Utshintsho lwezonyango lukwindawo ephambili yengxoxo yezopolitiko nezentlalo-ntle ehlabathini lonke. Izigqibo ezenziwa ngabamisi-mthetho nabalawuli zibumba ubomi babemi, ziphembelela uqoqosho, kwaye zimisela impilo epheleleyo yabemi. Lulonke utshintsho olucetyiweyo lubandakanya ukurhweba/ukungatshintshi-guquki okungabangela yonke iziphumo ezinqwenelekayo ngexesha elinye. Abenzi bomthetho-nkqubo mabajonge izinto eziphambili eziphikisanayo njengokufikelela, ubunjani, iindleko, iindleko, kunye nokulondolozwa kolawulo lwenkqubo yehlabathi. Ukuqonda ezi zinto zithengwa zikhokelela ekwenzeni izigqibo ezisebenzayo, ezilinganayo, kunye neenkqubo ezihlala zikho. Eli nqaku lihlola inkqubo engundoqo yorhwebo yorhwebo engundoqo elungiselelwe utshintsho lwempilo, ukuvavanyaniswa kwemiqatha.

Ukuqonda Urhwebo Lwenkqubo Kawonke - wonke

Urhwebo lwenkqubo kawonke-wonke lwenzeka xa abenzi benkqubo kufuneka bakhethe phakathi kwezinto eziphambili ezikhuphisanayo. Kutshintsho lonyango, olu rhwebo lungaphembelela ukufikelela, ubunjani, kunye nexabiso lenkathalo. Ukuqaphela ezi ndleko kunceda ekuqwalaseleni ukusebenza kweenguqu ezicetyisiweyo. Itrandoffs azikhange zibonakale zingalunganga ngokwemvelo; kunoko, zimela into yokwenene yokuba ubuncwane /financial, umntu, kunye nentlangano (ukufikelela kumlinganiselo wemali). Isigqibo esinceda iqela elinye okanye injongo yokwamkelelwa sibeka indleko kwenye. Umzekelo, ukunyuso lwandisa urhulumente kunganyusa ukusetyenziswa kwerhafuthelo okanye ukuncitshiswa kwerhafu yemiciso yemicinelo yemali kubaguli abahlawulelwe okanye abathwayo.

Utshintsho Oluphambili Ekunyamekeleni Impilo

  • Umgangatho wokufikelela.
  • Ixabiso vs. Isigqumo
  • Iinketho zabucala
  • Iingenelo zexesha elide
  • Ukulingana vs. Ubuchule

Ngamnye kula manqaku uveza ucelomngeni olukhethekileyo. Ukwandisa ukufikelela kwinkxalabo yempilo kungakhokelela ekulindeni ixesha elide nokuncitshiswa komgangatho wenkathalo. Ngokuchasene noko, ukugxininisa kumgangatho wokufikelela kwabanye abantu. Ukudibanisa ezi zinto kusenokufuna uhlalutyo olucokisekileyo nokukulungela ukulalanisa. Abenzi benkqubo mabakwaqwalasele ukufaneleka kwezopolitiko kunye namaxabiso ebutho labantu abalimeleyo.

Umgangatho wokufikelela.

Ukufikelela kwiinkonzo zonyango lungundoqo wotshintsho. Noko ke, ukufikelela okukhulayo maxa wambi kunokulalanisa nomgangatho wenkathalo. Ukuqonda oku kurhweba kubalulekile kubenzi benkqubo. Ukufikelela kubandakanya ubukho beenkonzo, ukufumaneka kwemali, ukusondelelana kwelizwe, kunye nokufikeleleka kwenkcubeko. Kwelinye icala, ukufaneleka kubandakanya ukuphumelela kwezamayeza, ukhuseleko lomguli, amava omguli, kunye nokuhamba kwexesha.

Ukwanda Okunzima

Xa ufikelelo lubekwa kwindawo yokuqala, kuvela iziphumo eziliqela:

  • Ulwandiso lomlinganiselo womonde kwizibonelelo zonyango, ezinokuphelisa izibonelelo ezikhoyo.
  • [[Ubunzima:0] obunento yokwenza noxinzelelo kubanikezeli bempilo , nto leyo ekhokelela ekudinweni ngamandla nasekunciphiseni ingqalelo kumguli ngamnye.
  • Ulinde amaxesha amadinga, ingakumbi eenkonzo ezingagqibekanga.
  • Ingxaki yokudinwa engqondweni nasemzimbeni phakathi kweengcali zonyango. , enokuphelisa ubunjani.

