzedwe a inshuwalansi ya zaumoyo yokakamiza (Mutanelle de Santé) imene tsopano ikuphatikizapo 90% ya anthu ake. Zimenezi zanenedwa kuti zachepetsa kwambiri imfa za anthu ochepera pa zisanu ndi kuwonjezereka kwa mautumiki a zaumoyo a amayi.
  • Thailand’s Universal Courage Scheme (UCS): Mu 2002, UCS yofutukula zaumoyo kwa nzika zonse za Thailand zimene sizinafikidwe ndi antchito a boma kapena makonzedwe a zachitetezo cha anthu. Chiŵerengero chosadziŵika chinatsika kuchokera pa 30% kufika pa zero, ndipo dziko linachepetsa kwambiri ndalama zowonongera thanzi latsoka.
  • ku Brazil Sisema Único de Saúde (SUS): dongosolo la zaumoyo lapadziko lonse la Brazil, lokhazikitsidwa ndi malamulo a 1988, limapereka chisamaliro chaulere kwa nzika zonse. Ilo limaphatikizapo chigwirizano champhamvu cha chisamaliro (Estratégia Saúde da Família) chimene chimafikira anthu akutali ndi akumidzi, chimene chimawonjezera utali wa moyo ndi imfa ya makanda.

Mavuto a Umoyo wa Anthu Onse

Ngakhale kuti maprogramu a boma apambana, zopinga zazikulu za kuthekera kwa zipatala zikupitirizabe kupezeka m'maiko onse apamwamba ndi otsika omwe amapeza.

  • Zoletsa zowonjezera: [[FLT :1] Maprogramu ambiri a boma amafunidwa mochepera. Mwachitsanzo, mu U.S., kugawana kwa asing'anga mu Medicaid kaŵirikaŵiri kumalekezedwa ndi ndalama zochepetsera ndalama zopindulira oloŵa. Ku UK, bajeti ya NHS sinayendere limodzi ndi mtengo wokwera, kutulukapo kupereŵera kwa zipangizo ndi kuyembekezera kwanthaŵi yaitali.
  • Bureaucratic infeciencies : [[FLT :1] Njira za kusanthula kosiyanasiyana, mapepala obwerezabwereza, ndi madongosolo a maulamuliro ogaŵanika zingachedwe kusamala. Mwachitsanzo, zifuno za chilolezo m'Medicare GPU nthaŵi zina zimakana kapena kuchedwa kwa chithandizo chofunika. Mofananamo, kusamalira pakati pa maprogramu osiyanasiyana a boma (m. g., Medicare ndi Veterans Affaits Affairs) kumakhalabe osauka.
  • Kufikira kwa zaumoyo kwa magetsi kwa magetsi: Kufikira kwa umoyo kumasonkhezeredwa ndi zinthu zosakhala dongosolo la zaumoyo ilo lokha(umphaŵi, kusakhazikika kwa nyumba, kusatetezeka kwa chakudya, mlingo wa maphunziro, ndi kupezeka kwa zoyendera. Maprogramu a Boma amene salankhula za SDOH kaŵirikaŵiri amapanga kuwongoletsedwa kochepa kwa thanzi. Mwachitsanzo, Médicaid akuwongolera kufutukuka, koma opindulitsa m'madera akumidzi angakhalebe opanda madokotala apafupi.
  • madera a m’midzi a kumidzi mobwerezabwereza amasoŵa osamalira, akatswiri, ndi mautumiki a m’chipatala. Kufutukuka kwa Telehealth mkati mwa mliri wa Chovid [1] kunathandiza maulalo ena, koma kulera ana kwachikhalire. Bungwe la zaumoyo la U.S. Resources and Service Administration (HRSA) limatchula zikwi za Magawo a za Zaumoyo Okhalako Thunga.
  • Kusiyana kwa mafuko: maprogramu a Boma sanathetse kugaŵanikana ndi fuko. Mu U.S., Kuda ndi ku Hispanic anthu amakhala ndi ziŵerengero zapamwamba za kusatetezereka, kuchepa kwa kuchinjiriza, ndi zotulukapo zoipa kwambiri za thanzi ngakhale pamene zakhala zopinga. Utundu ndi mbiri yakale zochotsedwa ku mapindu a boma (m.g., poyamba kuchepa kwa zipatala za Mabwinja) zimathandizira ku kamphindikakakakakakakakaka.
  • Kusakhazikika kwa polisi ndi ntchito zauyang'aniro: m'maiko ambiri otukuka kumene, maprogramu a zaumoyo a boma amavutika ndi ziphuphu, kufooka, ndi kusintha kwa ndale zadziko. Kupangidwa kwa maprogramu kungakhale kosasintha, ndipo kaŵirikaŵiri ndalama zochokera kwa opereka ndalama zamitundu yonse zimafika m'nyengo zosadziŵika.

