Ingxoxo emalunga neenkqubo zonyango eUnited States idla ngokusekelwe kulwahlulo lwamandla phakathi koorhulumente borhulumente borhulumente norhulumente. Ukuqonda indlela ezi migaqo ezibunjwe ngayo kubalulekile kubafundisi nakubafundi ekuqondeni ubunkimbinkimbi bendlela yokunyamekela impilo yaseMerika. Eli nqaku linikela uhlalutyo olubanzi lwemigaqo yezonyango yesizwe neyonyango, ukuhlolisisa imigaqo engokwasemthethweni, imali, kunye neziphumo ezisebenzisekayo kubantu ngabanye kunye nabantu. Ngokuhlolisisa iinkqubo ezithile, imizekelo engokomthetho, nemiphulo yokwenene, sizimisele ukucacisa ukuba ngubani ogqibele oko kulungileyo kuwe nendlela okwenziwe ngayo izigqibo.

Ingqwalasela yeGunya loMgaqo-nkqubo woNcedo lwezeMpilo kwiU.S.

Iinkqubo zolawulo lwempilo zisemgaqo-siseko wezigqibo nezenzo ezithathwa ngurhulumente ukuze aphumeze iziphumo ezithile zempilo. E-U.S., le nkqubo isenokubekwa kumgangatho wesizwe nowaseburhulumenteni, ngamnye one-inshorensi kunye nempembelelo yakhe. Isiseko salo candelo sise-U.S.: urhulumente wesizwe ufumana igunya elinxulumene nezempilo kumazwe afana noCelause (ulawulo lwamazwe ahlukeneyo, kuquka i-inshorensi) kunye ne-Classisten kunye ne-Medicareas. Ngelinye ixesha, urhulumente oMlawuli weSizwe ugcina onke amandla angagunya eligunya-orhulumente kumazwe, kuquka igunya elibanzi elinjenge-e-e-atmastical, umgaqo-orsmession, nomgaqo-omatila e-omatila.

Ngokwembali, umlinganiselo uye watshintsha ngokuhamba kwexesha. Kwinkulungwane ye-19 kunye nasekuqaleni kweye-20, amaphondo ayengabaqhubi abaphambili bezonyango loluntu kunye nomthetho wezonyango. Indima karhulumente yanda ngokuphawulekayo ngokudalwa kweMedicare kunye neMedicaid ngo1965, kwakhona ngoMthetho weAffordable Care (ACA) ngo-2010. Namhlanje, inkqubo yonyango lwase-U.S. isebenza njengentlanganisela yemilinganiselo karhulumente, ingxube-lulo, kunye nenxaxheba yabucala. Esi sakhiwo solawulo sivelisa amathuba omabini okuphuculwa nokubeka ubomi obusemngciphekweni.

Imigaqo-nkqubo yezempilo yoManyano-ntle:

Urhulumente wesizwe udlala indima ephambili ekuxhaseni ukunyamekela impilo yabemi abathile nokumisela imigaqo ebanzi yolawulo. Imigaqo-nkqubo engundoqo karhulumente iquka:

i-Medicare

IMedicare yinkqubo karhulumente elawulwa ngamaZiko eMedicare & iMedicaid Services (CMS) enika inkcazo yempilo kubantu abaneminyaka engama-65 nangaphezulu, kunye nabantu abathile abancinane abakhubazekileyo (umz., abo baneEnd-State Renal Disease). Ixhaswa ngemali ngerhafu yerhafu, irhafu nemali-mali jikelele. IMedicaracide iquka icandelo lecandelo A (i-inshorensivery), icandelo B (i-inshorensidensidensi (imali ye-yamayeza), icandelo (intenxanxalazeli), kunye neMedicareave (Intelligence) enikelwa ziindleko zabucala zabucala zemali zabucala. I-Rhoversitentinel icwangcisi ye-a ye-R3202, i-R32, kunye nemali esetyenziswa nguMvundla ye-R32,42, kunye ne-R32,000, kunye ne-iirfuyonke