Ezi zinto zingakhokelela ekuthotyweni komgangatho wokhuseleko. Umzekelo, uphando olupapashwa [ngu- yiNational Institutes of Health lufumanise ukuba umlinganiselo omphezulu womguli ukuya kulwamkelo kumaziko ezempilo oluntu unxulumene nomgangatho ophantsi wokukhusela kunye nolawulo lwezifo ezinganyangekiyo. Noko ke, ulwandiso aluthobeki ngokungenakunqandwa ukuba lukhatshwa lungeniso lwasemsebenzini, ubugcisa, kunye nomanyano lokunyamekela. Amazwe afana nolo Bukumkani buye bakwazi ukwandisa ufikelelo olubanzi olululo ngelixa kusetyenziswa kwi-National Health Service, nangona amaxesha okulinda kuhlala kungumbandela oqhubekayo.

Ngokuchaseneyo, ukugxininisa ngokungqongqo kumgangatho kunokuthintela ukufikelela. Imali ephezulu, ukukhathalelwa okuphezulu okuphezulu kungafumaneka kuphela kwabo banokuyithenga okanye bahlala kufuphi namaziko akhethekileyo. Abenzi-nkqubo kufuneka balinganisele umnqweno wokufikelela okubanzi nemfuneko yokugcina imigangatho ephezulu yenkathalo. Enye indlela kukuzalisekisa iiphawuli zomgangatho webhentshi kunye nembuyekezo yeqhina ukuze kwenziwe, njengokuba kubonwa kwimodeli zexabiso lenkathalo. Enye kukumkhankatho wokufikelela phantsi kwabemi abagciniweyo ngexesha elinye kunye neenkqubo zoqeqesho.

Isifundo Semeko: Isicwangciso Sempilo SeOregon

IsiCwangciso sempilo e-Oregon sandisa inkcaso yeMedicaid kubantu abadala abafumana imali ephantsi kwiminyaka yee-1990. Uhlolisiso lwabonisa ukuba ukukhutshwa kwengxelo kuphucule ukufikelela kwinkathalo kunye nokhuseleko lwemali, kodwa iziphumo zokuqala zabonisa ukuba akukho nkqubela ephawulekayo kwiziphumo zomzimba emva kweminyaka emibini. Oku kubonisa ukurhweba phakathi kokwandisa ufikelelo nokufikelela komgangatho othe kratya phakathi kwe-i-afrejini encinane. Uphando lwamaxesha amaninzi kamva lwacebisa iingenelo zempilo yengqondo kunye nenkcitho eyintlekele, ukugxininisa imfuneko yokuqwalasela zombini okwexeshana kunye nomgangatho omde.

Ixabiso vs. Isigqumo

Enye inkcitho ebalulekileyo ekuphuculeni unyango lwempilo iphakathi kwendleko kunye nokukhutshwa kwengxelo yezonyango. Ukunyuswa kwengxelo yezonyango kudla ngokufuna inkxaso-mali engakumbi, enokunyusa iindleko zabahlawuleli kunye norhulumente. Kwelinye icala, imigudu yokuqulatha iindleko ibandakanya ukulinganisela inkcitho, ukunyusa ii-asethi ezingenakufikeleleka, okanye ukuxinana kwemibutho yokubonelela. Oku kusesona sikhululo sengxoxo yonyango, ukusuka kumthetho weAffordcable Care eUnited States ukuya kwizicelo zenkcubeko yempilo kwihlabathi lonke eKhanada naseYurophu.

Amanyathelo Okusebenzisa Imali Ezonyango

Amanyathelo okubonelela ngenkxaso-mali anokuvela kwimithombo eyahlukeneyo:

  • [[UMTL:0] Irhafu eyongezelelekileyo [umzekelo, ukuhlawula irhafu eqengqelekayo okanye ingeniso esetyenziswa ukuxhasa unyuso lwe-inshorensi kawonke-wonke.
  • indawo yokwenene yezibonelelo zohlahlo-lwabiwo-mali ezikhoyo]
  • [[[UMTL:0] Utyalo-mali lwecandelo ]
  • [[Umthetho:0] Imali ebolekiweyo, enokuthi ibangele amatyala exesha elide.

