Isisekelo Sokuphathwa Kwempilo KaHulumeni

Ohulumeni bamazwe yibona abaklami abayinhloko bokuthweswa kwezempilo emingceleni yabo, besebenza phakathi kwezimiso eziphansi zikahulumeni kuyilapho benokuhlakanipha okukhulu ngokuhlelwa kwezimiso. Leli lungiselelo, elisekelwe eSichibiyelweni seshumi, lakha indawo yokuhlola engokwemvelo lapho izindlela ezihlukahlukene zokuhlanganisa, izinga, nokulawula izindleko zingahlolwa futhi zifaniswe. Ukuqonda indlela imibuso elawula ngayo izimiso zayo zezempilo ibalulekile kubenzi bemithetho, abaphathi bezokunakekela impilo, nezakhamuzi ezifuna ukubona ukuthi zisebenzani nokuthi yini engasebenzisi.

Isimiso ngasinye sombuso, umbusi, nomnyango wezempilo wezimiso ezibonisa ukusabela okuphuthumayo kwenani labantu bendawo, izinto eziza kuqala kwezombangazwe, namaqiniso ezomnotho. Umphumela yisimiso esihlonipheke kakhulu esiveza imiphumela ehlukene kakhulu ezakhamuzini kuye ngokuthi zihlalaphi. Kusukela ezinqumweni zokwanda ku- ekusabeleni okuphuthumayo, ekukhetheni izinqumo zezempilo zomphakathi ezithinta ukufinyelela, ukukhokha, nokunakekela kwezigidi zamaMelika.

Umsebenzi Ongokomthetho Nomthetho

Ohulumeni bahulumeni bamisa eminye yemithetho elandelwayo ekunakekeleni impilo. Bagunyaza odokotela, abahlengikazi, nochwepheshe bezempilo abahlangene, ukunquma imithetho yezinga lokusebenza, kanye nokulawula izicwangciso zomshuwalense ezithengiselwa ezimakethe zabo. Iminyango yomshuwalense yokuhlola isilinganiso semali ekhokhwayo, ukuphoqelelwa kwezokuvikela abathengi, futhi bengamele ukuxazululwa kwezezimali. Okwamanje, iminyango yezempilo yezwe ilawula ukuhlola izifo, amarekhodi abalulekile, nemithetho yezemvelo. Igunya lokumisa lemithetho isho ukuthi udokotela oyinhloko onakekela izimpahla esebenzela ezweni elithile angasebenza ngaphansi kwemithetho ehlukile kakhulu kunomngane womakhelwane.

Amazwe futhi anamandla okuchaza izinzuzo eziyisisekelo zempilo ngalé kwesitezi sikahulumeni esibekwe yi-Affordal Care Act. Ezinye izifundazwe zigunyaza ukugunyazwa kwemvume yokwelashwa kwenzalo, ukuhlolwa kokuziphatha kwe-autism, noma izinkonzo zempilo yengqondo ezikhulisiwe. Lemiyalo ingandisa ukutholakala kwemali kodwa futhi ikhuphule izindleko ezikhuphukayo, iphoqelela abenzi bemithetho ukuba baqhubeke bethengisa phakathi kokuhlanganisa nokuthenga.

UMose WaseMedicaid: Ukwakhiwa Kokwanda Nesimiso

IMedicaid iwumthombo omkhulu kakhulu wezempilo e-United States, inikeza izingane ezifikayo eziphansi ezingaphezu kwezigidi ezingu-80, abantu abadala, nabantu abadala, nabantu abakhubazekile. Ohulumeni boMbuso basebenzisa uhlelo ngobudlelwane nohulumeni, futhi bajabulela inkululeko enkulu ekunqumeni imikhawulo engakwazi ukuvuleka, amaphakethe azuzisayo, kanye namaholo akhokhelwayo. Lokhu kuvumelana kuveze umsebenzi ohlukene kakhulu ngokuphana nangokufinyelela.

