Tapuro Yezvirongwa zveHurumende Pakuwana Utano Hwavose

Muitiro Wokutarisira Usingadhuri (ACA)

Yakanyorwa muna 2010, ACA ndiyo inonyanya kudzorwa nemitemo yezvoutano yeUnited States kubvira paMedicare naMedicaid. Urongwa hwayo hunosanganisira chibvumirano chemunhu oga (zvino chava kubviswa neBhazi reCut nerokut), misika yeinishuwarenzi yezvoutano inotsigirwa nehurumende, kubhadhara zvikwereti zvemitero uye kuderedza mari, zvinodiwa neutano, uye urongwa hunodiwa kuti vechiduku varambe vachirarama maererano nezvirongwa zvomubereki kusvikira pazera ramakore 26.

• Mhindu dzemari: Pakasvika 2016, mamirioni 20 avanhu vasina kutenderwa akanga awana chinyorwa kupfurikidza neACA. Nepo kunyoresa kwakachinja mukati moudzori hweTrump, American Reduction Act ya2021 uye yakazotevera Indaneti Act yakasimudzira mari, inotungamirira kukunyora kubhadharwa kwemisika mamiriyoni 21 muna 2024.
• Betsero dzoutano dzakasimba: DAI ROUSA yakaraira kuti mapurani ose anotengeswa pamisika ane zvikamu gumi zvebetsero dzoutano dzinokosha, kubatanidza mabasa ekurumidziro, kurapirwa muchipatara, kuchengetwa kwapamberi pezvipatara, kurapwa kwendangariro, mirimo inodzorwa nachiremba, uye mabasa anodzivirira.
• Migariro iripo: ACA inorambidza vashupi vemishuwarenzi kuramba kubhadharwa kana kuti kubhadharisa mari yakakwirira yakavakirwa pamigariro isati yavapo. Iyi gadziriro yave ichikosha kumamirioni eAmerica ane hosha dzinogara kwenguva refu dzakadai seshuga, hosha yemwoyo, uye asima avo vaitarisana nemhinganidzo dzokuwana inishuwarenzi.
• Kuzvinyima nedenho: Pasinei zvapo nemhindu, ACA haina kuwana chinyorwa chavose. ACA inenge mamirioni 27 vaAmerica vanoramba vasina kufukidzwa, zvikurukuru nemhaka yomukaha wokupfuudza weMedicaid muruwa urwo rusina kukudza, mitengo isingakodzerwi nokuda kwaavo vasingawaniki nokuda kwemari, uye vatami vasina kunyorwa avo vanobviswa.

National Health Service (NHS) (United Kingdom)

NHS igadziriro inobhadharwa nevoruzhinji yezvoutano inogovera mabasa ezvokurapa akawanda kuvagari vose veUK vepamutemo, vanobhadharwa nemari nemipiro yemitero yehurumende uye yeInishuwarenzi yeNational. Ndiyo inobhadharwa zvikurusa munyika yose, ine vashandi vanopfuura mamiriyoni 1,5.

• Kubhadharwa kusina mufungo: NHS inovimbisa kuti tarisiro youtano inowanika kuna vose pasinei zvapo nemari inowanwa, mugariro webasa, kana kuti nhau yezvokurapa. Uyu muenzaniso wakabvisa zvikuru mhinganidzo dzemari kutarisiro yokutanga nechipatara. Mushumo wezvionioni wa2021 wakaronga NHS segadziriro yezvoutano yakakwirira pakati penyika 11 dzinowana nokuda kwemitengo, kuwanikwa, uye kushanda zvakanaka kwezvipatara.
• Sundo yetarisiro yokuwedzera: NHS inoisa mari yakawanda mugadziriro dzoutano hwevagari vemo, kubatanidza kudzivirira utachiona kwakapararira, mapurogiramu okuongorora nyika nokuda kwekenza (chipfuva, chipfuva, mubhedha) uye zvinhu zvine ngozi yemwoyo. Zvirongwa izvi zvakabetsera kunatsiridza upenyu hunotarisirwa uye zvakaderedza kufa mumigariro inorapika.
• Calmentes: NHS inotarisana nedzvinyiriro huru inobva kuchiverengero chavagari vemo vakwegura, kudikanwa kunowedzera, kuganhurirwa kwemari, uye kuperevedza kwamabasa. Kubvira muna 2023, nguva dzakamirira miitiro inosarudzwa neshanyo dzekurumidziro dzakarebesa zvikuru, kunyandura kurukurirano pamusoro pemari yokuwedzera nechinjo. Zvisinei, nheyo huru yokuwana kwese kwapasi inoramba yakakurumbira mumativi ose ezvematongerwe enyika.

