Table of Contents
Izigqibo zemigaqo yezempilo azinanto ilula. Zifuna ukulungelelanisa amaxabiso akhuphisanayo afana nokulingana, ukuphumelela, ubunjani, kunye nenkululeko yomntu ngamnye ngokuchasene nengcinezelo yoqingqo-mali, umsebenzi, kunye nokuthanda kwezobupolitika. Kubafundisi-mfundo kunye nabafundi abafunda iinkqubo zikawonke-wonke, ukuqonda iiprojekthi ezifunekayo, kubalulekile ekuqondeni isizathu sokuba kwaneenguqu ezizinzileyo zisoloko zidala impikiswano neziphumo ezingacwangciswanga. Olu hlalutyo olubanzi luhlola ubunjalo benkqubo yezonyango, imizekelo yehlabathi yemiqobo, imiqobo yemiqobo, imigaqo yovavanyo, iindlela zovavanyo, kunye nemithetho ekhokelayo yokwenza isigqibo.
Ukuchaza Iintengiso Kwinkqubo Yonyango
Ukurhweba kwinkqubo yonyango yimeko apho ukukhetha indlela enye yomsebenzi ngokungenakuphepheka kubandakanya ukuncama iingenelo ezinokufunyanwa zezinye. Ezi zigqibo zenzeka kumgangatho ngamnye (ukusuka kumthetho wesizwe ukuya kwizabelo zoqingqo-mali zezibhedlele zobulali. Uxinezeleko olungundoqo kukuba oovimba bokokuba iimfuno zempilo zingenasiphelo. Abenzi bemithetho kufuneka benze ukhetho oluvelisa iimpumelelo kunye nokulahlekelwa kwabemi, ooshishino, nezizukulwana.
Imiqathango Esisiseko Yezorhwebo
- [[UMTL: 0] Ixabiso eliqulathe intengo: Isambatho esandisiweyo singanyusa inkcitho yoluntu okanye intlawulo ye-inshorensi, ngelixesha imilinganiselo yokusika iindleko idla ngokunciphisa ukufikelela kumaqela angakhuselekanga.
- [[UMTL: 0] Ubunjani bs. Ukungaphumeleli: ukulingana okuphezulu, inkathalo engokobuqu idla ngokufuna ixesha elininzi nemali, okunokuthi kunciphise umlinganiselo wenkqubo.
- Ukungatshintshi. Ukuphumelela: Ukukhuthaza iziyobisi ezintsha kunye nophuhliso lwesixhobo kungaqhuba amaxabiso aphezulu; ulawulo lwamaxabiso lungadambisa i-R&D izihlomelo.
- [[UMTL:0] Izixhobo Zokukhetha ezizizo. Ukuqokelela Okulungileyo: Iintsuku ezifana neemfuno zokugoma okanye imimiselo ye-inshorensi ilinganisela inkululeko yobuqu ngenxa yempilo yabemi.
- [[FLT: 0] Ingeniso yexesha elide: inkathalo yokuthintela ikhupha imali egciniweyo kwiminyaka kamva, kodwa imijikelo yezobupolitika ikhetha iziphumo ezikhawulezileyo.
Obona Buthunywashe Bubalulekileyo Obuphembelela Urhwebo
Amandla amaninzi okwakha nawasemongweni abumba indlela ezifunyanwa ngayo, zilinganiswe ngayo zize ziconjululwe ngayo inkqubo yempilo.