Imithombo nganye yenkxaso-mali inentsingiselo yeenkonzo zikawonke-wonke kunye nozinzo lwezoqoqosho. Abenzi benkqubo kufuneka baqwalasele indlela yokulungelelanisa imfuneko yokugqunywa komthwalo wemali obekwe kubemi. Umzekelo, inkqubo yokuhlawula omnye inganciphisa iindleko zolawulo kwaye iqhubele phambili amaxabiso asezantsi eziyobisi, mhlawumbi inciphise inkcitho yemali yonke. Noko ke, utshintsho lungafuna iirhafu ezintsha nezibalulekileyo kunye nokuphazamiseka kweemarikente ze-inshorensi ezikhoyo. Ngokutsho kwe- arsis eMicimbini yempilo, ukushenxanxanxanxanelwa kwenkqubo yomvuzo enye kwiU.S.

Ingqokelela yexabiso

Oorhulumente kunye nabafaki-mali basebenzisa amaqhinga ahlukahlukeneyo ukuqulatha iindleko ngaphandle kokuncama:

  • [[UMTL:0] Bulk ithenga kunye nengxoxo yexabiso
  • [[UMTL: 0] I-Reference princing]
  • [[UMTL:0] Inkathalo exhotyisiweyo
  • Ixabiso elikwixabiso eliphakathi (umz., iimali ezihlawulwayo, ezinokufumaneka) ukudiza ukusebenzisa okungeyomfuneko.

Noko ke, ixabiso elinzima linokuqulatha imiphumo engemihle: izinto ezinokusetyenziswa kakhulu zingathintela abantu ekufuneni inkathalo efunekayo, nto leyo ekhokelela kwiziphumo zempilo ezimandundu kunye neendleko eziphezulu zexesha elizayo. Ukurhweba phakathi kwendleko nentengiso kufuna ukupheliswa ngononophelo ukukuphepha ukucutha injongo yokubhalisa `ukukhusela impilo nokhuseleko lwemali.

Iinketho zabucala

Ingxoxo phakathi kwendlela zonyango lukawonke-wonke nolwabucala luyinxalenye ephambili yeengxubusho zotshintsho. Indlela nganye ineengenelo ezikhethekileyo nezingeyongenelo, kwaye amazwe amaninzi asebenzisa iinkqubo ezidityanisiweyo nezinezinto ezibucala nezizimeleyo. Intengiso idla ngokubhekiselela ekusebenzeni kakuhle ngokuchasene nokulingana, kunye nokulingana.

Iingenelo zokhathalelo loLuntu

Iinkqubo zonyango loluntu zinganikezela:

  • [[UMTL:0] Inkomfa engahambelaniyo kubo bonke abemi, ukuqinisekisa ukuba akukho namnye olahliweyo inkathalo ngenxa yokungakwazi ukuhlawula.
  • Ixabiso elipheleleyo lonyango lwempilo kulawulo olusembindini kunye namandla okucebisana.
  • Amaxabiso aqingqiweyo kumayeza neenkonzo, ngokufuthi kufunyanwe iindleko zeyunithi eziphantsi xa zithelekiswa neemarike zabucala.

Noko ke, iinkqubo zikawonke-wonke zisenokujamelana nocelomngeni olufana nokunqongophala kwemali, ukusetyenziswa kwemali, nokukhethwa komguli okulinganiselweyo. Ixesha lokulinda iinkqubo zokunyulwa linokuba lide, kwaye ukuhlaziywa kusenokucotha ngenxa yokungaqingqwa kwemali kunye nokunqongophala kwezizathu zokuthengiswa.

Iingenelo Zonyango Lwabucala

Iinkqubo zonyango lwabucala zinganika:

  • Ukhetho olukhulu kubaguli malunga nezinikezeli, unyango, kunye nezicwangciso ze-inshorensi.
  • [[UMTL:0] Amaxesha amafutshane okulinda [ eenkonzo, ingakumbi ezo zine-inshorensi ebanzi okanye amandla okuhlawula ngaphandle kwe-payithi.
  • Iinguqu zolwakhiwo oluphezulu [[FT:1] nomgangatho ophucukileyo oqhutywa lukhuphiswano nentshukumisa yengeniso.

