Inkulumo - mpikiswano ephathelene nezinqubo zokunakekela impilo eUnited States ivame ukugxila ekuhlukaniseni amandla phakathi kohulumeni bezwe nohulumeni. Ukuqonda indlela lezizimiso ezibunjwe ngayo kubalulekile kokubili kubafundisi nakubafundi ekuqondeni ukunkimbinkimbi kwempilo yaseMelika. Lesi sihloko sinikeza ukuhlaziywa okubanzi kwezimiso zezempilo zikahulumeni nezombuso ezinamandla, ukuhlola izimali, kanye nemiphumela ewusizo kubantu ngabanye nemiphakathi. Ngokuhlola izinhlelo ezithile, izenzakalo ezingokomthetho, nemiphumela yangempela, sihlose ukuchaza ukuthi ubani onqumele kahle kakhulu wena nokuthi lezo zinqunywe kanjani.

Ukubukeza kweGunya Lomthetho Wezempilo e - U.S.

Izimiso zokunakekela impilo ziyisimiso sezinqumo nezenzo ohulumeni abazenzayo ukuze bafeze imiphumela ethile yempilo. E-U.S., lezimiso zingahlukaniswa zibe amazinga kahulumeni nombuso, ngalinye elinezinga lalo nethonya. Isisekelo sale ngxenye sise-U.S.: uhulumeni wezwe uthola igunya elihlangene lempilo elivela emagunyeni anjengezentengiselwano zika Claus (izentengiselwano ezilawulayo, kuhlanganise nomshuwalense) kanye nentela ka-Claus (izinhlelo zezentengiselwano zezokuthelisa ezifana neMedicare). Okwamanje, iSimende seSimende sigcina wonke amandla agunya agunyasiwe kuhulumeni ezindaweni, kuhlanganise negunya elikhulu phezu kwezokuphatha izimboni zezempilo, izimaketheki, i-mishuwamunishi, ne-mishuwamure.

Ngokomlando, ukulinganisela kuye kwashintsha ngokuhamba kwesikhathi. Ingxenye enkulu yekhulu le-19 neyasekuqaleni kwekhulu lama-20, izifundazwe zazingabashayeli abayinhloko bezimiso zempilo yomphakathi nezokwelapha. Indima kahulumeni yanda kakhulu ngokudalwa kweMedicare ne-Medicaid ngo-1965, futhi futhi ngomthetho we-Affordable Care Act (ACA) ngo-2010. Namuhla, isimiso sezempilo somphakathi sisebenza njengenhlanganisela yezindinganiso zikahulumeni, ukuvumelana nengxenye yombuso, kanye nokuhileleka kweqembu leqembu lomphakathi. Lesi sakhiwo esilawulayo sidala kokubili amathuba okuthuthukisa nokufaka izingozi ze-ictiveity.

Imithetho Yezempilo Ehlangene: Izindinganiso Zesizwe Nezinhlelo

Uhulumeni kahulumeni ufeza indima evelele ekunakekeleni impilo ngokwezimali kubantu abathile futhi ubeke izindinganiso zokuqondisa ezibanzi. Izimiso zikahulumeni eziyinhloko zihlanganisa:

IMedicare

IMedicare iyisimiso sikahulumeni esilawulwa yiziNkampane zeMedicare & iMedicaid Services (CMS) enikeza abantu abaneminyaka engu-65 nangaphezulu inzuzo yezempilo, kanye nabantu abathile abasebasha abakhubazekile (umz., labo abane - End-Stage Renal Disease). Ixhaswe ngezimali ngentela ekhokhwayo, izimali, izimali nezimali ezivamile. IMedicaracule ihlanganisa iNgxenyana A (umshuwalense), iNgxenyana B (umshuwalensi) i-D (umshuwalempikisano), iNgxelo yezidakamizwa), futhi i-Medicareareve (Inani le-Creagence) enikelwa ngemali eyimfihlo yizingeni elizimele, futhi inzuzo ye-D2 000 (R3,5,5,5,000) ngenani lamandla onyaka kahulumeni ihlela i-D.

