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Kula da lafiya mai biyan kuɗi ɗaya

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Kula da lafiya mai biyan kuɗi ɗaya
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Ƙaramin ɓangare na Inshorar lafiya da Kula da lafiyar jama'a
Described at URL (mul) Fassara truthout.org…, pnhp.org… da talkingpointsmemo.com…

Kula da lafiya mai biyan kuɗi ɗaya nau'in kula da lafiya ne na gama gari, wanda tsarin gwamnati ɗaya ne ke biyan kuɗin kula da lafiya mai mahimmanci ga dukkan mazauna (don haka "mai biyan kuɗi ɗaya"). [1] [2] Tsarin masu biyan kuɗi ɗaya na iya yin kwangila don ayyukan kiwon lafiya daga ƙungiyoyi masu zaman kansu (kamar yadda yake a Kanada ) ko kuma su mallaki kuma su yi amfani da albarkatun kiwon lafiya da ma'aikata (kamar yadda yake a Burtaniya ). "Mai biyan kuɗi ɗaya" yana bayyana hanyar da ake biyan kula da lafiya ta hanyar hukuma ɗaya, ba hukuma mai zaman kanta ba, ko kuma gaurayen duka biyun. [3] [4]Page Samfuri:TOC limit/styles.css has no content. 

Labari da bayani

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A cikin tsarin kula da lafiya mai biyan kuɗi ɗaya, gwamnati ɗaya ko wata majiya da ta shafi gwamnati tana biyan duk ayyukan kiwon lafiya da aka rufe. Gwamnatoci suna amfani da wannan dabarar don cimma manufofi da dama, ciki har da kiwon lafiya na duniya baki ɗaya, rage nauyin tattalin arziki na kula da lafiya, da kuma inganta sakamakon kiwon lafiya ga jama'a. A cikin 2010, ƙasashen membobin Hukumar Lafiya ta Duniya sun ɗauki kiwon lafiya na duniya baki ɗaya a matsayin manufa; [5] Babban Taron Majalisar Dinkin Duniya ya kuma amince da wannan burin a 2015 a matsayin wani ɓangare na Ajandar Ci Gaba Mai Dorewa ta 2030. [6]

Tsarin kiwon lafiya mai biyan kuɗi ɗaya yana kafa wani yanki na haɗari guda ɗaya, wanda ya ƙunshi dukkan al'ummar yankin yanki ko siyasa. Hakanan yana kafa tsari guda ɗaya na ƙa'idoji don ayyukan da ake bayarwa, ƙimar biyan kuɗi, farashin magunguna, da mafi ƙarancin ƙa'idodi don ayyukan da ake buƙata. [7]i

A ƙasashe masu arziki, kulawar lafiya mai biyan kuɗi ɗaya yawanci tana samuwa ga duk 'yan ƙasa da mazauna doka. Misalan sun haɗa da Hukumar Lafiya ta Ƙasa ta Burtaniya, Medicare ta Ostiraliya, Medicare ta Kanada, Tsarin Lafiya na Ƙasa na Spain, Inshorar Lafiya ta Ƙasa ta Taiwan da Tsarin Lafiya na Ƙasa na Italiya (SSN Servizio Sanitario Nazionale ).

Tarihin kalmar

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An ƙirƙiro kalmar a shekarun 1990 domin bayyana bambance-bambancen da ke tsakanin tsarin kiwon lafiyar Kanada da waɗanda suka haɗa da NHS na Burtaniya. A tsarin kiwon lafiyar Kanada, gwamnati tana biyan hukumomi masu zaman kansu don samar da kiwon lafiya ga mutanen da suka cancanta. A wasu tsare-tsare, gwamnati tana ba da kuɗi kuma tana ba da kulawa. [8]

Yawanci, "kulawa mai biyan kuɗi ɗaya" yana nufin inshorar lafiya da aka bayar a matsayin hidimar jama'a kuma ana bayarwa ga 'yan ƙasa da mazauna doka; yawanci ba ya nufin isar da ayyukan kiwon lafiya. Gwamnati na iya sarrafa asusun kai tsaye ko a matsayin hukuma mallakar gwamnati kuma mai iko da iko. Mai biyan kuɗi ɗaya ya bambanta da sauran hanyoyin samar da kuɗi kamar "mai biyan kuɗi da yawa" (majiyoyi da yawa na jama'a da/ko masu zaman kansu), "mai matakai biyu" (wanda aka ayyana ko dai a matsayin tushen jama'a tare da zaɓin amfani da inshorar masu zaman kansu mai cancanta azaman madadin, ko kuma a matsayin tushen jama'a don kulawar bala'i da inshorar masu zaman kansu ke tallafawa don kulawar lafiya ta gama gari), da "umarnin inshora" (ana buƙatar 'yan ƙasa su sayi inshorar masu zaman kansu wanda ya cika ƙa'idar ƙasa kuma wanda gabaɗaya ake ba da tallafi). Wasu tsarin sun haɗa abubuwan waɗannan hanyoyin samar da kuɗi guda huɗu. [9]