Noko ke, ezi nkqubo zingakhokelela kulwahlulo ekufikeleleni nasekufikeleleni nasekunyukeni kwamaxabiso abantu ngabanye. Zingaqhekeka, zinyuse ulawulo, ziphucule iinkonzo ezinengeniso ngaphezulu kwempilo yabemi. Umzekelo, iUnited States ichitha malunga ne 8% yenkcitho yempilo iyonke kwiindleko zolawulo, xa kuthelekiswa nezi-2-4% kumazwe anamazwe anenkqubo ezilula zokuhlawula, ngokwesifundo se- i-Commonwealth Fund [

Iimodeli Ezixutyiweyo: Ngaba Zizezona Zilungileyo Kwezo Zombini Iihlabathi?

Amazwe amaninzi, njengeJamani, iNetherlands, neSwitzerland, asebenzisa inkqubo ye-inshorensi yobuqu elawulwayo enolawulo olunamandla lukawonke-wonke. Le mizekelo izama ukudibanisa ukuphumelela nokukhethwa kweemarike zabucala kunye nokulawula intengiso neendleko zeenkqubo zikawonke-wonke. Afuna ukuba ii-inshorensi zingabi yingeniso okanye zilawulwa kakhulu, zifake ingxubusho egunyazisayo, kwaye zisebenzise uhlengahlengiso oluluvo lokukhusela ukuqokelelwa kwabaqeshwa abasempilweni abanempilo. Urhwebo apha luntsonkothile lunganzima: inkqubo exulunyekileyo inokuba nzima ukuphatha kwaye isenokushiya imiqobo yabemi abathile.

Iingenelo zexesha elide

Abenzi benkqubo basoloko bejamelene nengxaki yokufumana iingenelo zexesha elifutshane kunexesha elide. Ulungiso olukhawulezileyo lunganika isiqabu esikhawulezileyo kodwa lungakhokelela kwimiba emikhulu ephantsi kwendlela. Umjikelo wezobupolitika (ngokufuthi iminyaka emibini ukuya kwemine) ukhuthaza izigqibo ezivelisa iziphumo ezibonakalayo phambi konyulo olulandelayo, kwanokuba zigcinele iingxaki zexesha elizayo.

Imizekelo yezicombululo zexeshana elifutshane

Eminye imizekelo yezisombululo zexesha elifutshane iquka:

  • [[UMTL:0] Imali exhasayo inyuswa yeMedicaid okanye izibhedlele zikawonke-wonke ezingathethiyo ngokungenayo i-efficiences.
  • [[UMTL:0] Imilinganiselo yonyango oluthe ngqo , efana nokuhlawula imali enika ipeyinti ngexesha lesifo esibulalayo, ekufuneka iguqulwe kamva.
  • Iinguqu zomgaqo-nkqubo ophilayo, njengolawulo lwexabiso kudidi oluthile lweziyobisi, olunokugqwetha iimarike ngaphandle kokuguqula inkqubo.

Ngoxa la manyathelo enokunciphisa inkxalabo ekhawulezileyo, asenokungacombululeli iingxaki ezikhoyo kwinkqubo yonyango. Ngokomzekelo, ngokuphindaphindiweyo kusetyenziswa izicelo ezongezelelekileyo ukuze abantwana bagcine inkqubo yempilo isebenza ngaphandle kokufumana inkxaso esisigxina ebangela ukungaqiniseki nokungasebenzi kakuhle kolawulo.

Imigudu Yexesha Elide Yotshintsho

Iindlela zexesha elide zingabandakanya:

  • [[UMTL:0] Inkqubo yocoselelo lonyango etshintshayo elungisa kwakhona izikhuthazo, iimodeli zokuhlawula, kunye neenkqubo zokuhambisa.
  • Ungenelelo kunonophelo lokukhusela kunye namanyathelo onyango lukawonke-wonke anciphisa umthwalo wesifo sexesha elizayo kunye nokuchitha imali.
  • [[Umthetho:0] Ukusetyenziswa kwemodeli ezisi sesixhaso semali , njengerhafu enikezelweyo okanye ii-akhawunti zogcino-mali zempilo, ezinokumelana nokuwohloka kwezoqoqosho.
  • [[UMTL:0] Isigaba- esingaphakathi ukunqanda uphazamiseko nokuvumela ixesha lolungiso.