I-Medicaid

IMedicaid yinkqubo edityanisiweyo yesizwe esincedisana namaxabiso ezonyango kubantu abafumana ingeniso elinganiselweyo kunye nezibonelelo. Urhulumente worhulumente umisela imfuneko encinane kunye nemfuno yokugquma kwaye unikela ngemali engqinelanayo (isuka kuma-50% ukuya kuma-78% eendleko, kuxhomekeke kwisigqibo se-ofekta yorhulumente semali nganye). Amazwe alawula inkqubo kwaye anokukhetha ukugubungela abemi kunye neenkonzo ezingezozezezezonyango. I-ACALED ilawula ukuba i-Mdicaid yandise bonke abantu abadala ngaphantsi komlinganiselo we-888% wobuhlwempuma, kodwa iNkundla engu-2012 ye-2012 yesigqibo se-FT:0] i-Intelligement ye-Intelligence. I-Sebell ingenza ulwando oluthe hle. Njengamatshi 2025, 41, kunye nezithithi ze-Mdilidi ye-M

ISebe linika inkxaso-mali

I-ACA yamiselwa ngo-2010, yeyona inguqu yonyango olubanzi ukususela eMedicare. Iinkqubo zayo ezingundoqo ziquka: (1) ukwenziwa kwentengiso ye-inshorensi yempilo (ukutshintshwa) apho abantu kunye namashishini amancinane benokuthenga iiplani ezifanelekileyo; (2) ukunyuswa kwerhafu kunye nokuncitshiswa kwexabiso lerhafu kunye nokuncitshiswa kwexabiso lemali ukuze kungabi namali; (3) iingenelo zempilo eziyimfuneko (EHB) ezichaza iindidi ezilishumi zenkcitho; (4) ukuvalwa kwemiqathango yangaphambili yemeko ekhoyo; kunye (5) nomthetho ngamnye nomqeshi (isigunya ngasinye sasuswa ngokunempumelelo ngowama-2019). I-A yaseka kwakhona iziko lokhuseleko lweMedictarection and Mdiction Invition (MMI) ukuvavanya nokuhambisa iimodeli. Igunya eliphakathi koomatila phantsi kolawulo lwe-AA lisebenza ngooomand

Ezinye iinkqubo zempilo zomanyano kunye nezongxamiseko

  • Inkqubo yeInshorensi yezempilo yaBantwana (CHIP): Inkqubo edityanisiweyo enika impesa kubantwana kwiintsapho ezifumana ingeniso ephezulu kakhulu ukuba bafanelekele iMedicaid kodwa isezantsi kakhulu ukuba ingayihlawula i-inshorensi yabucala. I-CHAP inenani eliphezulu lesizwe elingqinelanayo kunye nomba obanzi wemeko.
  • IVeterans Health Administration (VHA): Inkqubo karhulumente epheleleyo enika inkathalo engqalileyo kumagqala omkhosi afanelekileyo adlula kumaziko ezamayeza eVA.
  • Inkonzo yempilo yeIndian (IHS): Umbutho wezwe okwiSebe lezempilo nezoluntu onika iinkonzo zempilo kumaIndiya aseMerika namaIndiya ase-Alaska amaIndiya amaIndiya.
  • [[UMTL:0] Isidlo kunye noLawulo lweziyobisi (FDA): ibuyisela ukhuseleko, ukusebenza, nokuphawulwa kweziyobisi, izixhobo zonyango, kunye nemichiza yokugoma.
  • Abathathi-nxaxheba boLawulo lwezifo nothintelo (CDC): ikhokelela ekujongweni kwempilo kawonke-wonke, ukuqhambuka, kunye nemigudu yonyuselo lwezempilo, idla ngokuba kunxibelelwano norhulumente kunye namasebe ezempilo asekuhlaleni.

Le ntlangano yorhulumente imisela imilinganiselo yesizwe, kodwa ukuphumelela kwayo ngokufuthi kuxhomekeke kwintsebenziswano nozalisekiso lukarhulumente.