Sabanin yadda ake amfani da kalmar a matsayin tsari, wasu marubuta suna bayyana duk tsarin da gwamnati ke gudanarwa a matsayin "tsarin biyan kuɗi ɗaya", wasu kuma sun bayyana duk wani tsarin kiwon lafiya wanda ke da niyyar rufe dukkan al'umma, kamar tsare-tsaren bayar da takardar shaidar, a matsayin "tsarin biyan kuɗi ɗaya", kodayake waɗannan amfani gabaɗaya ba su cika ƙa'idodin ma'anar kalmar ba.

Yankuna masu tsarin biyan kuɗi ɗaya

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  Kasashe da dama a duniya suna da shirye-shiryen inshorar lafiya na biyan kuɗi ɗaya. Waɗannan shirye-shiryen gabaɗaya suna ba da wani nau'i na kula da lafiya na duniya baki ɗaya, wanda ake aiwatarwa ta hanyoyi daban-daban. A wasu lokuta likitoci suna aiki kuma gwamnati ce ke gudanar da asibitoci, kamar a Burtaniya ko Spain. [10] A madadin haka, gwamnati na iya siyan ayyukan kiwon lafiya daga ƙungiyoyin waje, kamar hanyar da aka bi a Kanada .

Kanada

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☁Ana bayar da kulawar lafiya a Kanada ta hanyar tsarin kula da lafiya na gwamnati, wanda galibi kyauta ne a lokacin amfani kuma yana da yawancin ayyukan da ƙungiyoyi masu zaman kansu ke bayarwa. An kafa tsarin ne bisa tanadin Dokar Lafiya ta Kanada ta 1984. [11] Gwamnati tana tabbatar da ingancin kulawa ta hanyar ƙa'idodin tarayya. Gwamnati ba ta shiga cikin kulawa ta yau da kullun ko tattara duk wani bayani game da lafiyar mutum, wanda ke kasancewa sirri tsakanin mutum da likitansa.

Tsarin Medicare na lardin Kanada yana da inganci sosai saboda sauƙin gudanarwarsu. A kowace lardi, kowane likita yana kula da da'awar inshorar da ake yi wa kamfanin inshora na lardin. Babu buƙatar mutumin da ke samun damar kula da lafiya ya shiga cikin lissafin kuɗi da kuma dawo da kuɗi.

Gabaɗaya, ana biyan kuɗaɗe ta hanyar kuɗaɗen shiga daga harajin samun kuɗi. Ma'aikatar Lafiya ta Lardin tana ba da katin lafiya ga kowane mutum da ya yi rajista a shirin kuma kowa yana samun irin wannan matakin kulawa. [12]

Babu buƙatar tsare-tsare iri-iri domin kusan dukkan muhimman kulawa ta asali ana biyan su, gami da matsalolin haihuwa da rashin haihuwa. Dangane da lardin, kulawar hakori da ta gani ba za a iya biyan su ba amma galibi ana ba su inshora ta hannun ma'aikata ta hanyar kamfanoni masu zaman kansu. A wasu larduna, ana samun tsare-tsaren ƙarin masu zaman kansu ga waɗanda ke son ɗakunan zama na kansu idan an kwantar da su a asibiti.

Tiyatar kwalliya da wasu nau'ikan tiyatar zaɓi ba a ɗaukar su a matsayin kulawa mai mahimmanci ba kuma gabaɗaya ba a rufe su ba. Ana iya biyan waɗannan daga aljihu ko ta hanyar kamfanonin inshora masu zaman kansu. Rashin ko canjin aiki ba ya shafar inshorar lafiya, kuma babu iyaka ko keɓancewa na tsawon rai ga yanayin da ya riga ya kasance.

Ana biyan kuɗin gwamnati ne ta hanyar asusun gwamnati, ko kuma ta hanyar inshorar sirri ta hanyar aiki. Gwamnatin tarayya tana tattaunawa da masu samar da magunguna don sarrafa farashi.