Ukwanda Kwemijovo Njengomngcele Ohlukanisayo

Enye yeziphendu eziphawuleka kakhulu zikahulumeni yalandela isinqumo seNkantolo Ephakeme ngo-2012 esenze i-Medicaid yandisa ngaphansi kwe-Affordal Care Act yezifundazwe ngokuzithandela. Ngasekuqaleni kwe-2025, 41 izifundazwe neWashington, D.C., iye yathola ukwanda, kuyilapho izifundazwe eziyishumi zingakwazanga. Izifunda ezandisiwe zivumela abantu abadala abathola isilinganiso esingu-138 sobumpofu obuphakathi, okumboza izigidi ngaphambili ezawela egejini eliyindilingayo. Izigodi ezithi ezingasakazini le-otanssion, ezigxile eNingizimu nasezingxenyeni zeMidwest, ziye zashiya abantu abadala abaningi abangakhokhiwe ngaphandle kwemali yokukhetha.

Imiphumela ifakazelwe kahle. ukucwaninga okukhishwe eHealth Affairs kuye kwabonisa ngokuphindaphindiwe ukuthi ukwanda kwezwe kunezinga eliphakeme lokulithwa, izindleko zokunakekelwa eziphansi ezingasheshiwe ezibhedlela, nokuthuthukiswa kokuthola izinkonzo ezivimbelayo. Izimo ezingezona ezenkathi ephezulu zinezikweleti zezokwelapha kanye nokuhlala ezigwenywayo phakathi kwemiphakathi ethola imali ephansi. Isinqumo sokunganwetshwa siqhutshwa kakhulu ngenxa yezindleko zikahulumeni, ukuphikisa kwefilosofi ezimisweni zikahulumeni, noma ukukhetha ezinye izindlela zokusetshenziswa komsebenzi kanye nosizo olukhokhelwayo.

Ukuhlukahluka Ezinzuzoni Nasebuqondisweni

Ngaphandle kwesinqumo sokwandisa, kuphawula ukuthi ihluke kakhulu endleleni abahlela ngayo izinhlelo zabo ze-Medicaid. Ezinye izifundazwe, njengeCalifornia ne-New York, zinikeza izinzuzo ezibanzi ezihlanganisa amazinyo, ukubona, ukuzwa, nokusebenzisa ikhono lengqondo kanye nezidakamizwa. Ezinye, kuhlanganise ne-Alabama neMississippi, zinikeza izinzuzo ezilinganiselwe kakhulu ezihlangabezana nezimfuneko ezilinganiselwe zikahulumeni kodwa zivimbela izinkonzo ezinjengokunakekelwa kwamazinyo asebekhulile noma ukwelashwa ngokomzimba.

Isivumelwano sokusebenza kwezindawo zokunakekela siphinde sihlukane. Izivumelwano eziningi nezinhlangano eziphethwe yiwo wonke umuntu ukuze zinikeze izinkonzo ze-Medicaid, zikhokhela inani eliyinani labezemisebenzi. Ezinye zisebenzisa izindleko zemishini ye-operacecensi ngokuqondile, noma zisebenzise izithombe ezixubile. Indlela ngayinye isebenza ngokudayisa ukudayiswa: ukunakekelwa okungathuthukisa ukuhleleka nokukhokhwa kodwa kungavimbela ukuhlelwa kweminyango futhi kubangele imithwalo yokulawula abangeneli. Izwe limelwe futhi likwazi ukuthatha izilinganiso ezivumela ukuzama ukufinyelela izinhlelo ezintsha zempilo, izinhlangano zokunakekela ezikhokhelwa, noma usizo olukhokhelwayo lomqashi okhokhelwayo.

Ukuhola Kwempilo Yomphakathi Nokusabela Ngokuphuthumayo

Ohulumeni boMbuso banomthwalo wemfanelo oyinhloko wokuvikela impilo yabantu babo ngokuvikela izifo, ukukhushulwa kwempilo, nokuzilungiselela okuphuthumayo. Umqedazwe we-COVID-19 waveza imiphumela yokuqonda kukahulumeni, wembula ukuhlukahluka okukhulu ekuhlolweni kwamandla, imikhankaso yokugoma, nezinyathelo zokulinganisela.