Ezi ndlela zinokukhokelela kwiziphumo eziphucukileyo zempilo kunye nenkqubo yonyango ekwaziyo ukumelana nemeko kwixesha elizayo. Noko ke, zifuna inkalipho yezopolitiko nenkxaso kawonke-wonke eqhubekayo. Iingenelo zisenokungabonwa ngokupheleleyo kangangamashumi eminyaka okanye ngaphezulu, zizenze zibe sengozini yokulahlwa xa kuvela iingxaki ezikhawulezileyo.

Ukulungelelanisa Ixesha

Ukwenziwa kwenkqubo esebenzayo kusoloko kubandakanya ukuxubana kwemilinganiselo emifutshane kunye neyexesha elide. Umzekelo, ngexesha lobhubhani we-COVID-19, oorhulumente banwebe ngokukhawuleza ukugquma kwe-telehealth kunye nemimiselo ethile (ixeshana), ngoxa beqalisa ukuxhasa izibonelelo zoluntu zempilo nophando kwimveliso ye-gamthemin (ixesha elide). Ubuchule bokulungisa buqonda xa kuyimfuneko ukuzinziswa kwexesha elifutshane ukuqinisa inkqubo kunye naxa kunyanzeleka ukutshintsha kwesakhiwo okuza kuhlawula amashumi eminyaka.

Ukulingana vs. Ubuchule

Nangona ingadweliswanga ngokucacileyo kwinqaku lokuqala, ukurhweba phakathi kwe-ective kunye nokusebenza kakuhle kungundoqo ekuhlaziyweni kwempilo. I-quity ibhekisela ekugqibeleleni ekufikeleleni, ekunyangeni, nakwiziphumo ezikumaqela ahlukahlukeneyo abantu. Ukugqibelela kubhekisela ekufumaneni unyuselo oluphezulu lwempilo kwiyunithi nganye yovimba ochithweyo.

Imithetho ejolise ekujoliseni ixhoba elilingana nezixhobo ezixabisa imali eninzi zokuxhasa izibhedlele zokhuseleko, ukubonelela ngenkathalo kubantu abafumana imali ephantsi, okanye ukuhlaziywa kweenkonzo zokutolika ngolwimi oluncinci "ezingalunganga kakuhle kunengxowana yengubo yokungena." Bangafuna iindleko eziphezulu zolawulo kwizixhobo ezijoliswe kuzo, okanye basenokunikezela ngezixhobo kumaqela axabisa kakhulu ukuze ancede. Ngokuchasene noko, iinkqubo zempumelelo njengeenjongo zonyango eziphezulu okanye ukuqinisa izibhedlele zisenokuyingozi ngokungenakuthelekiswa nanto ezibangela abantu abachanakeleyo.

Umzekelo, uphando kwi JAMA lufumanise ukuba ulwandiso lwe-Medicaid luncitshisiwe umahluko weentlanga ekugqunyweni kodwa luneziphumo ezidityanisiweyo kwiziphumo zempilo. Abenzi-nkqubo kufuneka bagqibe ukuba zingakanani impumelelo abakulungeleyo ukuncama ukufikelela usukelo lobuchule, okanye indlela yokuyila iinkqubo ezifikelela kuzo zombini ngokuzifinyeza njengemali elungiselelwe umngcipheko kunye neenkqubo zomsebenzi wezempilo.

Isiphelo

Ukuqonda ukutshintshisana kwemigaqo-nkqubo yoluntu ekuhlaziyweni kwezonyango kubalulekile ekwenzeni inkqubo esebenzayo. Ngokuqaphela ubunkimbini bokufikelela, ubunjani, indleko, intelekelelo, i- eququation, kunye neendawo zexesha, abagcini-zisombululo banokusebenza kwizisombululo ezilungelelanisa izinto eziphambili. Ikamva lotshintsho lezempilo lixhomekeke kwizigqibo zolwazi eziqwalasela ezikhawulezileyo kunye nezizinzileyo. Akukho nkqubo igqibeleleyo yokufumana ungenelo, intengiso, intengiso, kunye nobuncwane bebutho labantu. Abaphathi-mathelisi kufuneka babandakanye nobungqina, baphulaphule amazwi ahlukeneyo, baze bahlale bethobeke imida yemiqathango yayo nayiphi nayiphi na inguquko. Ngokwenjenjalo, bayakwazi ukuqhuba ezi zinto zinzima nokuzinzisa iinkqubo zonyango ezinceda abantu babo kwixa elizayo.