Table of Contents

Izinqumo zezokunakekela impilo azilula. Zidinga ukulinganisela izindinganiso ezincintisanayo ezinjengokulingana, ukusebenza kahle, izinga, nenkululeko yomuntu ngamunye ngokumelene nemingcele yemali, imisebenzi, nentando yezombangazwe. Kubafundisi nabafundi abafunda isimiso somphakathi, ukuqonda izinqubo ezifuzekayo zibalulekile ekuqondeni ukuthi kungani ngisho nezinguquko ezihloselwe kahle zivame ukudala impikiswano nemiphumela engalindelekile. Lokhu kuhlola okukhulisiwe kuhlola isimo sezimiso zempilo, izibonelo zangempela zezempilo, iziphathisikhundla, izindlela zokuhlola, izindlela zokuhlola, kanye nezici ezingokokuziphatha eziqondisayo eziqondisayo.

Ukuchaza Izindlela Zokuhwebelana Ngesimiso Sempilo

Ukuhweba kwenqubo yokunakekela impilo kuyisimo lapho ukukhetha inkambo eyodwa ngokungenakugwenywa kuhilela ukudela izinzuzo ezazingafinyelelwa ngenye. Lezi zinqumo zenzeka kuzo zonke izinga(ukusukela kumthetho wezwe kuya kumanani emali ezindawo zomphakathi.) Ukucindezeleka okuyinhloko kuwukuthi imithombo yemali ilinganiselwe kuyilapho izidingo zezempilo zingami phakade. Abaphathi-mithetho kumelwe benze ukukhetha okuveza abawini nabahluli phakathi kwemiphakathi, izimboni, nezizukulwane.

Izinga Eliyisisekelo Lokuhwebelana

  • Iqoqo lemali elikhokhwayo: Isambatho esinwetshwayo singandisa imali esetshenziswa umphakathi noma imishuwalense, kuyilapho izinyathelo zokunciphisa izindleko zivame ukunciphisa ukutholakala kwamaqembu angenayo.
  • Ubunjani bs. Ukungasebenzi: Ukulingana okuphezulu, ukunakekela komuntu siqu kudinga isikhathi esengeziwe nemali, okunganciphisa amandla esimiso.
  • Ukulungisa ama-vs. Ukusebenziseka: Ukukhuthaza ukuthuthukisa izidakamizwa ezintsha nomshini kungakhuphula amanani; unqanda amanani kungadambisa i-R&D izisusa.
  • [ Inkokhelo yokukhetha eqoqiwe. Inkokhelo enhle: ihlela izimfuneko zokugoma noma imithetho yokukhokha umshuwalense ilinganisela inkululeko yomuntu siqu ngenxa yempilo yomphakathi.
  • I-Term vs. Izinzuzo ze-Term-refu: Ukunakekela kovimbeleka kuveza imali egciniwe eminyakeni ethile kamuva, kodwa imijikelezo yezombangazwe isekela imiphumela esheshayo.

Izici Eziyinhloko Ezithonya Ukuhweba

Amandla amaningana okwakha nawama - almos athonya indlela ukuhwebelana okutholakala ngayo, okulinganiswa ngayo, nokuxazululwa ngayo kwesimiso sezempilo.

Izinkinga Zokusetshenziswa Kwemali Nezohlelo

Izimiso zezempilo emhlabeni wonke zibhekene nezindleko ezikhuphukayo ezibangelwa amanani asebegugile, imithwalo yezifo engapheli, nobuchwepheshe obubizayo bezokwelapha. Uhulumeni uhlela imali − noma intela noma izindleko zomshuwalense − azinamkhawulo. INhlangano yezentengiselwano Co-aperfection and Development (OECD) iphawula ukuthi imali echithwayo yezempilo engaphezu kwa 9% ye-GDP emazweni angamalungu ngokwesilinganiso, ishiya indawo encane kwezinye izinto eziza kuqala. Abaphathi-mthetho kumelwe banqume ukuthi banganikela malini ezibhedlela, ekunakekeleni impilo yomphakathi, noma ekucwaningeni, ngokuvamile ngokuxhasa indawo ethile.

Inkathi Yezombangazwe Nezinhlangano

Isimo sezombangazwe sinquma ukuthi ikuphi ukuthengiselana okunokwenzeka. E-United States, i-gridlock block ehlukanisayo iye yavala izinguquko ezinkulu njengokukhetha komphakathi noma ukuhlanganisa imbulunga yonke. Ezimisweni zephalamende njenge-United Kingdom, izinguquko zingamiswa ngokushesha kakhulu, kodwa zisekhona ukuphikisa okuvela kuzokuxhumana kwezokwelapha, amaqembu eziguli, nakubezindaba. Izinkolo futhi zisho ukuthi: izinhlelo zikahulumeni zisakaza igunya phakathi kohulumeni wezwe nohulumeni womhlaba wonke, zidala izingqimba zengxoxo nokuhlehla.