Iziphepho Zempilo Ezivimbelayo

Izwe liphethe izinhlelo zokuvimbela izifo ezingamahlalakhona ezihlasela izimbangela eziyinhloko zokufa nokukhubazeka: isifo senhliziyo, umdlavuza, isifo sikashukela, kanye nokuphefumula. Lezi zinyathelo zihlanganisa izinkonzo zokuvimbela ugwayi, imikhankaso yokuvimbela ukukhuluphala, umdlavuza ohlolwa, nezinhlelo zezisebenzi zezempilo zomphakathi. Ukuxhasa kuvela enhlanganiseni yemali enikezwa uhulumeni, ukuphana kwezwe, nokuphana kwezenhlalakahle. Amazwe anezinkonzo zezempilo ezingcono kakhulu ziphumelela ngokuqhubekayo ekuvimbeleni isibhedlela nasekubulaweni kwangaphambi kwesikhathi.

Izinhlelo zikahulumeni ezikhona zihlanganisa iMassachusetts ’ imizamo ebanzi yokulawula ugwayi, ehlanganisa izintela eziphakeme, imithetho ekhululekile kagwayi, kanye nezinkonzo eziqinile zokuthola amazinga okubhema aphansi kakhulu ezweni. I-Colorado ̱ igxile ekuvimbeleni ukukhuluphala kakhulu ngezinguquko ezakhelwe imoto, njengokuxhasa imigwaqo yebhayisekili kanye nabalimi i-̱ izimaketheku, ziye zabonisa imiphumela engathi sína emsebenzini womzimba nokondleka. Lezi zibonelo ziqokomisa indlela ukutshala izinga lokuvimbela uhulumeni ekuvikeleni okungabuyisela ngayo inzuzo enkulu empilweni yabantu.

Ukulawula Ukuphazamiseka Kwempilo Yomphakathi

Ukusabela koMbuso ezimweni eziphuthumayo zempilo kuyahluka ngokwegunya elingokomthetho, ukuhola kwezombangazwe, kanye nekhono lempilo yomphakathi. Phakathi nobhadane lwe-COVOID-19, isho ukuthi njengoVermont noHawaii basungula izinhlelo zobudlelwano zobudlelwano futhi bagcina ezinye zezinga eliphansi kakhulu lokungenwa yizifo nenani lokufa ezweni. Ezinye izifunda, kuhlanganise iFlorida ne-South Dakota, zathatha izindlela zokuyekelela kakhulu ezifaka intuthuko engokomnotho nenkululeko yomuntu, okuphumela ekuthatheni isilinganiso esiphezulu sezifo ezithathelwanayo kodwa futhi futhi kwaveza nezinqumo ezihlukene zentengo yentengo phakathi kwempilo nemiphumela yezomnotho nezomnotho.

Isifo somqedazwe i-opioid sinikeza enye i-lens ekusabeleni kwesifundazwe. Amazwe anjenge-Ohio neWest Virginia, abhekene nenani eliphakeme kakhulu lokufa, aye andisa amathuba okuthola i-naloxone, izinhlelo ezisunguliwe ze-ritine, kanye nezimali ezithe xaxa ekutholeni imithi exubile. Lezi zinyathelo ziye zabangela ukwehla kwamuva kokubulawa kwabantu abasetshenziswa ngokweqile, okubonisa ukuthi isenzo sikahulumeni esihloselweyo singagoba igebese ezinkingeni zempilo zomphakathi ezingalawuleki kakhulu.

Ukuqondisa Izisebenzi Zezempilo

Izisebenzi ezifanele nezinolwazi oluhle kwezempilo zibalulekile kunoma isiphi isimiso sezempilo esisebenzayo. Izwe lisebenzisa inhlanganisela yegunya elilawulayo, ukutshala imfundo, kanye nezisusa zemali ukuze kuxazululwe ukuswelakala okungapheli, ikakhulukazi emaphandleni nasezindaweni zasemaphandleni ezinganakekelwa kahle.