IMedicaid

I-Medicaid iwuhlelo oluhlangene nombuso olusiza ngezindleko zezokwelapha kubantu abahola imali elinganiselwe nempahla. Uhulumeni umisa izimfuneko ezilinganiselwe zokuhlanganisa futhi unikele izimali ezihambelanayo (zisukela ku-50% kuya ku- 78% zezindleko, kuye ngemali kahulumeni ngayiphi na inzuzo). Amazwe asebenzisa uhlelo futhi angakhetha ukuhlanganisa izindleko zomphakathi neminyango. I-ACA yasekuqaleni igunyaza ukuhlanganisa i-Medicaid ukuze ihlanganise bonke abantu abadala ngaphansi kuka-88% bezinga lobumpofu obuphakathi, kodwa i-National Courtment’s 2012 kwi-FLT i-Fondment of Independent Busity. Selius v ingenza ukwandiswa. Njengama 2025, 41, nezigodi zika-Mlicnum, kanti i-Mlidmarne-Pridentine i-ne, kanti i-Prid.[netic proversethi ye-gevertivetic proverse.]

UMthetho Wokunakekela Ongafinyeleleki (ACA)

Ngo-2010, i-ACA iyinguquko ebanzi kakhulu yezempilo kusukela eMedicare. Amalungiselelo ayo ayinhloko ahlanganisa: (1) ukwakhiwa kwezimakethe zomshuwalense wezempilo (ukushintsha) abantu namabhizinisi amancane abangathenga ngazo izinhloso ezivamile; (2) ukunyuswa kwezikweleti zentela kanye nokuncishiswa kwezindleko ukuze kungabi namali; (3) izinzuzo ezidingekile zempilo (EHBs) ezichaza izigaba eziyishumi zemali edingekayo; (4) ukuvinjelwa kokukhishwa kwezimo zangaphambi kokuvela; (5) isigwebo somuntu ngamunye nomqashi ngamunye (isigwebo somthetho ngamunye sasuswa ngokuphumelelayo ngo-2019). I-AA yamisa futhi i-CICII (intengo yeze-Medicreare and derntion Invidetion (MMI) ukuze ihlole ukukhokha nokuthwala) ngaphansi kwemibuso ephakathi ye-AAAAA.

Ezinye Izinhlelo Zezempilo Ezingokwenani Nezimo Eziphuthumayo

  • Uhlelo lwezingane lwe-Heal Health Inshuwarence (CHIP): Uhlelo oluhlangene olunikeza imfihlo kubantwana abahlala emikhayeni abathola imali ephakeme kakhulu ukuba bafanelekele iMedicaid kodwa ephansi kakhulu ukuba bakhokhe umshuwalense womuntu siqu. I-CHAP inezinga eliphakeme elihambelanayo nobubanzi bombuso.
  • IVeterans Health Administration (VHA): Isimiso sikahulumeni esiphelele esinikeza ukunakekela okuqondile komakadlelwano bezempi abafanelekayo abadalwe eVA ezikhungweni zezokwelapha.
  • Inkonzo yempilo ye-Indian (IHS): Inhlangano kahulumeni eMnyango wezempilo neNkonzo yoLuntu enikeza amaNdiya aseMelika nama-Alaska oMdabu.
  • Food and Drug Administration (FDA): ihlela ukuphepha, ukusebenza, nokubizwa kwemilaliso, imishini yezokwelapha, kanye nemijovo yokugoma.
  • Izibambo zokulawula nezokuvimbela izifo (CDC): zihola ukuqashelwa kwempilo yomphakathi, ukuqubuka, kanye nemizamo yokuthuthukisa impilo, ngokuvamile ekuxhumaneni neminyango yezempilo yendawo.

Lezinhlangano zikahulumeni zibeka izindinganiso zesizwe, kodwa ukuphumelela kwazo ngokuvamile kuxhomeke ekubambisanani kukahulumeni nasekugcwaliseni imibuso.