Imibono Yomphakathi Nezindinganiso

Amathemba ezakhamuzi ngokunakekela impilo − noma ziwabheka njengelungelo noma njengempahla . Ukuhlola kwe Kaiser Family Foundation kubonisa ngokungaguquki ukuthi amaMelika abeka ukunakekela kwempilo kuqala njengendaba ephambili kodwa angaphikisa ngendima kahulumeni. Umbono womphakathi ungaphoqelela abenzi bemithetho ukuba bagcine izinhlelo zithandwa kodwa zingalawuleki noma bayeke izinyathelo ezibizayo ezibhekwa njengezingahlukaniswa.

Ubufakazi Nokungaqiniseki

Inqubo yempilo kufanele isekelwe kahle ebufakazini, kodwa ubufakazi ngokuvamile abuphelele, bungqubuzana, noma buphuza ukufika. Ngokwesibonelo, imiphumela emide yesimiso sokudlulisela izidakamizwa ezintsha ingathatha iminyaka eminingi ukuze ifezeke. Abenzi bomthetho kumelwe benze ngokungaqiniseki, benze ukuthengiselana ngesisekelo sokwaziswa okungaphelele.

Izibonelo Zezwe Langempela Zezokuhweba Ngezimiso Zezempilo

Izenzakalo eziqondile zicacisa indlela ukuhweba okusebenza ngayo.

Isibonelo 1: Ukuhlanganisa Indawo Yonke Nezikhathi Zokulinda

Amazwe afinyelela cishe ububanzi obuphelele cishe kunyaka wonke — njengase-Canada, e-UK, namazwe amaningi aseYurophu − ngokuvamile amukela izikhathi ezinde zokulinda izinqubo zokukhetha njengendawo yokuthengiselana. I-Canada Institute for Health Information ibika ukuthi imemezelo yokubuyisela inqulu esukela ku-20 kuya ku-30 entweni efundayo. E-US, lapho i-U, lapho imfihlo ingeyomhlaba wonke kodwa izikhathi zimfushane khona kulokhu kufunwa, ukuthenwa kuyashintsha: ukufinyelela kangcono kwabantu abayizigidi ezingu-26 abangazifaki ekukhokheleni (i-Census Bureault). Abenzi bemithetho kumelwe banqume ukuthi yisiphi isigelekelo esikhona esikhona esikhona.

Isibonelo 2: Ukusetshenziswa Kwezidakamizwa Nokubuyiselwa Kwazo

Imizamo yokwehlisa amanani ezidakamizwa − ukuxoxisana, ukudluliswa kwemiqondo, noma ukuthengwa kwemali zokwenza inzuzo yezinkampani zemithi kanye ne-R&D. Ukuhlolwa kwe-2021 kwezempilo kwathola ukuthi ukulawulwa kwentengo eYurophu akuyimigoqo, kodwa imakethe yase-US ilokhu iyisikhungo senzuzo ebaluleke kakhulu. Abenzi bezomthetho kumelwe balinganisele imali esheshayo ezigulini ezisemuva zokwelapha okusha.

Isibonelo 3: Ukwanda Kwe - Teleheath Nemfanelo Yokunakekela

Phakathi nobhadane lwe-COVOID-19, kwaqhuma i-telehealth active. I-Tecoff ihilela ukuvuselelwa nokuvunyelwa (ikakhulukazi iziguli zasemaphandleni) kanye nokukhathazeka ngokunemba kokuhlola, ukuqhubeka kokunakekela, nokuhlukana kwamanani. I-Medicare kanye nezinkampani zezimali zomuntu siqu zikhulula imithetho yokukhokha okwesikhashana, kodwa njengoba abenzi bezimiso becabangela ukwanda okuhlala njalo, kumelwe bahlole izinzuzo zokuhambela cishe ngokumelene nengozi yokusebenzisa ngokweqile nokulahlekelwa isilinganiso.

Isibonelo 4: Impilo Yomphakathi Iyabhekana Nenkululeko Kanye Nomuntu Ngamunye

Phakathi nobhadane lwe-COVID-19, izigunyazo ze-off, izikhundla, izibopho zokuvala amabhayisekili, kanye nezimfuneko zokugoma kwabangela ukuphikisana okukhulu. I-thenaff yayicacile: ukubeka imingcele enqanda ukudluliselwa kwamagciwane (ukuvikela izibhedlela nokusindisa ukuphila) kodwa futhi kwabangela ukulimala okungokomnotho, izinkinga zempilo, nokuphazamisa inkululeko yomuntu siqu. Amazwe ahlukahlukene nemibuso kwaveza imingcele ehlukene, ukungezwani okukhulu.