IPolicies yezonyango yeSizwe: Imisebenzi Yolawulo - melo

Kudala kuchazwa irejista njenge "amashishini edemokhrasi" nguJaji Louis Brandeis, ezama iindlela ezahlukeneyo kwimigaqo yempilo. Olu vavanyo lungakhokelela kwizahluka-hlukeneyo eziphawulekayo kwintlawulo, amaxabiso, nomgangatho kulo lonke ilizwe. Iindawo ezingundoqo zomgangatho karhulumente ziquka:

Ulwando LwaseMedicaid Neentaka

Isigqibo sokwandisa iMedicaid mhlawumbi yeyona nkqubo yombuso elandela ilandela inkqubo yonyango phantsi kwe-ACA. Amazwe awandisayo uMdicaid abona ukuncitshiswa okuphawulekayo kwinani elingakhange likhanyisweyo ngezantsi. Umzekelo, isantya seArkansas sehla ukusuka ku 22.5% ku-2013 ukuya ku-7. 0% ku-2016. Iindawo ezingeyo-pansiliyo njengeTexas, iFlorida, kunye neGeorgia ziyaqhubeka zinemigangatho engakhutshelwanga ngaphezulu kwe12%. Kwandiswa, namazwe angasebenzisa icandelo 1115 ukuvavanya ezinye iintengiso okanye iimodeli zokuhambisa. Umzekelo, isiCennainaian's Isicwangciso sokuHlaba 2.0. Imali ephambili ifuna iminikelo kwaye ibandakanya iingxelo zempilo, ngexa uArkans isebenzisa imodensiundiswa yezo zorhwebo yangasese apho ulwamkelo lwabucala lwentengiso lwanga yabantu.

Iintlobo zeinshorensi zempilo yeRhulumente

IACA yanika indlela yokusebenzisa ezona zindawo zayo, ixhomekeke kwiqonga lengingqi lesizwe (HealthCare.gov), okanye isebenza utshintshiswano olusekelwe kurhulumente kwiqonga lezwe (SBM-FP). Ngokwango2025, amaphondo ali-19 asebenzisa ngokupheleleyo ne-DC esekelwe kurhulumente, enikela ngemiqathango exhotyiweyo nesebenzayo. ICalifornia igqunywe ngokungqongqo, umzekelo, i-ingxoxo kunye nabafaki-mali ukugcina ingeniso ephantsi kwaye igcine iqula elizinzileyo. I-RGamesssss iyakwazi ukutshintsha iinkqubo (usebenzisa i-1332222) ukuthelekelela.

Ulawulo olunikezelweyo kunye nomlinganiselo woqheliselo

Amazwe alawula iingcali zonyango ngeebhodi ezimisela imfundo, uqeqesho, kunye nomgangatho wezoqheliselo. Oku kuyahluka kakhulu ngokwemeko kunonopheli (NPs), agqirha (amaPA), kunye nabanye abasebenzi abaphambili. Umzekelo, amaphondo angama-25 kunye ne-DC avumela iiNP ukuba ziqhelise ngaphandle kolawulo lwagqirha, ngoxa ezinye zifuna izivumelwano ezisebenzisanayo. Le mithetho ichaphazela ukufikelela konobangela wokunyamekela abaguli, ingakumbi kwiindawo zasemaphandleni. Ngokunjalo, ichaza ukuba kulawulwa imithetho yesatifiketi-soluncedo (CON) elawulayo nokuba izibhedlele zinokuyandisa okanye zifumana izixhobo ezintsha; amanye amaphondo akhuthaza i-Conicconel, ngoxa eminye imithetho ekhuthaza ukukhuphisana, ngoxa eminye ifuna ukusetyenziswa.

Amanyathelo Okuqalisa Empilo Kawonke - wonke

Amazwe anegunya eliphangaleleyo lokuzalisekisa amaphulo ezempilo kawonke-wonke, ukusuka ekugonyeni icuba ukuya kuthintelo lwecuba. Iinkqubo zeKhalifoniya ezilwa nokutshaya ezinamandla, kuquka irhafu ephezulu nemithetho yomsebenzi engatshayiyo, zifak' isandla ekuncipheni kwexabiso lokutshaya ukusuka kwi-20% kwi1990 ukuya kutsho ku-10% ngo-202020. Ngokuchasene noko, imimandla enezibonelelo zempilo kawonke wonke isenokuphelelwa kugqunywa okanye ukujongwa kwezifo. I-COVOVID-19 ka-19 ibala ibalase oku: kuchaza njengaseNew York neyaseCalifornia eyamisa imiyalelo yokuhlala ezindaweni zokuhlala ezingaphezulu, ngelixa ngeminyaka yoo 1990, ngoxa ezi zingenelwe zinyathelo eliyelele kwizifo ezahlukeneyo kunye nezifo ezibulalayo.