Izikhulu Zezempilo ZoMbuso: Izinhlangano Zentando Yeningi

Sekuyisikhathi eside i-odoli bechaza ngokuthi "amasuntswana entando yeningi" nguMahluleli uLouis Brandeis, ezama izindlela ezihlukahlukene ezisemthethweni wezempilo. Lokhu kuhlola kungaholela ekuhlukahlukeni okukhulu ekuhlanganiseni, izindleko, nobungako ezweni lonke. Izindawo eziyinhloko zesimiso sombuso zihlanganisa:

Ukwanda Kwe - Medicaid Nezinhlansi

Isinqumo sokwandisa iMedicaid mhlawumbe yinqubo kahulumeni elandela u- 2016. Izimiso zempilo zezwe ezikhethelwe i-ACA. Amazwe anwetshile uMedicaid abona ukwehla okuphawulekayo emazingeni angahlolwanga [1] ngokwesibonelo, izinga le-Arkansas lehla lisuka ku 22.5% ngo-2013 kuya ku-7% ku-2016. Amazwe angena-pansidis anjenge-Texas, iFlorida, ne-Georgia ayaqhubeka enamanani akhuphukile angaphezulu kwa-12%. Ngisho naphakathi nokwanda, izifunda zingasebenzisa icandelo 1115 ukuhlola noma ukuhambisa ezinye izithombe. Ngokwesibonelo, i-Hendinadina’s Departles Plantic Intenatic Plan 2.0 idinga iminikelo nokugcina izimali, kuyilapho i-Arkansal asebenzisa i-ms amanani azimele lapho izitestnazo ezithentia eziza ethola khona iziteshini zezentengo yezente.

Izindlela Zomshuwalense Wezempilo KaHulumeni

I-ACA yanikeza indlela yokuzithengela, ithembele epulatifomu kahulumeni (HealthCare.gov), noma isebenzise ukuhwebelana okusekelwe kuhulumeni epulatifomu kahulumeni (SBM-FP). Njengango-2025, izifundazwe ezingu-19 ze-DC zisebenzisa ngokugcwele, ezivame ukunikeza izinqumo ezilungiselelwe kahle nezisebenzayo zokuthenga. I-California ifihla iCalifornia, ngokwesibonelo, i-ingxoxo ne-inshuwashishi egcina intengo eziphansi futhi igcine itheku elizinzile. Izivumelwano zazo ziyakwazi kakhulu ukubuyisela izinhlelo (ngokusebenzisa i-133222) ekuthengeni imali encishisiwe. Ngokungafaniyo, ukuthi i-senendlela ehlelekile yokulawula nokuzishintshanisa izinhlelo ezisemfashinini.

Usizo Nezinga Lomkhuba

I-odoli abalawula izinkampani zezempilo eziqondisa izinqumo zemfundo, ukuqeqesha, nokusebenza kwezinga. Lokhu kuhluka kakhulu ngokwesimo sasebemzanyana (NPs), odokotela (amaPA), kanye nabanye abaqashi abaphambili. Ngokwesibonelo, amazwe angu-25 ne-DC avumela i-NP ukuba iqhubeke ngaphandle kobuqondisi bukadokotela, kuyilapho ezinye zidinga izivumelwano ezihambelanayo. Lemithetho ithinta ngokuqondile ukufinyelela ekunakekeleni okuyinhloko, ikakhulukazi ezindaweni zasemaphandleni. Ngokufanayo, iphawula ukuthi ilawula imithetho yesatifiketi-so-odingeka (CON) elawulayo ukuthi izibhedlela zingayandisa noma zithola imishini emisha; ezinye izigungu-NP ziphinde zisebenzise imithetho emisha yokukhuthaza ukuncintisana, kuyilapho ezinye ifuna ukuphatha izindleko.

Izinyathelo Zokuqala Empilweni Yomphakathi

Amazwe anegunya elikhulu lokusebenzisa imikhankaso yezempilo yomphakathi, kusukela ekulawuleni ugwayi kuya ekugonyeni. Izimiso zeCalifornia ezinamandla zokulwa nokubhema, kuhlanganise nentela ephakeme nemithetho yomsebenzi engenantuthu, zanezela ekuncipheni kwamazinga okubhema kusukela ku-20% kuma 1990 kuya ku-10% ngo-202020. Ngokuphikisanayo, izifundazwe ezinezisekelo zezempilo ezibuthakathaka zingase ziphelelwe amandla okugoma noma ukuhlola izifo. Umqedazwelo wesifo se-COVIID-19 uqokomisa lokhu kungafani: kuphawula njengaseNew York nase California ezindaweni zokuhlala i-California lapho i-indesheni ithathe izinyathelo ezithathela i-delela ngokwengeziwe. Lokhu kungena kwezentengo zempilo yomphakathi kungaholela ekuguleni okuhlukene okuthathela noma ekubulaleni izifo.