Kirechi Youtano Hukuru (PHC) Mukukudziridza Marudzi

Gadziriro dzehurumende munyika dzinowana mari shoma napakati dzinowanzoita chimiro chezvirongwa zvokutarisira zvoutano zvikuru, zvinowanzotsigirwa namasangano amarudzi ose akadai seWorld Health Organization (WHO) neWorld Bank. Chibvumirano cha1977 Alma- Ata Declaration chakadana nokuda kwe "Kuporesa Vose pagore ra 2000" kupfurikidza nokutarisira kukuru. Mienzaniso inobatanidza:

• Inishuwarenzi youtano yenzanga: Rwanda yakatanga gadziriro inoraira yeinishuwarenzi youtano (Mutuelle de Santé) iyo zvino inofukidza 90% yavagari vayo. Ikoku kwakarumbidzwa nokuderedza zvikuru kufa kwapasi peshanu uye kuwedzera kusvika kumabasa outano kuna amai.
• THAIN’SCHETH UNICER Fubecage (UCS): Irori muna 2002, UCS inofukidza utano hwavagari vose vemo veThailand isina kufukidzwa nemhiko dzechengeteko yehurumende kana kuti dzenzanga. Mwero usina kuvhozhokerwa wakaderera kubva pa30% kusvika kudokusvika zero, uye nyika yakawana kuderera kukuru mukushandiswa kweutano kune ngwavaira.
• Brazil’s Sistema Único de Saúde (SUS): tsika yenzanga yavose yeBrazil, yakagadzwa nebumbiro remitemo ra 1988, inogovera tarisiro yapachena kuvagari vose. Inobatanidza chikwata chakasimba chetarisiro (Estratégia Saúde da Família) iyo inosvika kuvagari vemo vari kure navaruwa, ichiparira kuvandudzwa kwoupenyu nokufa kwavacheche.

Matambudziko Mune Zvokutarisira Utano

Pasinei zvapo nokubudirira kwegadziriro dzehurumende, zvinodzivisa zvikuru kuwana tarisiro yezvoutano dzakakwana zvinopfuurira munyika dzose dziri mbiri dzinowana mari yakakwirira neyakaderera.