Ubuchule bokwenza uhlahlo-lwabiwo-mali kunye noHlahlo lohlahlo-lwabiwo-mali
Iinkqubo zempilo ehlabathini lonke zijongene nonyuka kwamaxabiso aqhutywa ngabantu abalupheleyo, iingxaki zezifo ezingapheliyo, kunye nobugcisa bezonyango obubiza imali eninzi. Uqingqo-mali lukarhulumente (‘ nokuba luxhomekeke kwirhafu okanye kwimali ye-inshorensi okanye kwi-inshorensi) alunamda. IQumrhu lezezoqoqosho Co-operation kunye noPhuhliso (OECD) liphawula ukuba iindleko zempilo ezichithwayo ze-GDP kumazwe angamalungu ngokomlinganiselo, ukushiya indawo encinane kwezinye izinto eziphambili. Abenzi benkqubo kufuneka bagqibe ukuba banikele kangakanani kwizibhedlele, kwimpilo, okanye kusini nakusetyenziswa kophando, ngokufuthi ngemali evela kumazwe asemalungwini ukuze basekele amanye.
Imeko Yezobupolitika Nezeziko
Imeko yezobupolitika imisela ngamandla ukuba ziziphi izinto ezinokwenzeka. E-United States, i-gridblock edibeneyo iye yavala iinguqu ezinkulu ezifana nokukhetha kukawonke-wonke okanye ukugquma jikelele. Kwinkqubo yepalamente efana noBukumkani boMbuso, iinguqu zinokwenziwa ngokukhawuleza ngakumbi, kodwa zisekho inkcaso evela kulwamkelo lwezamayeza, amaqela abaguli, kunye namajelo-ndaba. Iinguqu zikwanjalo: iinkqubo zikarhulumente zisasaza igunya phakathi koorhulumente besizwe nabesizwe, zidala umaleko wengxoxo kunye nokulalanisa.
Iimbono Nemilinganiselo Yoluntu
Amathemba abemi ngempilo------asethi bayijonga njengelungelo okanye njenge-active system transmittery. Uhlolisiso oluye lwenziwa yiKaiser Family Foundation lubonisa ukuba amaMelika abeka inkathalo yempilo njengenkupho ephezulu kodwa angavumelani ngendima karhulumente. Uluvo lukawonke-wonke lunganyanzela abenzi bemithetho ukuba bagcine bekho kodwa kwiinkqubo ezingalawulekiyo okanye balahle amanyathelo okugcina imali athathwa njengokwahlulwa.
Ubungqina Nokungaqiniseki
Inkqubo yempilo kufuneka isekelwe ngokufanelekileyo kubungqina, kodwa ubungqina busoloko bungaphelelanga, bungqubana, okanye bucotha ukufika. Umzekelo, iziphumo zexesha elide zomgaqo-nkqubo wokudlulisela amayeza amatsha zisenokuthatha iminyaka ukuthatha indawo. Abenzi bomgaqo-nkqubo mabathathe amanyathelo okungaqiniseki, benze urhwebo ngesiseko solwazi olungaphelelanga.
Imizekelo yehlabathi lokwenene yee-tradoffs zezonyango
Amatyala athe ngqo abonisa indlela ezisetyenziswa ngayo izinto zokurhweba.
Umzekelo 1: Ukugqunywa Kwehlabathi Lonke Namaxesha Okulinda
Amazwe aphumeza uphicotho-mhlaba olumalunga ne-ibhunga elingu-20%. "njengeK," kunye ne-UK," asoloko amkela amaxesha amade okulinda iinkqubo zokunyulwa njengendawo yokuthengiselana. ICanadian Institute for Health Information inikela ingxelo yokuba i-median ilindele amaxesha okubuyiselwa kwenyonga ukusuka kuma-20 ukuya kuma-30 eeveki kuxhomekeke kwiphondo. Kumazwe ase-US, apho intlawulo lungakho kuyo yonke indawo kodwa amaxesha asoloko efutshane kakhulu ekhutshelwayo, ukurhweba kuyaguqulwa: ufikelelo olungcono lwexabiso labantu abangangeni ngaphaya kwexabiso lama-26 (i-Census Bureaual data). Abenzi bemithetho kufuneka bagqibe ukuba kuphi unikezelo oluninzi.