Kufufuza za Matenda: Kulephera ndi Kulephera

Kufufuza nkhani mwatsatanetsatane kumathandiza kudziwa zimene zimagwira ntchito ndiponso zimene sizimachitika ngati maprogramu a boma akuyesetsa kupititsa patsogolo njira zosamalira thanzi.

Chipambano: Kufutukuka kwa Medicaid mu California ndi Kentucky

California anafutukula Medicaid pansi pa ACA mu 2014, kufutukula pafupifupi anthu onse achikulire omwe alandira ndalama zochepa. Chiŵerengero cha boma losayendera mayeso chinatsika kuchokera pa 17.2% mu 2013 kufika pa 6.5% mu 20222. California anagwiritsiranso ntchito ndalama za boma zoperekera ndalama zosaŵerengeka kuti apeze ndalama zopindulira achinyamata osaŵerengeka ndiponso, powonjezera, kuti apeze anthu osaŵerengeka ngakhale a msinkhu wawo. Kufufuza kochuluka kwachititsa kuti awonjezere kugwiritsa ntchito kwa poyamba, kuyang'anira bwino matenda a shuga ndi nyumbu, kuchepetsa mavuto a zachuma kuchokera ku zifunsinsipo za mankhwala, ndi kuchepa kwa imfa pakati pa achikulire. Ngakhale kuti kuwonjezeka kwa zaka zambiri, kuchepetsanso kukwera kwa anthu odzikongoletsa ndi kuchuluka kwa matenda a khansa, kuchepetsa matenda a khansa, ndi kuchepetsa kusuta.

Kulephera: Vuto la Uyang’aniro wa Zaumoyo (VHA)

VHA imatsogolera imodzi ya njira zaumoyo zogwirizana kwambiri ku United States, yotumikira olembapo ntchito yoposa 9 miliyoni. Mosasamala kanthu za ntchito yake, VHA yalephera bwino, makamaka “kulephera kwa kadamsana wa kuyembekezera ” kumene kuli ndi mpambo wachinsinsi wobisika wa kuchedwa kwa nthaŵi yaitali, kutsogolera anthu osasamala. Zochititsa zake zinaphatikizapo imfa zosatha pansi pa kulembedwa, njira ya za za zaumoyo yamakono, kuvuta kwa kupeza akatswiri, ndi chikhalidwe cha anthu amakono. Chigawo cha 2018 VA MISION chita kuwonjezera njira ya oyembekezera anthu anthaŵi yaitali kuti afune chisamaliro chaumwini, koma zimenezi sizinathetse mavuto. Odziŵa zamakono ambiri amayembekezerabe miyezi yapadera ya kuikidwa kwapadera. Nkhani imeneyi ikusonyeza kuti ngakhale ntchito za boma ziyendere bwino, ikufuna kuyang'anira ndi kulephera kulephera kuyendetsa ntchito kwangozi.

Zimene Zikuthandiza: Kachipangizo kotchedwa Universal Coutesy of Thailand

Universal Courage (UCS) imapereka mautumiki ofunika a thanzi kwa anthu pafupifupi 48 miliyoni amene ali ndi ndalama zochepa zowonongedwa. UCS imayendetsedwa ndi ndalama za msonkho ndi kuyang'anira National Health Office . Programme yapeza chifupifupi chiwonjezeko chonse kuyambira pamene inayamba mu 2002, kuchepetsa ndalama zowonongera thanzi lakupha, ndi kufutukuka kwambiri kwa anthu olimbana ndi HIV / AIDS. Zipambano zazikulu zimaphatikizapo njira zamphamvu zothandizira anthu (ndipo ndi ndalama zaumoyo ku zipatala ndi zipatala za chigawo), pulogalamu ya kulipira anthu otetezeredwa, ndi kusungidwa kwa anthu. Thailand ikusonyeza kuti kuchuluka kwa anthu opeza chithandizo chapakati pa zaumoyo wapadziko lonse kupyo kupyolera ndi ku ndale za ndale zadziko.

Kulephera: Inshuwalansi ya zaumoyo ya ku United States (2013-2014)

Kutsegulidwa kwa HealthCare.gov mu October 2013 kunawonongeka ndi mavuto aakulu a zolembalemba zimene zinalepheretsa anthu mamiliyoni ambiri a ku America osawadziwa kulembetsa. Webusaitiyi inawonongeka, kulephera kwa chitetezo cha makompyuta inatulukira, ndipo manambala a anthu anatsika kwambiri. Kulephera kumeneku kunachitika chifukwa cha kuthamanga, kulephera kwa kuyesa, ndi kusagwirizana ndi malo a makampani a makompyuta a boma. Debacle inawononga chidaliro cha anthu onse ndi kupatsa adani andale mfuti kuti achotse ACA. Pamene malowo anakonzedwa pakati-2014, kulephera koyamba kunagogomezera kufunika kwa ntchito yoyendetsera zinthu ndi kuyang'anira ntchito yaudindo a boma pamene anali kudutsa m'makonzedwe a zaumoyo waukulu.