Likitocin iyali (wanda aka fi sani da likitoci na yau da kullun ko kuma likitocin iyali a Kanada) mutane ne ke zaɓen su. Idan majiyyaci yana son ganin ƙwararre ko kuma aka ba shi shawara ya ga ƙwararre, likita zai iya tura shi ta hanyar likita.

'Yan ƙasar Kanada suna jiran wasu jiyya da ayyukan bincike. Matsakaicin lokacin jira don ayyukan bincike kamar MRI da CAT scans [note 1] makonni biyu ne, tare da 86.4% suna jira ƙasa da watanni uku. [13] Matsakaicin lokacin jira don tiyata shine makonni huɗu, tare da 82.2% suna jira ƙasa da watanni uku. [14]

Duk da cewa kudin shigar likitoci ya fara karuwa bayan aiwatar da shirin biyan albashi ɗaya, an samu raguwar albashin likitoci, wanda mutane da yawa ke fargabar zai zama sakamakon kiwon lafiya na dogon lokaci da gwamnati ke gudanarwa. Duk da haka, a farkon karni na 21, kwararrun likitoci sun sake kasancewa cikin manyan masu samun kudin shiga a Kanada. [15]

Taiwan

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Ma'aikatar Lafiya ta Babban Yuan ce ke kula da harkokin kiwon lafiya a Taiwan. Kamar sauran ƙasashe masu ci gaba, mutanen Taiwan suna da isasshen abinci mai gina jiki amma suna fuskantar matsalolin lafiya kamar kiba mai tsanani da cututtukan zuciya . [16]

A shekara ta 2002, Taiwan tana da likitoci kusan 1.6 da gadajen asibiti 5.9 ga kowace al'umma 1,000, kuma akwai jimillar asibitoci 36 da asibitoci 2,601 a tsibirin. [16] Kudaden kiwon lafiya sun kai kashi 5.8% na GDP a shekara ta 2001, wanda kashi 64.9% daga cikinsu sun fito ne daga kudaden gwamnati. [16]

Duk da farkon girgizar tattalin arzikin Taiwan sakamakon karuwar farashin fadada tsarin kula da lafiya, tsarin biyan albashi daya ya samar da kariya daga manyan hadurra na kudi kuma ya sa harkokin kiwon lafiya ya fi samun karbuwa ga jama'a, wanda hakan ya haifar da daidaiton gamsuwar jama'a da kashi 70%. [17]

An kafa tsarin kiwon lafiya na yanzu a Taiwan, wanda aka sani da Inshorar Lafiya ta Ƙasa (NHI), a shekarar 1995. NHI wani shiri ne na inshorar zamantakewa na dole wanda ke biyan kuɗi ɗaya tilo wanda ke mai da hankali kan rarraba kuɗaɗen kula da lafiya. Tsarin ya yi alƙawarin samun daidaito ga dukkan 'yan ƙasa don kula da lafiya, kuma yawan jama'a ya kai kashi 99% a ƙarshen 2004.

Ana samun kuɗin NHI ne ta hanyar biyan kuɗi, wanda aka gina bisa ga harajin albashi, kuma ana ƙara masa kuɗaɗen da za a biya daga aljihu da kuma kuɗaɗen gwamnati kai tsaye. A matakin farko, kuɗin sabis ya mamaye masu samar da sabis na gwamnati da masu zaman kansu. Yawancin masu samar da lafiya suna aiki a ɓangaren masu zaman kansu kuma suna samar da kasuwa mai gasa a ɓangaren samar da lafiya. Duk da haka, masu samar da kiwon lafiya da yawa sun yi amfani da tsarin ta hanyar bayar da ayyuka marasa amfani ga adadi mai yawa na marasa lafiya sannan suka yi wa gwamnati lissafin kuɗi.

A yayin da ake fuskantar karuwar asara da kuma buƙatar rage farashi, NHI ta canza tsarin biyan kuɗi daga kuɗin sabis zuwa kasafin kuɗi na duniya, wani nau'in tsarin biyan kuɗi mai zuwa, a shekara ta 2002. Nasarar da Taiwan ta samu tare da shirin inshorar lafiya mai biyan kuɗi ɗaya yana da alaƙa da albarkatun ɗan adam na ƙasar da ƙwarewar gwamnati ta ƙungiya, wanda hakan ke ba da damar gudanar da shirin inshorar lafiya mai inganci da inganci na gwamnati. [17]