Inkxalabo ePhathiswayo noTshintsho

Inkoliso yezivumelwano zelizwe nemibutho elawulwayo (MCOS) yokuhambisa iinzuzo zeMedicaid, kwaye iyakwazi ukuyila imizekelo ehlawulwayo. IOregon neMassachusetts bezingoovulindlela kwiinkcitho zemali yehlabathi lonke kunye nemibutho yokunyamekela abantu (ACOS) ejongene neMidicaid. Kwakhona ama-United States alawula ukungenelwa kwe-khemikhali kumgangatho we-medicaid, kuquka ukusetyenziswa kweziyobisi kunye nemichiza ethandwayo. Ubuchule bokunxibelelana ne-rebitable rebates kwaye agunyazisa imvume ngaphambili bungatshintsha ngokuphawulekayo ukusetyenziswa kweziyobisi ezigunyaziswayo nokufikelela kumthetho.

Iintsebenziswano Phakathi kwemithetho yoManyano nePhondo: Intsebenziswano Nengxabano

Ulwalamano phakathi kwemigaqo-nkqubo yolawulo lwempilo karhulumente neyorhulumente luntsokothile, lubandakanya zombini intsebenziswano kunye nengxabano. Ngelixesha imithetho karhulumente imisela imilinganiselo encinane, amajelo anobubhetyebhetye bokulungisa iinkqubo zawo ukuhlangabezana neemfuno zasekuhlaleni. Le mpembelelo isoloko ichazwa njenge-"communicationism," kodwa amashumi eminyaka akutshanje aye abona uxinezeleko olukhulayo, ingakumbi kumacala asekuhlaleni, amalungelo okuqhomfa, kunye nakumandla obomi kawonke-wonke.

Intsebenziswano

Kwiimeko ezininzi, oorhulumente besizwe kunye noorhulumente basebenza kunye ukunyusa ukunikezelwa konyango lwempilo. Inkxaso-mali karhulumente ixhasa amanyathelo karhulumente ngenkxaso-mali (umz., iMathernal neChild Health Block Grant, iSithintelo neNgxowa-mali yoLuntu). Amazwe angafaka isicelo sokunika imivuzo (Izibonelelo ze-Mdicaid ezili-1115, iCandelo le-1332 kwiintengiso zonyango) ukuvavanya ubuchule bokufikelela kwii-entengiso. Umzekelo, uMaryland usebenzise umxhasi wesizwe wendlela yokukhupha ingeniso yemali yesikhululo esibhedlele ngonyaka nge-206, ukucutha ukuhla kwemali ngoxa kuphuculwa komgangatho wempilo kawonke. Unxulumano lwandibani noncedo lwezobugcisa ukubonelela iimali ze-SCrediod remictiesting, iinkqubo ze-mozignoteances, kunye neenkqubo zokuthintela ukuthintela izifo ezingokwe-ance.

Ungquzulwano Nocimo

Kuphakama impikiswano xa iinkqubo zikarhulumente zisuka kwimithetho karhulumente okanye xa oorhulumente bezama ukukhetha ngaphandle kwemiyalelo karhulumente abazichasayo. Owona mzekelo ubalaseleyo kukuhlaziywa kweMedicaid okukhankanywe ngaphambili: emva kokuba iNkundla ePhakamileyo igqibile ulwandiso ngokuzenzekelayo, amazwe amaninzi akwiRiphabliki alwamkelwa ukwandisa, kwanangama-90% emali karhulumente. Oku kwadala isithuba sokugquma apho abantu abadala abangaphezu kwisigidi esi-1,5 beyela kwi "umngxuma"",-incuka eziphezulu kakhulu ukwenzela ukuba i-Medicaid yesithethe kodwa iphantsi kakhulu kwe-makentengiso.