Indima Yababambi Bezisulu Ekuhwebelaneni Nezikhungo Zokuhwebelana

Isimiso sempilo asiyona into engenalutho, kodwa kuneqembu lababheki, ngalinye elinezinto eziza kuqala.

Izikhulu Nezikhulu Zikahulumeni

Izikhulu zikahulumeni, uhulumeni, nezindawo zidala imithetho, izinhlelo zezimali, futhi zimise imithetho. Ziyalandisa kubavoti futhi ngokuvamile kumelwe zenze izinqumo ezizuzisayo kwezombangazwe, ngisho noma ubufakazi busikisela indlela ehlukile. Ngokwesibonelo, iSishaya-Mkhandlu sase-US siye senqaba ngokuphindaphindiwe isimiso somkhokheli oyedwa naphezu kobufakazi obuvela kwamanye amazwe esibiza imali ephansi kakhulu yokulawula nokuhlanganisa indawo yonke.

Abaphakamisi Bempilo (Odokotela, Abahlengikazi)

Abanikazi bemali bathinteka ngokuqondile ngezinqumo ezinqunyiwe. Bangase bafune ukukhokhelwa imbuyiselo ephakeme, imithwalo ephansi ekhuphukayo, noma ukukhokhelwa okukhulisiwe okuletha iziguli ezikhokhelwa kakhulu. Ubuchwepheshe babo nenzuzo yemali kungangqubuzana nemigomo yokukhokha izindleko. Ngokwesibonelo, ukuqhubekela ekukhokheleni imali esekelwe emandleni (kubopheleleni ukukhokhela iziguli) kungamelana nokumelana nokuncitshiswa kwemali ehlawulwa abaxhasi abafuna ukulahlekelwa yimali.

Amakhampani omshuwalense Namacebo Okunakekela Alawulwa Kahle

Abafaki-mfunda-mfundamathengi bathonya izinqumo zokuhlanganisa, ukuklama i-social neprincing. Bangase bamelane nokukhetha komphakathi okusongela ukuthengwa kwabo. Ngesikhathi esifanayo, banolwazi ekulawuleni izingozi nokusetshenziswa okunganikeza ulwazi ngenqubo. I-metadoff ngokuvamile iphakathi kokuvumela ukuncintisana kwezentengiselwano zezentengiselwano ukuba kuqhube ukuphumelela kanye nezimiso eziqinile ukuze kuvinjelwe imikhuba yokuvimbela ubugebengu.

Iziguli, Imikhaya, Namaqembu Abodwa

Iziguli zenza izinhlangano zokungatholi nzuzo − njenge-American Cancer Society noma i-National Alliance on Mental Illness", i-pash yokuthola ukwelashwa okukhethekile, ukuxhaswa kwezesayensi, noma ukunakekelwa okuthuthukisiwe. Imibono yazo ingaletha ukuphuthuma kokuziphatha kodwa ingasiza futhi ithakazelele imfuno elinganiselwe kunezindawo ezithengwa umphakathi wonke. Ngokwesibonelo, imikhankaso yezidakamizwa ezizintandane ezibiza imali eningi ingaholela ekuthengeni imali eningi kubantu abancane abagulayo, iphambukise imali ezimali ezinkonzweni zempilo zomphakathi.

Izinhlangano Zemithi Nezokwelapha

Imali ekhona embonini i-R&D, ukuhlola kwezempilo, kanye nokuthengisa. Isisusa sabo senzuzo sibangela ukusungulwa kwenzuzo kodwa futhi singaholela ekukhushuleni kwamanani nokuthengisa okunonya. Izindawo ziphakama lapho abenzi bemithetho becabangela ukunciphisa amanani noma izinguquko ezigunyaziwe ezingase zinciphise inzuzo futhi, zingathuthukisa ikusasa.

Izincwadi, Abacwaningi, Neziteshi Zokucabanga

Amaqembu anikeza ubufakazi nokuhlaziya, ngokuvamile aqokomisa ukuhweba okunganakwa ezimpikiswaneni zezombangazwe.

Imisebenzi Yesakhelo Yokukhipha Imfucumfucu

Ukuze bahlole imishini yokuhweba, abasunguli bezimiso nabahlaziyi basebenzisa izindlela eziningana.