Koriya ta Kudu

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Koriya ta Kudu ta kasance tana da tsarin inshorar lafiyar jama'a na biyan kuɗi da yawa, kamar tsarin da ake amfani da shi a ƙasashe kamar Japan da Jamus, tare da ƙungiyoyin kiwon lafiya suna ba da inshorar lafiyar jama'a ga dukkan jama'a. Kafin 1977, ƙasar tana da inshorar lafiya mai zaman kansa na son rai, amma gyare-gyaren da aka fara a 1977 sun haifar da inshorar lafiya ta duniya baki ɗaya a 1989. [18] Wani babban garambawul na kuɗaɗen kiwon lafiya a 2000 ya haɗa dukkan ƙungiyoyin kiwon lafiya cikin Sabis na Inshorar Lafiya na Ƙasa. Wannan sabon sabis ya zama tsarin kiwon lafiya mai biyan kuɗi ɗaya a 2004. [19]

Yankuna masu tsarin "Beveridge Model"

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Kasashen Nordic

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A wasu lokutan ana ɗaukar ƙasashen Nordic a matsayin suna da ayyukan kiwon lafiya na biyan kuɗi ɗaya, sabanin inshorar kiwon lafiya ta ƙasa mai biyan kuɗi ɗaya kamar Taiwan ko Kanada. Wannan wani nau'i ne na tsarin kiwon lafiya na " Beveridge Model " wanda ke ɗauke da masu samar da lafiyar jama'a ban da inshorar lafiyar jama'a. [20]

Kalmar "samfurin Scandinavian" ko "samfurin Nordic" na tsarin kiwon lafiya yana da wasu siffofi da suka zama ruwan dare: galibin masu samar da ayyukan gwamnati, ƙarancin inshorar lafiya na masu zaman kansu, da kuma tsarin da yankuna ke gudanarwa, wanda gwamnatin tsakiya ke da hannu a ciki. [21] Saboda wannan siffa ta uku, ana iya jayayya cewa su masu biyan kuɗi ɗaya ne kawai a matakin yanki, ko kuma tsarin biyan kuɗi da yawa, sabanin tsarin kiwon lafiya da ake gudanarwa a ƙasa da ake samu a Taiwan da Koriya ta Kudu.

Ƙasar Ingila

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Kula da lafiya a Burtaniya lamari ne da aka raba shi, ma'ana Ingila, Scotland, Wales, da Arewacin Ireland duk suna da nasu tsarin kula da lafiya na sirri da na gwamnati, wanda galibi ake kira Hukumar Lafiya ta Ƙasa (NHS). Tare da masu samar da lafiya na gwamnati ko na gwamnati, wannan kuma ya dace da "Tsarin Beveridge" na tsarin kula da lafiya, wanda wani lokacin ana ɗaukarsa a matsayin mai biyan kuɗi ɗaya, tare da ƙaramin hannun masu zaman kansu idan aka kwatanta da sauran tsarin duniya baki ɗaya. Kowace ƙasa tana da manufofi da fifiko daban-daban ya haifar da bambance-bambance daban-daban tsakanin tsarin. Duk da haka, kowace ƙasa tana ba da kulawar lafiyar jama'a ga duk mazauna Burtaniya na dindindin waɗanda ke da kyauta a wurin amfani, ana biyan su daga haraji na gabaɗaya.

Bugu da ƙari, kowannensu yana da wani kamfani mai zaman kansa wanda ya fi ƙanƙanta da na gwamnati, tare da samar da kiwon lafiya mai zaman kansa da aka samu ta hanyar inshorar lafiya mai zaman kansa, wanda aka ba da kuɗi a matsayin wani ɓangare na tsarin kiwon lafiya wanda ma'aikaci ke ɗaukar nauyinsa ko kuma wanda abokin ciniki ke biyansa kai tsaye, kodayake ana iya iyakance tanadin ga waɗanda ke da cututtuka kamar HIV / AIDS . [22]

Tsarin guda ɗaya sune:

  • Ingila: Hukumar Lafiya ta Ƙasa (NHS)
  • Scotland: NHS Scotland
  • Wales: NHS Wales
  • Arewacin Ireland: Lafiya da Kula da Jama'a (HSC)

A Ingila, ana amfani da kuɗaɗen haraji na gabaɗaya ta hanyar NHS England, wacce ke da alhakin ba da umarni ga ayyukan ƙwararru da kulawa ta farko, da kuma Ƙungiyoyin Gudanar da Asibiti (CCGs), waɗanda ke kula da kashi 60% na kasafin kuɗi kuma suna da alhakin ba da umarnin ayyukan kiwon lafiya ga al'ummar yankinsu. [23]