I - licensure, Izinga Lenqubo, Nezinhlanganisela Ze - Interstate

Izimfuneko ze-infire kahulumeni zithinta ngokuqondile ukunikezelwa nokusakazwa kochwepheshe bezokwelapha. Imithetho yokusebenza yezobuchwepheshe inquma ukuthi yiziphi izithako abancelisayo, abasizi, nosokhemisi abangenza ngazo ngokwabo. Izwe elinegunya eligcwele lokusebenza kwasebenceli, kuhlanganise nezifunda-o-2024, libona ukukhula okusheshayo ezindaweni eziyinhloko zokunakekela nokuthola ulwazi olungcono emaphandleni. Imithetho evimbela idinga ukuqondisa bonke abaqeqeshiwe abaqeqeshiwe abasebenza ngokuzisekeli libhekene nezinselele ezinkulu kakhulu zokufinyelela.

I-Interstate Medical Licensure Compact, eyamukelwa yizifundazwe ezingu-39, ilandela inqubo yodokotela ukuba bathole amalayisense ezifundazweni eziningi, ithuthukisa ukukwazi ukufinyelela kwe-telemedicine nokusabela ngenhlekelele. Amaqoqo afanayo akhona kubahlengikazi, abelaphayo, izazi zengqondo, nezinye izimboni. Ukuhlanganyela kulamaqembu kuveza i-stade ̱ isibopho sokusebenza futhi kungaba inzuzo engcono ekutholeni italente yezempilo.

Izinhlelo Zezezimali Nezinsimbi

Izwe lifaka izinhlelo zokukhokha imali ebolekiswayo, izikhokhelo, nezindawo zokuqeqeshela ukukhokha izimali ukuze idolophini likhange abathola iziguli ezindaweni ezidinga kakhulu. I-National Health Service Corps, eqiniswa izinhlelo zesilinganiso sikahulumeni, ibekwa odokotela, amazinyo, kanye nezikhungo zezempilo zengqondo ezindaweni ezibizwa ngokuthi i-Healsalgial Professional Shorta. Amazwe anjenge-Texas nase California aye asebenzisa imali eningi ekuthuthukiseni izinhlelo zokwelapha ngokufundisa izikhungo zezempilo nezokuqeqesha umphakathi, andisa ngokuqondile uphayingidi odokotela abayinhloko.

Ukuqoqwa kwemininingwane yezisebenzi kungomunye umsebenzi obucayi. Iminyango yezempilo yoMbuso inyathelisa imibiko yaminyaka yonke emayelana nokuthengwa kwempahla, izikhala, nezinga lokuzalana kwabantu, ukutshela ukujoyina nokuzinza. Ezinye izifundazwe ziye zasungula amakhomishane asebenza ngezokwelapha ahlanganisa othisha, abaqashi, nabenzi bezimiso ukuze kuhlolwe ukuthi baqeqeshelwe yini nezidingo zomphakathi.

Izimonyo Ezibhakathiwe Nezinga lokuthutha

Ohulumeni boMbuso basebenza ngokuqhubekayo njengezindawo zokucwaninga zokukhokha inguquko nokunakekela. Ngokusebenzisa amandla abo okuthenga emishinini yezempilo yezentengiselwano neyamazwe, kanye negunya labo lokuqondisa izimakethe zomshuwalense, imibiko ingahlola abakhangisi abakhokhela inani elikhulu.

Izinhlangano Zokunakekela Nenkuthalo Esemthethweni

Izifundazwe eziningana ziye zasungula izinhlelo zokunakekela ze-Medicaid ezinomthwalo wokunakekela, eziphethe izinkampani ezinakekela asebezimo ezinakekelayo ezikhokhela ingqikithi yezindleko nezingalo zokunakekela abantu abahlongozwayo. I-Oregoṉ i-Aunted Care Organizations, esungulwe ngo-2012, ihlanganisele ndawonye impilo engokomzimba, ukuziphatha, nezinkonzo zamazinyo ngaphansi kwezinhlangano ezizimele, ukuncishiswa kokusetshenziswa komnyango wesibhedlela nokukhishwa kweminyango esibhedlela kuyilapho ilawula ukukhula kwezindleko. I-Coloradoradovia ̱ i-Constivery Care Coltivation Carence Izinhlangano zesifunda ngokufanayo zifaka impumelelo yesidingo esiphakeme, ukuzuza inani eliphakeme.