Ukuhlaziya Izindleko Ezibizayo (CEA)

ISA isilinganiso semiphumela yempilo (umz., isilinganiso seminyaka yokuphila esilungisiwe, iQALY) ifinyelele izindleko. Isetshenziswa imizimba njenge-UK's Institute for Health and CareExcellence (NICE) ukunquma ukuthi yikuphi ukwelapha kokuxhasa. Abagxeki baphikisa i-CEA bangazenza zibe nenani eliphansi izidingo zabantu abanezifo noma ukukhubazeka okungavamile. Ukuhweba kuphakathi kwe-National Institute for Health and Carececeallence (NICE) phakathi kwendlela yobuchwepheshe nezindinganiso zomphakathi.

Ukuhlaziya izindleko zokulungisa izindleko (CBA)

Imizamo yeCBA yokufaka yonke imiphumela, kuhlanganise nokufa nobuhlungu, ukuze kutholakale inzuzo yezenhlalo. Ibanzi kakhulu kodwa iphikisana nezimiso zempilo. Zimbalwa izimiso zezempilo ezithembele kuyi-CBA kuphela ngoba ukubeka inzuzo ye - dollar ekuphileni kubangela ingxabano.

Ukuhlola izinqumo eziningi ezinezinqubo eziningi (MCDA)

I-MCDA ihlanganisa izilinganiso eziningi − ukulingana, ukwamukelwa, nokuthinteka kwezombangazwe, kanye nomphumela wempilo (ukudlula nje izindleko kanye namaQALY. Ivumela abagcini bezilinganiso ukuba balinganise izindinganiso ngokuhlukile, i-statoffs ngokucacile.

Imisebenzi yeFrame ebizwa ngokuthi iUtilitharian Communists

Izinqubo zezokusebenza zandisa inzuzo yempilo ephelele, engase inciphise labo abanempilo eqinile. Imibono yangaphambi kwayo ibeka kuqala ukuphuma okubi kakhulu, ukwamukela inzuzo ephansi yezimiso zempilo. Izimpikiswano zesimiso sezempilo ngokuvamile zibonisa lokhu kuvumelana okuphikisanayo kwezimiso zokuziphatha.

Izinqubo Eziwusizo Zokuhwebelana Nemikhumbi

Abenzi bemithetho bangasebenzisa izindlela ukuze benze ukuhweba okucace ngokwengeziwe nokunolwazi.

Uhlelo olubonisa ngale

Ukusebenzisa amakomiti obuciko anezici ezihlukahlukene kungadalula izindinganiso ezincintisanayo futhi kuthuthukise ukufaneleka. Ngokwesibonelo, i-Health Evince Review Commission ye-Oregon ihlanganisa abaqeqeshi bezokwelapha, abathengi, nabenzi bezimiso abamisa i-Medicaid ngaphambi kokuba ibekwe.

Ukuhlola Nokuhlola Okunenzuzo

Izinhlelo zohambo kanye nezindawo ezigawuliwe zivumela ukuhlolwa kwezimiso ezisesilinganisweni esincane ngaphambi kokusetshenziswa okugcwele. I-Affordble Care Act ye-Affordble esekelwe kumbuso yamiswa eminyakeni eminingana, yenza ushintsho olusekelwe kwimiphumela yangaphambili.

Ukuhlanganyela Komphakathi Nokungcolisa Ngobuqili

Ukuhlanganyela izakhamuzi ngamahholo asemadolobheni, izingqapheli, nama - stale alulayo kungahlanganisa isimiso nezindinganiso zomphakathi. Lokhu kusiza abenzi bezimiso ukuba baqonde ukuthi yikuphi okuxosha umphakathi ozimisele ukukwamukela.

Ukwakha amathuluzi esinqumo

Amathuluzi anjengezihlahla zesinqumo, ukuhlela izenzakalo, no "ukuhlola ukuphathwa kwempilo kamini" asiza ekuhleleni imiphumela ngaphambi kokuba yenze. Lokhu kuwusizo kakhulu ezimweni ezinezikhawu lapho amaphutha abizayo.

Imishini Yokuhweba Ezimisweni Zezempilo Eziqhathaniswayo

Ukuhlola amazwe ahlukahlukene kwembula indlela ukuhweba okuxazululwa ngayo ezimweni ezihlukile zamasiko nezombangazwe.

Umdleleli Oyedwa (eCanada, eTaiwan)

I-Tradoff: Imali esetshenziswayo esetshenziswayo ebhadla izindleko eziphansi, kodwa izikhathi zokulinda ukunakekelwa kokuvota nokuhileleka okulinganiselwe kwezindawo ezizimele. Iziguli zingafuna ukunakekelwa kwamanye amazwe noma zikhokhele umsebenzi owenziwe ngokushesha.