Waɗannan hukumomin da ke ba da umarni ba sa bayar da ayyuka kai tsaye, amma suna samun su daga NHS Trusts da Foundation Trusts, da kuma masu samar da kamfanoni masu zaman kansu, na sa kai, da na zamantakewa. [24]

Yankuna masu tsarin inshorar masu biyan kuɗi ɗaya/na masu zaman kansu

[gyara sashe | gyara masomin]

Ostiraliya

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Kula da lafiya a Ostiraliya yana gudana ne ta hanyar cibiyoyin masu zaman kansu da na gwamnati. Medicare kamfani ne na kula da lafiya na duniya baki ɗaya da gwamnati ke tallafawa. An kafa shi a shekarar 1984 kuma yana rayuwa tare da tsarin kiwon lafiya mai zaman kansa. Misali, Medicare yana biyan duk kuɗin da ɗan ƙasar Ostiraliya ke kashewa a asibiti na gwamnati, yayin da yake biyan kashi 75% kawai na kuɗin da ake kashewa a asibiti mai zaman kansa . Medicare wani ɓangare ne na kuɗin harajin shiga na kashi 2% (banda ga masu ƙarancin kuɗi), amma galibi daga cikin kuɗin shiga na gabaɗaya. Ana sanya ƙarin kashi 1% ga masu samun kuɗi mai yawa ba tare da inshorar lafiya mai zaman kansa ba. [25]

Baya ga Medicare, akwai wani Tsarin Fa'idodin Magunguna daban-daban wanda ke ba da tallafi sosai ga nau'ikan magungunan da likita ya rubuta. Ministan Lafiya yana gudanar da manufofin kiwon lafiya na ƙasa, waɗanda jihohi daban-daban ke kula da su (kamar gudanar da asibitoci).

Indiya

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Indiya tana da tsarin kula da lafiya mai biyan kuɗi da yawa wanda ake biyan kuɗi ta hanyar haɗin inshorar lafiya na gwamnati da na masu zaman kansu tare da ɓangaren asibitocin gwamnati kusan gaba ɗaya waɗanda ke biyan haraji. [26] Tsarin asibitocin gwamnati kyauta ne ga duk mazauna Indiya banda ƙananan biyan kuɗi na haɗin gwiwa a wasu ayyuka. [27] A matakin tarayya, Gwamnatin Indiya ta ƙaddamar da wani shirin inshorar lafiya na ƙasa a cikin 2018, mai suna Ayushman Bharat . Wannan yana da nufin rufe ƙasa da kashi 50% (mutane miliyan 500) na al'ummar ƙasar da ke aiki a ɓangaren da ba shi da tsari (kamfanoni waɗanda ke da ƙasa da ma'aikata 10) kuma yana ba su magani kyauta ko da a asibitoci masu zaman kansu. [26] Ga mutanen da ke aiki a ɓangaren da aka tsara (kamfanoni waɗanda ke da ma'aikata sama da 10) kuma suna samun albashin wata-wata har zuwa Rs 21000, tsarin inshorar zamantakewa na Inshorar Jiha na Ma'aikata wanda ke ba da kuɗin kula da lafiyarsu gaba ɗaya (tare da fa'idodin fansho da rashin aikin yi), duka a asibitoci na gwamnati da na masu zaman kansu. [28] [29] Mutanen da ke samun fiye da wannan adadin suna samun inshorar lafiya daga ma'aikatansu ta hanyar kamfanonin inshora na gwamnati ko na masu zaman kansu da yawa. Ya zuwa shekarar 2020, 'yan Indiya miliyan 300 ne ke da inshorar da aka saya daga ɗaya daga cikin kamfanonin inshora na gwamnati ko na masu zaman kansu ta hanyar ma'aikatansu a matsayin tsarin rukuni ko na mutum ɗaya. [30] Mutanen da ba su da aikin yi ba tare da inshora ba suna da inshorar inshorar jiha daban-daban idan ba su da hanyar biyan kuɗin. [31]

A shekarar 2019, jimillar kudaden da gwamnati ta kashe kan harkokin kiwon lafiya sun kai dala biliyan 36 ko kuma kashi 1.23% na GDP dinta. Tun bayan samun 'yancin kai na kasar, tsarin asibitocin gwamnati gaba daya ana daukar nauyinsa ta hanyar haraji na gama gari.