Umzekelo 2: Ukusetyenziswa kweziyobisi zonyango
Imigudu yokunciphisa amaxabiso eziyobisi .ukuxilonga, inkcazo, okanye ukurhweba ngaphandle ngezantsi kwengeniso enokwenzeka kwiinkampani zamayeza kunye nekamva le-R&D. Uphando lwe-2021 kwiMicimbi yezempilo lufumanise ukuba umgaqo wexabiso eYurophu awukhange uthintele ukusetyenziswa kwentengo, kodwa imakethe yase-US isesona siko sibalulekileyo kwingeniso. Abenzi bezonyango kufuneka balinganisele belungelelanise iimali ezikhoyo ngokusondeleyo kwizigulana nexesha elide lonyango olutsha.
Umzekelo wesi-3: Ulwando locingo nomgangatho wokunyamekela
Ngexesha lesifo se-COVID-19, i-telehealth iqhushumbisa. I-Tentevosiff ibandakanya ukunceda nokufikelela (ingakumbi kwizigulana ezisemaphandleni) kunye nenkxalabo ngokuchanano kokuxilonga, ukuqhubekeka kococeko, kunye nokwahlulwa kwamanani. I-Medicare kunye nezingenisi-mali zobuqu zikhululekile kwimithetho yokuhlawula okwethutyana, kodwa njengoko abenzi bemithetho becinga ngolwando olusisigxina, kufuneka bavavanye iingenelo zokulwa nomngcipheko wokusetyenziswa ngokugqithisileyo nokuphoswa kweziphumo.
Umzekelo 4: Impilo Kawonke-wonke Ihlalisana Nenkululeko
Ngexesha lesifo se-COVID-1919, izigunyaziso, izitshixo, kunye neemfuno zokugoma zabangela impikiswano ekrakra. Ukudaya kwabangela impikiswano ekrakra: ukubeka imiqathango ecuthayo yokudluliselwa kwentsholongwane (ukukhusela izibhedlele nokusindisa ubomi) kodwa kwabangela umonakalo ngokwezoqoqosho, iingxaki zempilo yengqondo, kunye nokuphazamisa inkululeko yomntu ngamnye. Amazwe namazwe awahlukeneyo adwelisa umgca kwiinkalo ezahlukeneyo, eveza ukungavisisani okunzulu.
Indima yabaxhasi kwiSayimi
Imigaqo yezorhwebo yempilo ayenzelwanga kwi-athom. Uthungelwano lwabaxhasi lunempembelelo, ngamnye unokubaluleka okukhethekileyo.
Amagosa noorhulumente
Umanyano, urhulumente, namagosa asekuhlaleni adala imithetho, iinkqubo zentlawulo, kunye nemimiselo. Bamele baphendule kubavoti kwaye basoloko besenza ukhetho olufanelekileyo kwezobupolitika, kwanokuba ubungqina bubonisa indlela eyahlukileyo. Umzekelo, iKhomishini yeUnited States iye yasikhaba isohlwayo somhlawuli omnye phezu kwabo nje ubungqina obuvela kwamanye amazwe amaxabiso aphantsi olawulo kunye nenkxalabo yendalo yonke.
ISebe lezeMpilo (IiHospital, Oogqirha,
Abanikeli bachaphazeleka ngqo ngezigqibo ezimiselwe yinkqubo. Basenokubhenela kwimali yokubuyisa imbuyiselo ephezulu, intlawulo encinci, okanye ukugquma intlawulo eyandisiweyo ezizisa izigulana ezihlawulayo. Ulawulo lwabo kunye neemfuno zemali zingangqubana neenjongo zexabiso. Umzekelo, ukushukuma ukuya kwintlawulo yexabiso elisekelwe kwiziphumo zesigulana (ubophelelo lwembuyekezo) kujongene nokuchasana nokungangeneleli kwemali kubabonelelo abarhwebi abafuna ukuhlawulwa yimali.