Amazwe futhi aqala ukunikeza izifekethiso zokunakekela ezihlangene zenani labantu abanokulinganiselwa kabili i-̵ abantu abafanelekela kokubili iMedicare ne-Medicaid. Izinhlelo zokufaka isiboniso eCalifornia, eMassachusetts, naseMinnesota zisebenzisana ngezimali kuzo zombili izinhlelo ukuze zinikeze i-mthelela ekhudlwana encipheni yabagugile nabakhubazekile. Lezi zimo zinciphisa ukuqhekeka futhi zithuthukise izinga lokuphila kwabantu abanokusetshenziswa kakhulu kwemali empilweni.

Ukuthenga Nokubhapathiza Inguquko Yenani

Amanxusa eMedicaid ezifundazweni kuhlanganise ne-Arkansas, iTennessee, neVermont aye asebenzisa izindlela zokuthenga ezisekelwe emalini ezisekela inzuzo yokubopha ukuze afeze inzuzo yezinga elifanele, okuhlangenwe nakho kweziguli, nezindleko eziphambili. I-Arkansas ̱ i-Healthpency Reconciliation Program, ngokwesibonelo, yashintsha izikweletu eziningi zemali yeMedicaid zasetshenziswa kwezinye izikweletu zemali ezikhokhwa ngeminyaka embalwa, ihlanganisa ukukhokha kwemiphumela ehambisana nemiphumela efana nokubuyisela nokubeletha.

Amasu ezisebenzi zempilo kahulumeni asebenza futhi njengezisekelo zokuhlola ukukhokhwa kwenguquko. I-California Public Grouceeces ’ i-System yoMhlalaphansi ne-Massachusetts & 8817; i-Group Minishuwarence Commissioner iye yasebenzisa izikhokhiso zokukhokha, i-minxanxala eqoqeneyo, ithonya ezentengiselwano nokunikeza ukwaziswa okungathathwa ezinye izifundazwe. Lezi zihlongozo zibonisa ukuthi ohulumeni bakhona abangasebenzisa amandla abo okuthenga ukuze baqhube ushintsho lwesimiso emhlabeni wonke ngaphandle kokufuna umthetho omusha wezwe.

Izinselele Eziqhubekayo Nokuqala Izinto Eziza Kuqala

Naphezu kwentuthuko enkulu, ohulumeni bombuso babhekana nezithiyo ezinkulu ekuqondiseni ukunakekelwa kwempilo kwezakhamuzi zabo.

Umehluko Wendawo Nendawo

Imiphakathi yasemaphandleni kulo lonke izwe ihlushwa ukuvalwa kwesibhedlela, ukuswelakala komphandle, nokulinganiselwa kokunakekelwa okukhethekile. Izibhedlela zasemaphandleni ezingamashumi amane nayisikhombisa ziye zavalwa phakathi kuka-2020 no-2024, okungalingani nokungalingani okuthinta izifundazwe ezingandisanga iMedicaid. I-Telehealth yanda phakathi nobhadane olwanciphisa lezindawo ngokwengxenye, kodwa ukutholakala okubanzi akulingani. Izwe eMountain West nase-Deea entshona libhekene nemiphumela ebanzi kakhulu yempilo yamadolobha nasemaphandleni.