Ukunakekelwa KwamaMedicaid Nokubhajwa Kwawo

Izivumelwano zemibuso eminingi nezinhlangano eziphethwe (MCOS) zokuletha izinzuzo ze-Medicaid, futhi iyakwazi ukuklama amasampula akhokhelwayo. I-Oregon ne-Massachusetts baye baba amaphayona embulungeni yonke futhi basebenzisa izinhlangano zokunakekela (ACO) ezizolandisa abantu baseMedicaid. I-United States futhi ilawula ukulawulwa kwemithi ephakathi kwe-Medicaid, kuhlanganise nokusetshenziswa kwezidakamizwa ezisetshenziswayo kanye nezinhlu ezithandwayo zezidakamizwa. Ikhono lokuxoxa ngemidayisa i-rebital rebates futhi ifaka imvume ngaphambi kokuba ivunyelwe kungashintsha kakhulu ukusetshenziswa kwemilaliso yezidakamizwa nokutholakala kwezidakamizwa.

Ukuhlangana Phakathi Kwemithetho Kahulumeni NoMbuso: Ukubambisana Nengxabano

Ubuhlobo phakathi kwezimiso zombuso zosizo lwempilo nombuso buyinkimbinkimbi, buhilela kokubili ukubambisana nokuxabana. Nakuba imithetho kahulumeni ibeka izindinganiso ezilinganiselwe, izifundazwe ziyakwazi ukuvumelanisa izinhlelo zazo ukuze zihlangane nezidingo zendawo. Lokhu kuvame ukuchazwa ngokuthi "umbuso womphakathi ohlangeneyo," kodwa amashumi eminyaka amuva nje kuye kwaba nokwanda kwezingxabano, ikakhulukazi ezizungezeni ze-ACA, amalungelo okukhipha isisu, kanye nasemandleni empilo yomphakathi aphuthumayo.

Ukubambisana

Ezimweni eziningi, ohulumeni bamazwe nohulumeni basebenza ndawonye ekuthuthukiseni ukunikezelwa kwempilo. Izimali zesifundazwe zisekela imizamo kahulumeni yokuhlola ukufinyelela izimali ngezipho (umz., iMaternal neChild Health Block Grant, iPrevention and Public Health Fund). I-United States ingafaka isicelo sokufaka i-rapiver (I-Simedia 1115, i-Requement 1332 ye-ACAID yezenterry) ekuhloleni ukufinyelela kolwazi olusha. Ngokwesibonelo, uMaryland uye wasebenzisa umxhaphazi wezeli kahulumeni ukuze asebenzise zonke izilinganiso zemali zesibhedlela ezikhokha isibhedlela eziphazamisa ukukhula kwaminyaka yonke nge-206, ukuncitshiswa kokuthuthukisa izinga. Ubuhlobo bunwebela empilweni yomphakathi: iCDC inikeza ukuxhasa nokusiza kwezentengo yobuchwepheshe yezo ezimo zezifo ezisezingeni, izinhlelo ze-Elchizincreactic, izinhlelo zokuvimbela zezifo ezilungiselelwe.

Ukulwa Nokwehluleka

Izimpi ziphakama lapho izimiso zikahulumeni zisuka ezimisweni zikahulumeni noma lapho imibuso izama ukukhipha iziyalezo zikahulumeni eziziphikisayo. Isibonelo esivelele kakhulu ukunwebeka kwe-Medicaid okushiwo ngaphambili yi-prigit last: ngemva kokuba iNkantolo Ephakeme inqume ukwanda ngokuzithandela, izifunda eziningi zeRepublican zenqaba ukwandisa, ngisho nangemali exhaswa ngu-90% kahulumeni. Lokhu kwadala igebe lapho abantu abadala abangaphezu kwezigidi ezingu-5 bewela khona e "mgodini we-Medicaid""",[infiks lé ziphakeme kakhulu kakhulu ngenxa yezentengiso yakudala kodwa ziphansi kakhulu ukuba zingangeniselwa izimakengiselwa.