Elinye icala lemfazwe libandakanya inkqubo yokuqhomfa. Emva kwesigqibo seDobs v. Jackson’s Health Organization (2022), eyabhukuqa uRoe v. Wade, yafumana phantse onke amagunya okulawula ukuqhomfa. Amanye amazwe, njengoKhalifoniya neNew York, amisela imithetho yokuba abe yi "amazwe aphezulu" kubafuni-kuqhomfa, ngoxa amanye, njengeTexas neMissouri, abekelwe kufuphi noluvolo. Imigudu yeBhiden yokunyanzelisa ukunyanzelisa ukunyanzelisa ukunyanzelisa ukunyanza kwe-Memodytarial Actalal Act (EMTALTAL) kunye neM) ifuna izibhedlele ukubonelela izibhedlele ukuqhoza izigula ezingxamisekileyo kwiimfazwe zonyango, nto leyo eyenzekayo isenza icace ngokuqhubekayo, engathi itheth'ithsus.

Imigudu karhulumente yokulawula amaxabiso eziyobisi ikwabangela ingxabano. Ngo-2023, iColorado neMaryland bamisela imithetho ephezulu yokunyanzelisa imiqathango yemiqathango ethile yeziyobisi ezigunyazi, kodwa amaqela oshishino amayeza amangalela, aphikisa isantya somthetho wemvume karhulumente ne-Unicee Infectance Security Act (ERISA). Iziphumo zezi meko ziza kuchaza imida yamandla karhulumente kwiindleko zeziyobisi.

Impembelelo Kumntu ngamnye: Ukufikelela, Ubunjani, Iindleko Nemiphumo

Icandelo lemithetho yezonyango lichaphazela ngokuphawulekayo ukufikelela kwabantu ekunyamekeleni, ubunjani beenkonzo, kunye noxanduva lwemali. Oothunywashe abalandelayo babonisa indlela inkcaso yemithetho yengingqi yesebe elilawulayo eguqulela ngayo kwiimeko zehlabathi zokwenene:

Ukufumaneka kwi-inshorensi

Iinkqubo zomanyano ezifana neACA zifuna ukwandisa ukufikelela ngenkxaso-mali ehlawulelwayo kunye nolwandiso lweMedicaid, kodwa izigqibo zikarhulumente zingalinganisela okanye zikhulise ezo ziphumo. Umntu ofumana ii-$200,000 ngonyaka uhlala kwimo engeyoyo-kunyuka njenge Texas akanakukufanelekela ukufikelela kwiMedicaid kwaye angawa phantsi komda osezantsi wentengiso (ukuba akakho phantsi komthetho we "entsapho" omiswe ku 2022). Umntu omnye uya kukufanelekela ukuba neMidid kwilizwe elifana neKhalifoni okanye iNew York. Izinga elingenawo amatyala alinganayo phakathi kwabantu abadala abangengoocela-nkulu eMassachusetts ukuya kwi-18%, ngokutsho kwe-[FF: 0]

Ubunjani Benkathalo

Umlinganiselo ophezulu wokunika ingxelo ofana nowokuvulwa kwesibhedlele, izibonisi zokhuseleko zomguli, kunye nokusetyenziswa kwendlela yokukhusela izigulana kuyahluka ngokwemeko, ngokwenxalenye ngenxa yokwahluka komgaqo kunye notyalo-mali lwempilo kawonke-wonke. Amazwe ajongene nolawulo oluphezulu (umz., iimfuno zokunika ingxelo ezinzima zePennsylvania) adla ngokufumana iziphumo ezingcono kwimiqathango yokuzikhusela kwisibhedlele. Noko ke, umgangatho uxhomekeke kwiinkqubo zokuqinisekisa ngemali kunye nokhuphiswano. Amazwe angayangandiswanga kakhulu kwiMidi yeMedicaid ngokufuthi asoloko ebona awona amazinga aphezulu enkathalo angahlawulwanga, anokunyusa uhlalo lwezibhedreji yomgangatho wezibhedrio-o.