Iinkampani ze-inshorensi namalungiselelo acwangcisiweyo
Abangenisi-mali baphembelela izigqibo zokukhutshwa kwengxelo, ukwenziwa kwenethwekhi, kunye ne-prices. Basenokuchasa ukhetho lukawonke-wonke olusongela ulwahlulo lwabo lwentengiso. Kwangaxeshanye, banobuchule ekulawuleni umngcipheko kunye nokusebenzisa okunokuthi kwazise inkqubo yokwazisa. I-Cresoff idla ngokuvumela ukhuphiswano lwentengiso ukuba luqhubele phambili ubuchule kunye nemithetho ecwangcisiweyo ukuthintela uqheliselo lolwaphulo-mthetho.
Izigulana, Iintsapho Namaqela Aboyikekayo
Imibutho ekhuthaza ukusetyenziswa kweziyobisi ezincinane, ukuphakanyiswa kwemali okanye ukusetyenziswa kwemali ephuculiweyo. Iimbono zabo zingazisa ungxamiseko lwemilinganiselo yokuziphatha kodwa zisenokuxhasa izilangazelelo ezimxinwa ngaphezu kokwabiwa kwabantu ngokubanzi. Umzekelo, amaphulo eziyobisi ezinkedanjiweyo zingakhokelela ekusebenziseni imali eninzi kubantu abancinane abagulayo, iphazamisa imali kwiindlela zonyango zoluntu ngokubanzi.
Iikhampani zesixhobo sonyango nesamayeza
Imali yeshishini i-R&D, iimvavanyo zezamayeza, kunye norhwebo. Intshukumisa yabo yengeniso ibangela ukuba kubekho ingeniso etsha kodwa isenokukhokelela ekunyuseni amaxabiso kunye norhwebo olunobundlobongela. Izakhono zivela xa abenzi bezolawulo becinga ngolawulo lwexabiso okanye utshintsho olusemthethweni olunokunciphisa ingeniso kwaye, lungaphunyezwa kwixesha elizayo.
Ubugcisa, Abaphandi Neendlela Zokucinga
Amaqela anikela ubungqina nohlalutyo, ngokufuthi abalaselisa ukurhwebelana okungahoywayo kwingxoxo yezobupolitika, kodwa impembelelo yawo ayichananga, yaye asenokunganconywa xa engqubana nezinto ezithandwayo.
Imisebenzi yeFrames yokukhupha iiFomati
Ukuze bahlole intengiso, abaququzeleli bemithetho nabahlalutyi basebenzisa iindlela eziliqela.
Uhlalutyo lwendleko yeziphumo (CEA)
CEA ilinganisa iziphumo zempilo (umz., ubulunga beminyaka yobomi obulungiselweyo, iiQALY) ezifunyenwe kwixabiso ngalinye. Isetyenziswa yimizimba efana ne-UK's Institute for Health and Care Excellencence (NICE) ukugqiba ukuba luluphi unyango lokuxhasa. Abahlalutyi baphikisa i-CEA ukuba iimfuno zabantu abanezifo ezinqabileyo okanye abakhubazekileyo. Urhwebo luphakathi kobuchule bobugcisa kunye namaxabiso oluntu.
Uhlalutyo lwexabiso-lendawo (CBA)
I-CBA izama ukufaka zonke iziphumo, kuquka ukufa neentlungu, ukuze kubonwe iingenelo zentlalo. Ichanile kodwa ithanda ukuphikisana ngemigaqo. Zimbalwa iinkqubo zempilo ezixhomekeke kwi-CBA kuphela kuba ukubeka ixabiso leerandi kubomi kudala ingxabano.
Uhlalutyo lwesigqibo se-Criteria ezininzi (MCDA)
I-MCDA ibandakanya imilinganiso emininzi, ukulingana, ukwamkelwa kwezobupolitika, kunye nempembelelo yempilo (ukudlula nje kwixabiso ne QALY. Ivumela abagcini beepali ukuba balinganise imilinganiselo eyahlukileyo, bakhangele ngokucacileyo ukuthengwa kwentengiso.