Isibonelo SaseBismark (eJalimane, eJapane)

Tradoff: Umshuwalense womqashi osekelwe kumsebenzi okhokhelwa kakhulu kodwa oyinkimbinkimbi wesimiso sokukhokha imali eshibhile. Izindleko zilawulwa ngezimiso ezilawulwayo zenkokhelo, kodwa intela ingaba ngaphezulu kuzisebenzi eziholayo imali ephansi.

Umfanekiso Webheveridge (UK, ESpain)

Tradoff: Intela ekhokhelwayo, ukunakekelwa obala kuqinisekisa ukulingana kodwa kubhekana nokungahleleki kwemali kanye nokungahleleki kwezikhathi ezithile. Ukulinda izinhlu zezinqubo ezingaqhumi kuyimpikiswano engapheli.

Ingaphandle lePocket Mode (amazwe amaningi afikayo aphansi)

I - Tradeff: Kuvamile ukuba abantu abampofu bangakwazi ukuthola izinto ezivamile, kodwa abaholi bezokwelapha abavamile futhi bangabi nazo izindleko zezempilo.

Izimiso Ezifanele Zokuhwebelana: Ukukhetha Okunzima Enqubweni Yempilo

Ekugcineni, ukuhweba kuhilela ukucatshangelwa kokuziphatha okungaphezu kokuhlaziywa kobuchwepheshe.

Ukulinganisela Ngentengo. Ukulinganisela Ngokulinda

E-US, ukwabelana ngenani lemali kwenzeka kakhulu ngenani lentengo, phela labo abakwazi ukuthenga umshuwalense noma izindleko zemali ezingekho ngaphandle banakekelwa; labo abangakwazi, ukulibala noma ukuyeka ukwelashwa. ECanada nase-UK, ukunikezwa isilinganiso kwenzeka ngokulinda isikhathi esingu-$nanini, kodwa balinda isikhathi eside kakhulu ngezinkonzo ezithile. Iyiphi indlela engcono kakhulu? Alikho ikhambi lomhlaba wonke; lixhomeke ezindinganisweni zomphakathi ngokuphathelene nokulingana nokulingana nokuzimela.

Ukulinganisa Okusekelwe Ebudaleni

Ezinye izimiso zilinganisela ngokuphelele noma zinciphise isilinganiso sobukhulu bokwelashwa okubizayo kwasebekhulile (umzk., isilinganiso sobukhulu bokufakelwa izitho noma ukunakekelwa okunzima). I-trandoff iphakathi kokundisa iminyaka yokuphila egciniwe (iziguli ezisencane) nokuhlonipha ukubaluleka okufanayo kokuphila. Izinqumo ezinjalo azivamile ukwenziwa obala ngenxa yokuzwela kwezombangazwe.

Ukuzibekela Ukubaluleka Komsebenzi Ozazisayo

Phakathi ne-COVOVAD-19, imithetho yezezimiso yesithathu yahlula ngokucacile imithombo eswele njengemishini engenisa umoya nemibhede ye-ICU. Lemithetho emisiwe yalindela inzuzo yokusinda, ngokuvamile isusa abantu abadala nabane-coorbibitation. I-comestoff (*) esindisa ukuphila kwabantu abaningi. Ilapha isiguli ngasinye ngokulingana.

Isiphetho

Ukuqonda ukuthengiselana kwezimiso zokunakekela impilo akuwona umsuka wokulawula kwezemfundo; kuwukulawula okusebenzayo, okungokokuziphatha. Ukukhetha ngakunye kwenqubo kuvala amathuba okungasetshenziswa futhi kubeke izindleko kwamanye amaqembu kuyilapho kuzuzisa amanye. Kubafundisi nabafundi, ukwazi ulimi nokuhlakanipha kokuthengiselana kuyokwenza ukuba ukuhlaziya okucacile ngokwengeziwe nokungaqondi kahle kwezemfundo yobuntu kukwenze ukuba kubonakale kahle. Njengoba izimiso zokunakekela impilo zibhekene nokushintsha kwenani labantu, intuthuko yezobuchwepheshe, nokucindezela kobuchwepheshe, ikhono lokubona, ukuhluza, nokuxoxisana ngentengo kuhlale kusemqoka. Umgomo awukho ukuqeda ukuhweba ngentengo − okungenakwenzeka zokwenza kucace kakhulu ukuthi zingaphikisana ngokwethembeka futhi zixazululwe kahle.