Malamulo a M’tsogolo a Umoyo wa Anthu Osamala Umoyo

Zotsatirapo zingapo za kachitidwe ka ka kachitidwe ka zinthu ndi malamulo zingabwezeretse mbali ya maprogramu a boma a kuwongolera njira zosamalira thanzi m’zaka khumi zikubwerazi.

  • Kufutukuka kwa thanzi ndi makompyuta: malamulo a kanthaŵi kochepa pa mliri wa CHOVAD-19 anasonyeza kuti telehealth ingathe kufutukula kwambiri anthu a m’midzi ndi m'mitumbo. Kufutukulidwa kwanthaŵi zonse kwa Medicas kukhudza stelehealth, kuchirikiza ndalama za malo aakulu, ndi kugwirizanitsa makompyuta akutali kungawonjezere mabulone. Komabe, kuchotsa kwa anthu odziŵa kuŵerenga ndi kupezeka kwa intaneti kuyenera kulembedwa.
  • Ubwino wa thanzi la m'mimba ndi kugwirizana: Maboma akuzindikira mowonjezereka kufunika kwa kugwirizanitsa mautumiki a zaumoyo ndi chisamaliro chachikulu ndi kukhazikitsa malamulo aubwino omwe amafuna kukwaniritsa mofanana kaamba ka thanzi la maganizo ndi lakuthupi. U.S. adakhazikitsa bungwe la Miengo ya Zaumoyo ndi Addiction Equiny Act mu 2008, koma kugonjera kumakhala kosagwirizana. Zoyesayesa zatsopano monga 988 Suicide & Cristisline Life ndi likulu la zaumoyo wa anthu zikuimira kupita patsogolo.
  • Oletsa anthu mwa kupereka ndalama za zaumoyo: Maprogramu ena, monga ngati maprogramu a Zaumoyo ndi ntchito za U.S. Community Health Workers, akuyesa njira zogwiritsira ntchito ndalama za zaumoyo kusamalira odwala kusamalira zosoŵa zosakhala zamankhwala (m'b. kuchirikiza nyumba, ma shopu osonyeza chakudya). Ngati chipambano, maprogramu ameneŵa angapititsidwe m'maprogramu a boma onga Medicare ndi Médidid.
  • Kuchititsa kuchuluka ndi kulembetsa: [[FLT :1] Mitolo ya ntchito imaletsa anthu oyenerera kulembetsa m'maprogramu a anthu. Kupyola mu “kuzindikira,” kulembetsa kodzifunira, ndi kutumiza madata (m. g., kugwiritsira ntchito mafaelo a msonkho kulembetsa anthu ku Médicaid) kukhoza kuwonjezera kutengamo mbali. Zoyesayesa za Biden Administration za kufeŵetsa kutsa kwa Msika ndi kufutukula nyengo zapadera za kuŵerengera ndi zitsanzo.
  • Malingaliro osagwirizana: Mu U.S., mikangano imapitirizabe ku Medicas kaamba ka Onse kapena chosankha chapoyera. Pamene kuli kwakuti kugawikana kwa ndale zadziko, malingaliro ameneŵa amasonyeza kusakhutira ndi kugaŵana kwa anthu kwapaokha. Padziko lonse, maiko ambiri akutembenukira ku mapindulo a dziko lonse, ndi South Korea ndi Taiwan posachedwapa kukulitsa njira zawo za inshuwalansi.
  • Zaumoyo zapadziko lonse ndi mliri wokonzekera: Mliri wa Covid wirede kufooka kwa anthu onse padziko lonse. Maboma tsopano akuika ndalama zothandizira kusamalira koyambirira, kuyang'anira matenda, ndi kuyankha kwangozi. Mapangano a WHO olinganiza kupha kwa mliri ndi kuwonjezera ndalama za Global Fund angachititse kuthekera kwa thanzi m'zochitika zosachedwa.

Chiyambukiro cha maprogramu a boma pa kuperekedwa kwa anthu kwa zaumoyo nchakuya ndi chosagwirizana. Zochitika za m'mbiri monga NHS, Medicare , ndi ACA zimasonyeza kuti madongosolo okhazikitsidwa bwino angafutukule ndi kuwongolera kwambiri zotulukapo za umoyo. Komabe, mavuto osatha , kuthamanga, zopinga, kulephera kwa anthu, ndi kulephera kwa mayanjano, kutipangitsa kupita patsogolo kopitirizabe. Kusintha kwa mtsogolo kumene kumaloŵetsamo luso la zoletsa za anthu, kuchepetsa kuzoloŵera, ndi kuwonjezera lonjezo. Mwa kuphunzira zinthu zopambana ndi kulephera, opanga malamulo angawongowongolera maprogramu amakono amene abweretsa cholinga cha chilengedwe chonse, kukhoza kukwaniritsa moyo wapafupi.

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