Imisebenzi yeFrame e-Utilitharia
Iindlela zoorhulumente zandisa iingenelo zempilo ezipheleleyo, ezisenokungazisi ngxaki kwabo banempilo esisiseko esiphezulu. Iimbono zomntu ophambili zibeka kuqala ukususwa okubi kakhulu, ukwamkela inzuzo ephantsi kwe-agletrate ukwenzela ingcebiso enkulu. Iingxoxo ngaphaya kwenkqubo yempilo zidla ngokubonakalisa ezi mbono zikhuphisanayo.
Iindlela Ezisebenzisekayo Zokuqhuba Ishishini
Abenzi benkqubo banokusebenzisa iindlela zokurhweba ukuze babonise ngaphaya koko bafunde.
Ilibbari ecace gca
Ukusebenzisa iikomiti zokufundisa ezinomelo olwahlukeneyo kungabhenca amaxabiso akhuphisanayo nokuphucula ukwenziwa komthetho. Umzekelo, iKhomishini yeHealth Evince Review ye-Oregon iquka ii-kliniki, abathengi, kunye nabenzi benkqubo ukumisela iMedicaid ukwenziwa kwangaphambili.
Uvavanyo oluzizinzileyo novavanyo
Iinkqubo zesikhokelo kunye noluhlu olumisiweyo luvumela uvavanyo lwemigaqo-nkqubo kwisikali esincinane phambi kokuphumeza okupheleleyo. UMthetho we-inshorensi osekelwe kulawulo lwasemoyeni wandululwa kwiminyaka emininzi, uvumela ulungiso olusekelwe kwiziphumo zangaphambili.
Ubandakanyeko Lwasewonke Nokonakalisa
Ukudibanisa abemi ngeeholo zedolophu, uphando, kunye nokukhulula izicelo zequmrhu kungavumelanisa inkqubo nemilinganiselo kawonke-wonke. Oku kunceda abenzi benkqubo baqonde ukuba yiyiphi inkqubo erhwebelanayo noluntu abakulungeleyo ukuyivuma.
Izixhobo Zokwenza Isigqibo Esakhiweyo
Izixhobo ezifana nemithi yesigqibo, ucwangciso, kunye "iinkcazo zobugcisa obuphilileyo" zinceda ukuzoba iziphumo phambi kokuba zithathe. Ezi ziluncedo kakhulu kwizicwangciso ezimiliselwe imida apho iimpazamo zibiza imali eninzi.
Izixhobo zorhwebo kwiinkqubo zempilo ezithelekisa
Uhlolisiso olwenziwa kumazwe awahlukahlukeneyo lubonisa indlela ukurhwebelana okuconjululwa ngayo kwiimeko ezahlukahlukeneyo zezithethe nezezobupolitika.
Umbhatala omnye (eCanada, eTaiwan)
I-Tradoff: Ityala lehlabathi lonke elineendleko eziphantsi zolawulo, kodwa amaxesha okulinda ukunyanyekelwa kokhetho kunye nokubandakanyeka okusikelwe umda kwecandelo labucala. Izigulana zingafuna inkathalo phesheya okanye zihlawule ngaphandle kwephayinti ukwenzela umsebenzi okhawulezayo.
Umzekelo weBhasmark (eJamani, eJapan)
I-Tradoff: I-inshorensi esekelwe kumqeshi enentlawulo ephezulu kodwa inkqubo entsonkothileyo yokuhlawula. Iindleko zilawulwa ngemiqathango elawulwayo, kodwa inkcitho ingaba phezulu kubasebenzi abafumana imali ephantsi.
Imodeli ye Beveridge (UK, eSpeyin)
I-Tradoff: Irhafu ekhutshiwe, ibonelelwa ngokubanzi iqinisekisa ukuba inkathalo ihleli kodwa ijongene neengxaki zoqingqo-mali kunye nokungahlawulwa kwemali.