Inkcitho

Indleko zonyango zahluka kakhulu kwiimeko. Ngo-2023, umlinganiselo wemali ehlawulwayo yonyaka yeentsapho eziqeshiweyo esuswe ngaphantsi kwe-$200,000 e-Utah ukuya ngaphezu kwee-R2 000 e-Alaska, ngokweTS Imali ye-Commonwealth Fund[. Ukusetyenziswa kwemali eninzi kukwahluka-hlukene ngenxa yemimiselo ye-inshorensi, ukuthengiselwa kwemali yemali, kunye neMidicaid yokuhlawula intengiso. Amazwe alawula ngamandla ukudityaniswa nokudityaniswa (umz., umz., umnyanzeli womsebenzi weKhalifoni ephezulu kunamaxabiso aphantsi kolawulo olujongelwayo.

Iziphumo zempilo

Ulwahluko kwimiqathango yolawulo lwezolawulo luguqulela ngqo kwiziphumo zempilo. Uphando oluzii-2020 kwi- Affairs lufumanise ukuba phakathi ko-2013 no-2017, iMidicaid yamazwe afumana ulwandiso oluphezulu lwemiqathango yerhafu, i-4.5% ebangela ukufa kwabantu xa kuthelekiswa namazwe angaphangalelwanga- mpawu, nempumelelo enkulu phakathi kwabantu abadala kunye nongengobamhlophe. Ngokunjalo, ichaza ngemigaqo enamandla yokulawula icuba (umz. g., imithetho ebanzi yerhafu, imida ekhululekileyo ekhululekileyo ekhululekileyo) isezantsi yeziphumo zomhlazazo womhlaza nomphunga wentliziyo. Unyaka wokuzalwa kuyahluka ngeminyaka esixhenxe phakathi kwamazwe (Msippi.646.644) kugcino-data 209, i-data olubonisa ulawulo lwe-CD, kunye nemeko lwezentlalo lwezentlalo-mi, kunye nezo lwemeko yezomi.

Uqukumbela: Ukugawulwa komgaqo-nkqubo weSizwe weSizwe wezempilo

Ukudlala phakathi kwemigaqo-nkqubo yolawulo lwempilo yorhulumente norhulumente asiyonkxalabo nje yemfundo − ilolonga ngqo impilo kunye nempilo entle yemali yeMerika nganye. Iinkqubo zomanyano olufana neMedicare, iMedicaid, kunye neACA zinyuse ukhupho kunye nemigangatho yesizwe, kodwa amaphondo agcina izixhobo ezinamandla zokuyila kwaye maxa wambi acuthe olo sukelo. Isiphumo sisixokelelwano somsebenzi weziko lwezikhonkwane apho ikhowudi yezip isoloko imisela ubunjani kunye nokukwazi ukufikelela kwenkathalo yomntu.

Kubafundisi-mfundo, ukuqonda oku kubalulekile ekufundiseni abafundi ngokuganana kwezentlalo, uhlalutyo, iziphumo zokwenene zehlabathi lemibutho yolawulo. Ngokufunda indlela intsebenziswano yesizwe norhulumente edlalwa ngayo kwiindawo ezithile ezikhethekileyo .-Medicaid, iintengiso ze-inshorensi, inkcubeko yeziyobisi, iingxaki zempilo kawonke wonke, zinokuba luxabiso oluthe shwaka-gqaba-gqaba-gqaba ngezithembiso kunye nemiqobo yemeko yesizwe saseMelika. Njengoko uhlanga luqhubeka luphikisana ngekamva lenkcubeko yempilo, umbuzo womntu ogqiba oko kungcono kuwe ngentliziyo yencoko. Ngokufundisa abantu banokuxhasa iimeko zoluntu ezinxulumene nezithuba ezikufuphi, zinciphise iindleko, ziphucul nokuphucula impilo entle kuwo onke amazwe.

Kufundo olubhekele phaya, bona umsebenzi we [[FLT: 1] we Medicare & Iinkonzo ze Medicaid kulawulo lwenkqubo yequmrhu kunye nokhetho lwesizwe, kunye Kaiser Family Foundation [[FLT:]] kugcino-lwazi lwendlela yempilo yomgangatho wezwe.