• Mitemo inodzorwa: Zvirongwa zvizhinji zvehurumende zvinoiswa pasi pakuda. MuU.S., somuenzaniso, kutora rutivi kwavanachiremba muMedicaid kunowanzoganhurirwa nokuda kwemitengo yemari yakaderera, kuchitungamirira kukuderedza kuwanika kwemari inobhadharwa vanobetserwa. MuUK, bhajeti yeNHS haina kuchengeta fambiro mberi nendyiko dzinokwira, inoguma neperevedzo dzezvishandiso nero dzinorebesa.
• .Bureaucratic ifficiencies: Miitiro mizhinji, mapepa anowanzoitwa, uye gadziriro dzehurumende dzakakamukana zvinogona kunonotsa kutarisira. Somuenzaniso, zvinodikanwa zvokubvumidza muMedicare Begconst pane dzimwe nguva zvinoramba kana kuti kunonoka kurapa kunodikanwa. Nenzira yakafanana, kutarisirwa pakati pemapurogiramu ehurumende akasiyana- siyana (g., Medicare neVendans Affaiars) zvinoramba zviri varombo.
• Kuwana kwoutano kunoitwa nevanodzivisa utano (STORH): Kushanda kwoutano kunopesvedzerwa nezvinhu zvinopfuura gadziriro yezvoutano imene(urombo), kusagadzikana kwedzimba, kusachengeteka kwezvokudya, mwero wedzidzo, uye kuwanikwa kwezvifambiso. Gadziriro dzeHurumende dzisati dzichitaura SDOH dzinowanzoita vandudziko dzakaganhurirwa mumiuyo youtano. Somuenzaniso, Medicaid inovandudza kupfuudza, asi inobatira munharaunda dzomumaruwa dzingangoshaiwazve vanachiremba vari pedyo.
• Nharaunda dzomumaruwa dzinorerutswa nedzisingashandiswi zvikuru: Nzanga dzomumaruwa kazhinji kazhinji dzinotarisana nokuperevedza kwavatarisiri vakuru, nyanzvi, uye mabasa echipatara. Kuwedzera kwechiNgezi mukati medenda reCHOVAD yakabatsira bhiriji, asi kurera vana kwakasiyana. U.S. Resources and Service Administration (HRSA) inodudza zviuru zveMabasa ezveutano.
• Misiyano yetsika neyamadzinza: Gadziriro dzeHurumende hadzina kubvisa paradzano nedzinza. MuU.S., Nhamba dzavagari vemo dzeBlack neHispanic dzinowana mwero yakakwirira zvikuru yokusadzorwa, kusvika kwakaderera kukudzivirira, uye miuyo yakaipisisa youtano kunyange apo inoregeredzwa. Urudzi hwetsika nekubviswa kwenhau mubetsero dzehurumende (h.g., kutanga kuiswa pasi pezvipatarati zveBlack Dow) zvinoparira ichi chitsama.
• kusatsiga kwematuro uye mitoro yokutarisira: Munyika zhinji dzichiri kubudirira, zvirongwa zvoutano zvehurumende zvinotambura noushati, kudzikamisa kuneta, uye kushandura kwezvamatongerwe enyika. Kuitwa kwepurogiramu kunogona kuva kusingawirirani, uye mari inobva kuvapi vemari vemarudzi ose inowanzosvika mudenderedzwa risingadeyi kuzivikanwa.

Kuongorora Zviratidzo Zvemhosva: Zvakabudirira Uye Zvakakundikana

Kuongorora nyaya dzakadzama kunobatsira kuona zvinoshanda uye zvisingaitwi kana mapurogiramu ehurumende akaronga kuti pave nokutarisira utano.

Budiriro: Kukura kweMedicaid muCalifornia neKentucky

California yakakudza Medicaid pasi peACA muna 2014, ichifutunura kunenge vakura vose vakaderera vanowana mari. Mwero usina kunyorwa wakaderera wehurumende wakaderera kubva pa 17.2% muna 2013 kusvika ku 6,5% muna 2022. California yakashandisawo mari yehurumende kupfuudza mari isingaverengeki kuti ipedze mari inobhadharwa nehomwe isati yanyorwa, uye nguva pfupi yapfuura, kuti ipfuure vanhu vose vasina kuwanda vagari vemo pasinei zvapo nezera. Nzvero dzakawanda dzakabatanidza kuwedzera kushandiswa kwokutarisira kukuru, kutarisirwa zvakanaka kwechirwere cheshuga nechukele, kuderedza kuderera kwemari kubva pakubhadhara mari, uye kuderera kwekufa pakati pevakura. Kukura kwevakuru, kunyange zvazvo gare gare gare, kuderera kuderera kuderera kukura nokupfumba kwokuzvikwirira nokupfumba kwechipfumba kupfumba kupfuudzira, kudzivirira kupfupfura, kupfupfura vharo, kupfura kupfura.