Izigaba zempilo yobuhlanga neyobuzwe nazo ziyahlukahluka kakhulu ngokombuso. Izinga lokufa komama abansundu liphakeme ngokuphindwe kathathu kuya kwezine kunamanani okufa komama abamhlophe esizwe sonke, kodwa igebe likhulu kakhulu ezizweni ezinezimiso ezivimbelayo ze-Medicaid nezinkonzo zokubeletha ezimbalwa ezisekelwe esibhedlela. Amazwe aye afaka izinhlelo ze-doula, ukuqeqeshwa kobandlululo oluphelele kwababezinakekelayo, nokuqoqwa kokwaziswa ngezinhlanga nangobuzwe abonakala ethuthuka ekuncipheni lezizigodi.

Izingcindezi Zokusebenzisa Imali Nokuzisekela

I-Medicaid iyinto eyodwa enkulu kakhulu emalini yombuso, edla amaphesenti angaba ngu-20 engqikithi yemali esetshenziswa ngokwesilinganiso. Phakathi nokuwohloka kwezomnotho, ukubhalisa kwanda ngokuzenzakalela lapho inzuzo yehla, kufaka ukucindezela okwengeziwe kwezimali zikahulumeni. Amazwe kumelwe aphakamise izintela, anciphise imali, anciphise amasheya, anciphise izinzuzo, noma akhiphe iziqiwiso ukuze asekele izinhlelo zawo. Ukuphela kwesimo esiphuthumayo sempilo somphakathi ngo-2023 kwabangela ukuncishwa okukhulu kwezimfuneko eziqhubekayo zemali, okuholela ezigidini zezinhlangano zezokuqeda ukubhalisa nokungafukula izindleko zezombuso.

Izinqubo ezintsha zezimali, njengentela yokunakekela, ukuphatha izintela zokunakekela, nokuthutha kwezezikhundla zikahulumeni, kuvumela imibuso ukuba indise izimali zikahulumeni ezihambisanayo. Nokho, lamacebo avame ukuphikisana futhi abekwe ekuqondiseni kukahulumeni. Ukugcinwa isikhathi eside kuyodinga ukuba amazwe ahlale eqondiswa ekulawuleni izindleko kuyilapho ephishekela izinguquko ezithuthukisa ukuphumelela kwesimiso.

Bheka Phambili: Ikusasa Lobuhlakani Bezempilo BukaHulumeni

Ohulumeni boMbuso bazoqhubeka behlela ukuhlinzwa kwezempilo zaseMelika eminyakeni ezayo. Ukuvumelana okukhona phakathi kwe-social nohulumeni kuvumela ukuhlola okuveza ubufakazi bemisebenzi. Ukudlula kwe-Inflatiation Reduction Act, okuhlanganisa amalungiselelo entengo yemilaliso egunyaziwe kanye nokukhushulelwa kwenani lemali yemali ekhokhwayo ekhokhwayo, kudala amandla amasha amasha adinga ukudlula. Okwamanje, ukusungula ubuchwepheshe obunjengobuhlakani obungokokwenziwa ekuxilolonga nasekuqondiseni, ukukhula kwenani eliqondile lemilaliso yemali ebhayisekile, kanye nokwanda kwenani lenkokhelo lemifanekiso ekhona kuzo zombili izingozi ezikhona kanye nezingozi zezwe labaphathi bezokuthenga nezithengiza ezizokusebenza.

Abenzi bezimiso zikahulumeni bangafunda komunye nomunye ngezinhlangano ezinjenge-National Gurthers Association ne-National Academy for State Health Policy, evumela ukwaziswa okuhlanganyela emikhubeni engcono kakhulu. I-Bipartisan ekuthatheni izinyathelo zokuthatha izinyathelo eziqondene nezempilo yengqondo, ukuhlola ukufa kwabantwana, nokugoma kwezingane kubonisa ukuthi ukusungulwa kwezimiso zikahulumeni kungadlula ukuhlukaniswa. Njengoba isizwe silwisana nokwanda kwasebekhulile, ukudlondlobala kwezifo ezingapheli, nempilo eqhubekayo, ukuvusenelwa kwentando yeningi yeningi, ukuvusethi yentando yeningi ezingeni likahulumeni kuyohlala kunezikhungo zokucwaninga ezidingekayo ukuze kuthuthukiswe.