Enye inkundla yempi ihilela ukukhipha isisu. Ngokulandela isinqumo se-Dobbs v. Jackson Women’s Health Organization ngo-2022, eyagumbuqela uRoe v. Wade, yathola cishe imvume ephelele yokulawula ukukhishwa kwesisu. Ezinye izifundazwe, njenge California ne New York, zimise imithetho yokuba zibe "izifundazwe ezihlonzeni eziphuthumayo" zabafuna ukukhishwa kwezisu, kuyilapho ezinye, njengeTexas neMissouri, zafaka cishe uvikelo oluphelele. Imizamo ye-Biden yokuphoqesha i-Amergement Medical Active Act (EMTALY) yokufuna izibhedlela zokunikeza izibhedlela zokukhipha isisu ezimo eziphuthumayo, isholo eziqhubekayo ezibhekeneyo ezingokomthetho ezimpini.

Imizamo kahulumeni yokulawula amanani ezidakamizwa ibangela izingxabano. Ngo-2023, i-Colorado ne-Maryland bamisa imithetho ephakeme ukuze bakhokhe imingcele yemithi ethile egunyaziwe, kodwa amaqembu ezimboni zemithi amangalela, aphikisa izikhawu zesilinganiso semithetho yemvume kahulumeni ne-Unicee Respect of resistem Income Security Act (ERISA). Imiphumela yalezi zimo izochaza imingcele yamandla kahulumeni phezu kwezindleko zezidakamizwa.

Ithonya Kubantu Ngabo: Ukutholakala, Izindleko, Nemiphumela

Ukuhlukaniswa kwesimiso sokunakekela impilo kuthinta kakhulu ukungenela kwabantu ekunakekeleni, izinkonzo, kanye nomthwalo wemali. Izici ezilandelayo zibonisa indlela amandla kahulumeni wezwe aguqula ngayo ukungafani okungokoqobo:

Ukutholakala Komshuwalense

Izimiso ze-Federal njenge-ACA zihloselwe ukwandisa ukufinyelela ngemali ekhokhelwayo kanye nokwanda kwe-Medicaid, kodwa izinqumo zikahulumeni zinganciphisa noma zithuthukise leyomiphumela. Umuntu ohola ama-$200,000 ngonyaka uhlala esifundeni esinganqamuki kakhulu njenge Texas akanakukufanelekela ukumela iMedicaid futhi futhi angawela ngaphansi kwesebhuloho elingaphansi kwentengo yemakethe (uma engakhonjwa "umthetho womkhaya" omiswe ngo-2022). Umuntu ofanayo angafanelekela ukuhlanganisa uMedidid esifundeni esinjengeCalifornia noma eNew York. Izinga elingenayo lingasehla ngesilinganiso esingesingeni esiphansi esingaphezulu kwe-5% se-Massachusetts kuya ku-18% e-Texas, ngokwe-[FFF:]

Imfanelo Yokunakekela

Ama-metric aphambili anjengezilinganiso zokuthola isibhedlela, izikhombisi zokuphepha eziphethwe yiziguli, kanye nokusetshenziswa kokuvikelwa kuyahluka ngokwezwe, ngokwengxenye ngenxa yokungafani kwemithetho yemithetho nokusetshenziswa kwempilo yomphakathi. Izwe elinobubonisi obuphakeme bokunakekela (umz., izimfuneko zokubika ezinzima zePennsylvania) livame ukufinyelela isilinganiso esingcono ekuhlalisweni okungagwenywayo. Nokho, izinga futhi lixhomeke emikhakheni yokufaka imvume yokuqinisekisa nokuncintisana. I-omsmstered ivame ukubona amazinga aphakeme okunakekelwa okungasetshenziswa kakhulu, okungacindezela imali esibhedlela futhi kunciphe imithombo yemali engcono kakhulu.