Kukundikana: Dambudziko reVereterans Health Administration (VHA)

VHA inoita imwe yegadziriro hurusa dzezvoutano dzakabatanidzwa muUnited States, ichibatira vagara nebasa vanopfuura mamirioni 9 vakanyoresa. Pasinei zvapo nebasa rayo, VHA yakawana kundikano dzakasanonyorwa, zvikurukuru “chishamiso chekumirira ” umo muchivande makarongwa echivandika kunonozekidzwa kwenguva refu nokuda kwetarisiro, kuchitungamirira kurufu rwavadzivisi. Zvikonzero zvaibatanidza remare asingaperi pasi pokuzvinyoresa, gadziriro yezve zvoutano yemagetsi, kuoma kupinza nyanzvi, uye tsika dzechinyakare. 2018 MISIO Act inokudza chisarudzo nokuda kwenyanzvi dzokutsvaka tarisiro yezve, asi ikoku hakusati kwapedza chose chose. Varwi vazhinji vachiri kutarisana nemwedzi yezvirongwa zvechienzi nokuda kwokugadzwa chakananga. Chinotoko chinotoko chinotokosha zvikuru chinoda kutungamirira kwenguva dzose, kudziviswa kupfuudzodzodzodzodzodzo dzoudzo.

Kubudirira: Chirongwa Chokugadzira Zvinhu Zvose muThailand

Universal Courage Study yeThailand inogovera mibato inokosha youtano kuvanhu vanenge mamiriyoni 48 vane mutengo wakaderera wemari. UCS inoripirwa mari kupfurikidza nemitero uye inoshandiswa neNational Health Security Office. Purogiramu yacho yawana purofiti inodokuva yavose chifo chayo cha2002, mari inoderedza zvikuru kupedza njodzi youtano, uye kukura zvikuru kusvika kukurapa kweutachiona kweHIV /AIDS. Zvisakiso zvikuru zvinobatanidza gadziriro huru yetarisiro yezvoutano (ne purofiti youtano muzvipatara zvomuruwa nenzvimbo zvoutano), mutengidzo unobhadharira mari inodzivirira, uye kubatanidzwa kwenzanga kwakasimba. Thailand inoratidza kuti ruzivo rwokuzviwanira rwapakati pezvipo neyamukoshanga kuti nyika yose isvikire fambiro mberi kuutano kupfurikidza nehurumende.

Kukundikana: Inshuwarenzi yeU.S. yeU.S. yeUnishuwarenzi yeUS, Glitzs (2017-14)

Kutanga kweHomeCare.gov muna October 2013 kwakashatiswa nezvinetso zvakakomba zvounyanzvi zvakadzivisa mamirioni avaAmerica vasina kudzivirirwa kunyoresa. Website yakaparara, kusachengeteka kwemadata kwakamuka, uye nhamba dzokunyoresa dzakaderera zvikuru. Uku kukundikana kwakanga kuri nemhaka yokukurumidzisa kukura, kuedzwa kusina kukwana, uye kusabatana nenzvimbo dzemibatanidzwa yemibatanidzwa yemibatanidzwa yehurumende. Debacle yakadzosa chivimbo chavose uye akapa vashopu vezvamatongerwe enyika mabhomba kuti vaparadze ACA. Nepo nzvimbo yacho yakagadzirwa nepakati-2014, kundikano yokutanga yakasimbisa kukosha kwokugadzirwa nokungwarira uye kuiswa kwoumbidzani payaidzokorokorokorokorokororwa purogiramu dzehurumende huru dzoutano.

Nhungamiro Dzomunguva Yemberi Dzokuwana Utano Hwavose

Miitiro inoverengeka iri kubuda nezvikarakadzo zvemitemo zvingasimbisa basa regadziriro dzehurumende mukuvandudza kuwanwa kwokutarisira utano mumakore gumi anotevera.