Imodeli engaphandle kwePocket (amazwe amaninzi angenayo asezantsi)
ITradeff: Amahlwempu anokufumaneka lula, kodwa amahlwempu athambe yaye angabi nangxaki. Inkcitho yempilo eyingozi ixhaphakile, nto leyo ebangela iintsapho zibe buhlwempu.
Imilinganiselo Yorhwebo: Iindlela Ezinzima Zokukhetha Kwinkqubo Yempilo
Ekugqibeleni, ukurhweba kubandakanya ukuqwalasela imilinganiselo yokuziphatha engaphaya kohlalutyo lobugcisa.
Ukulinganisa ngexabiso. Umlinganiselo wokulinda
Kwi-US, ukwabelana kwenzeka kakhulu ngexabiso elingaphezulu, kwaye oku kwenzeka ngexabiso elingaphezulu, abo banokuhlawula i-inshorensi okanye abanokufumana iindleko ze-inshorensi okanye ze-odocter bafumana inkathalo; abo bangakwaziyo, ukulibazisa okanye ukuyeka unyango. EK, ukutyikitya kwenzeka ngexesha lokulinda. "Wonk'wethu angafumana inkathalo, kodwa ulinde ixesha elide kwiinkonzo ezithile. Yiyiphi na into elungileyo? Akukho mpendulo yendalo; ixhomekeke kumaxabiso entlalo malunga nomlinganiselo kunye nomgangatho womntu ngamnye.
Umlinganiselo osekelwe kubudala
Ezinye iinkqubo zilunciphisa ngokupheleleyo okanye zilunciphise ngokupheleleyo unyango olubiza imali eninzi kubantu abadala (umz., umlinganiselo wobudala wokufakelwa kwamalungu omzimba okanye ukunyanyekelwa kakhulu). I-trandoff iphakathi kokunyusela iminyaka yobomi egciniweyo (abaguli abaselula) nokuhlonela ixabiso elilinganayo lobomi babo bonke. Izigqibo ezinjalo azifane zenziwe ngokuphandle ngenxa yokuchana kwezobupolitika.
Ukubaluleka Kokuzibekela Ubomi
Ngexesha le-COVOID-19, imigaqo-nkqubo yesithathu yabela ngokucacileyo imithombo enqabileyo efana nezikhuseli-moya kunye neebhedi ze-ICU. Le mithetho icwangcisiweyo yalindela inzuzo yokusinda, ngokufuthi isusa abantu abadala kunye nabo banento yokusebenza. Imithetho yokuziphatha yokuthengisa i-compoff//inyusa ubomi obuninzi. Ukunyanga umguli ngamnye ngokulinganayo.
Isiphelo
Ukuqonda ukuthengiselana kwenkqubo yezonyango akuyonkqubo yokuzilolonga ephambili; kungundoqo wokulawula okusebenzisekayo, okungokokuziphatha. Ukhetho ngalunye lwenkqubo luphelisa ezinye izinto ezinokwenzeka kwaye lubangela iindleko kwamanye amaqela ngelinye ixesha lunceda abanye. Kubafundisi-mfundo nabafundi, ukwazi ulwimi kunye nokuqiqa kokuthengiselana kunceda ukucacisa okuthe gca nangakumbi ukusetyenziswa kobuntu. Njengoko iinkqubo zempilo zijongene nokunyuka kwamanani, impumelelo yobugcisa, kunye neengcinezelo zobuxhakaxhakaxhakaxhakaxha, amandla okuchaza, ukuchanaba, kunye nokuxokelisa ukuthelekisa. Injongo ayikokuphelisa ukurhweba ngaphandle kwe-interganizer-nters . Kodwa ukukwenza kucace gca kangangokuba banokuphikisana ngokunyanisekileyo, kwaye bagqibe.