Izindleko Zokunakekelwa

Izindleko zokunakekela impilo ziyehluka kakhulu ezifundazweni. Ngo-2023, isilinganiso semali ekhokhwa ngonyaka yemikhaya eqashiwe esukela ngaphansi kuka-R220 000 e-Utah kuya ngaphezu kuka-R3 000 e-Alaska, ngokwe- Commonwealth Fund[[. Ukusetshenziswa kwemali echithwayo kuyahluka futhi ngenxa yemithetho kahulumeni yomshuwalense, ukuthengiselana kwezentengiselwano, neMedicaid imbuyiselo. Amazwe alawula ngokulawula ukuhlanganiswa nokuhlanganisa (umz., iminyanzeliso yezentengiselwano eCalifornia igcwele izimakethengiso ezinciphisanayo nentengo ephansi kunamazwi okuyekelelayo.

Imiphumela Yempilo

Ukwehla kwemithetho yezomthetho kuguqula ngokuqondile ukufa kwaba khona emiphumeleni yempilo. Ucwaningo olungokonyaka wama-2020 [ku- Affairs luthole ukuthi phakathi kuka-2013 no-2017, iMidicaid yanda izifunda zezwe ezinenani eliphansi lezentengiselwano zokufa uma ziqhathaniswa nezimo zempilo ezingezona ezengeziwe, nentuthuko enkulu phakathi kwabantu abadala kanye nabamhlophe abangebona abamhlophe. Ngokufanayo, izikhulu zemithetho yokulawula ugwayi (umk., imithetho ephakeme yentela yokukhipha intuthu yentuthu) inciphisa amazinga okufa ngenxa yokuvela komdlavuza wemicu kanye nezifo zenhliziyo. Unyaka wokuzalwa kwezingane ezizalwa kuyahluka ngeminyaka engu-7 phakathi kwezindawo (Msipippi.6646.46) e-Stock ye-Stock 2023, ngaphansi kwemiyadio yezentengo yeze yezentengo yezentengo yezen

Isiphetho: Ukugada i-Federal-State Policy Health

Ukuhlanganiswa kwezimiso zombuso zobudokotela nombuso akuyona nje into ekhathazayo yezemfundo − ithonya ngokuqondile impilo nenhlalakahle engokwezimali yaseMelika yonke. Izinhlelo zeFederal njenge Medicare, Medicaid, ne-ACA ziye zandisa ukuhlanganisa nokubeka izindinganiso zesizwe, kodwa amazwe alondoloza amathuluzi anamandla okuzihlela futhi ngezinye izikhathi alulaze leyo migomo. Umphumela uyisimiso sokulungisa lapho i-zip ekhodi ngokuvamile inquma izinga nokukhokhwana kokunakekela kwawo.

Kubafundisi, ukuqonda lokhu kubalulekile ekufundiseni abafundi ngokuthembisana umphakathi, ukuhlaziya izimiso, nemiphumela yangempela yezwe yezakhiwo ezilawulayo. Ngokufunda indlela ukusebenzelana kwezwe kukahulumeni okudlalwa ngayo ezindaweni ezithile ``Medicaid', izimakethe zomshuwalense, izikhangiso zezidakamizwa, izimo eziphuthumayo zempilo yomphakathi, kungathuthukisa ukwazisa okungaqondakaliyo ngezithembiso nezingozi zombuso waseMelika. Njengoba isizwe siqhubeka siphikisana ngekusasa lezokunakekelwa kwezempilo, umbuzo wokuthi ubani onquma ukuthi yini engcono kakhulu kuwena engxoweni. Izakhamuzi ezifundile zingasekela imithetho ehlanganisa izikhala eziseduze, zinciphise izindleko, futhi zithuthukise impilo.

ukuze uqhubeke ufunda, bheka umsebenzi we- Izinxusela-Mnyango ze-Medicare & Inkonzo ye-Medicaid ekuqondiseni uhlelo nohlelo lwe-stative, kanye Kaiser Family Foundation [[FLT:]] kumnini wesimiso sezwe sempilo.