• Kukura kwoutano hwemagetsi neredhiyo: Miitiro yechinguvana mukati medenda reCOVID-19 yakaratidza kuti telehealth inogona kukudza zvikuru kusvika kwavagari vomumaruwa napamusha. Kufutunurwa kwechigarire kweMedicas kwetelehealth, mari yemari yezvigadzirwa zvemabhazi, uye kubatanidzwa kwemichina inonzvera zviri kure kugona kupfuudza mabhiriji. Zvisinei, kubvisa miganhuro mumichina yemichina neIndaneti zvinofanira kukurukurwa.
• Utano hwendangariro nokubatana:[[FLT: 1] Hurumende dziri kuziva nenzira inowedzera dikanwo yokubatanidza mabasa outano hwendangariro kuva tarisiro huru uye kumanikidzira mitemo inoda kufukidzwa kwakaenzana nokuda kwoutano hwendangariro nomuviri. U.S. yakagadza fambiro mberi yeMental Health Parity neUddiction Equity Act muna 2008, asi kuzviisa pasi kunoramba kusina kufanira. Nhano itsva dzakafanana ne 988 Suicide & Cristline Life nepatime rezvoutano hwendangariro zvinomirira fambiro mberi.
• Zviteshi zvemagariro avanhu kupfurikidza nemari yezvoutano: Mamwe mapurogiramu, akadai semapurogiramu oU.S. Arevice Health Community Health Community Minities Miniversetyss, ari kuedza nzira dzokushandisa nadzo mari yezvoutano kuti apedze zvinodikanwa zvisiri zvekurapa (zvikurukuru, tsigiro yedzimba, mapepa ezvokudya). Kana zvikabudirira, izvi zviidzorwa zvaigona kuenzana mumapurogiramu ehurumende akadai seMedicarea neMedicaid.
• Kushandiswa kwokuva akasununguka nokunyoresa: Mitoro yehurumende inodzivisa vanhu vakakodzera kunyoresa mumapurogiramu avose. Kupfuvura nomu “kurerutsa,” kunyoresa kwokuzviitikira, uye kunyora mashoko edata (mh., kushandisa marekodhi emitero kunyoresa vanhu muMedicaid) ingagona kuwedzera kutora rutivi. Nhambudzo dzeBiden Administration dzokupfavisa kushandiswa kweMCmCeting nokutambanutsa nhambo chadzo.
• Zvikarakadzo zvokupitira zvisina mufungo: MuU.S., kurukurirano dzinopfuurira makapoteredza Medicare yeZvose kana kuti chisarudzo chavose. Nepo zvikarakadzo zvinoparadzanisa mune zvamatongerwe enyika, izvi zvinoratidzira kusagutsikana kuri kuwedzera nevhenganiswa yenyika yavanhu yakakamukana. Kuwedzera munyika dzakawanda dziri kufamba kumifanikiso yepasi pose, neSouth Korea neTaiwan misi ichangobva kupfuura iyi kukudza gadziriro dzavo dzeinishuwarenzi yenzanga.
• Sangano routano renyika yose nedenda rakagadzirira: Murakatira weCHOVAD unoratidzira utera mugadziriro dzoutano dzavanhu munyika yose. Hurumende zvino dziri kuisa mari mukusimbisa kutarisirwa kukuru, kuongororwa kwehosha, uye simba rokupindura kwekurumidziro. Chibvumirano cheWHO chinokarakadzwa chakapararira uye mari inowedzerwa nokuda kweGlobal Fund yaigona kuwedzera kusvika kwoutano mumamiriro ezvinhu asina kusimba.

[[[FT:0] Mabatanidzo:[

• Matandi eMedicare & Ma Services Medicaid – Medicare E Kunyoresa foodboard
• [[NZVOKURWA] COMMOOLY - Chionir 2021: Kuratidzira Zvisina Kufanira (Masai eHwenzeve)[FL:1]
• [ World Health Organization – Universal Health Council Comficience True
• [Kaiser Fandes Fandes – Mamiriro eHurumende Zvisarudzo zveFutunuko