Isra'ila

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Kula da lafiya a Isra'ila abu ne na kowa da kowa kuma shiga cikin tsarin inshorar lafiya dole ne. Duk mazauna Isra'ila suna da haƙƙin samun kulawar lafiya ta asali a matsayin haƙƙi na asali. Tsarin kula da lafiyar Isra'ila ya dogara ne akan Dokar Inshorar Lafiya ta Ƙasa ta 1995, wanda ya umarci duk 'yan ƙasar da ke zaune a ƙasar su shiga ɗaya daga cikin ƙungiyoyin inshorar lafiya guda huɗu na hukuma, waɗanda aka sani da Kupat Holim (קופת חולים - " Sick Funds ") waɗanda ake gudanarwa a matsayin ƙungiyoyi marasa riba kuma doka ta hana su shiga duk wani zama na zama ɗan Isra'ila. Isra'ilawa na iya ƙara ɗaukar nauyin lafiyarsu da inganta zaɓuɓɓukan su ta hanyar siyan inshorar lafiya mai zaman kansa. [32] A cikin wani bincike da aka gudanar a ƙasashe 48 a shekarar 2013, tsarin lafiyar Isra'ila ya kasance na huɗu a duniya dangane da inganci, kuma a shekarar 2014 ya kasance na bakwai cikin 51. [33] A shekarar 2020, tsarin lafiyar Isra'ila ya kasance na uku mafi inganci a duniya. A shekarar 2015, an sanya Isra'ila a matsayi na shida a cikin ƙasashe mafi koshin lafiya a duniya a cikin jerin Bloomberg [34] kuma ta zo ta takwas a fannin tsawon rai.

Sipaniya

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A shekarar 1963, gwamnatin Spain ta kafa tsarin kula da lafiya mai biyan kuɗi ɗaya a Spain. [35] An ci gaba da wannan tsarin ta hanyar gudummawar ma'aikata, kuma an rufe su da waɗanda ke ƙarƙashinsu. [36]

An kafa tsarin duniya baki ɗaya daga baya a shekarar 1986. A lokaci guda kuma, an tura kula da lafiyar jama'a ga al'ummomi daban-daban masu cin gashin kansu a ƙasar. [37] Duk da cewa a da ba haka lamarin yake ba, a shekarar 1997 an tabbatar da cewa hukumomin gwamnati za su iya ba da gudummawar kula da lafiyar jama'a ga kamfanoni masu zaman kansu. [38]

Bugu da ƙari, a layi ɗaya da tsarin kula da lafiya mai biyan kuɗi ɗaya, akwai kamfanonin inshora masu zaman kansu, waɗanda ke ba da inshora ga wasu likitoci masu zaman kansu da asibitoci. Wani lokaci ma'aikata za su ba da inshorar lafiya mai zaman kansu a matsayin fa'ida, inda kashi 14.8% na al'ummar Spain ke ƙarƙashin inshorar lafiya mai zaman kanta a cikin 2013. [39]

A shekarar 2000, Hukumar Lafiya ta Duniya ta ayyana tsarin kula da lafiya na Spain a matsayin na 7 mafi kyau a duniya.

Tsarin kula da lafiya na Spain yana matsayi na 19 a Turai bisa ga ma'aunin masu amfani da lafiya na Euro na 2018. [40]

Amurka

[gyara sashe | gyara masomin]
Tawagar neman Medicare ga kowa a Los Angeles a shekarar 2017

Medicare a Amurka tsarin kula da lafiyar jama'a ne, amma an takaita shi ga mutanen da suka kai shekara 65 zuwa sama, mutanen da ke ƙasa da shekara 65 waɗanda ke da nakasa ta musamman, da duk wanda ke da cutar koda ta ƙarshe . An gabatar da shawarwari da dama don tsarin kula da lafiyar jama'a mai biyan kuɗi ɗaya a Amurka. An gabatar da Dokar Medicare for All Act a Majalisar Wakilai a watan Fabrairun 2003; an sake gabatar da ita sau da yawa. [41] A watan Yulin 2018, 'yan Democrat sama da 60 a Majalisar Wakilai ta Amurka sun sanar da kafa Dokar Medicare for All Caucus . A ranar 17 ga Maris, 2021, daidai shekara guda bayan COVID-19 ya bayyana a kowace jiha ta Amurka, [42] 'Yan Democrat na Majalisar sun gabatar da Dokar Medicare for All Act ta 2021 tare da magoya baya 112. [43] [44] [45] [46]

Masu fafutuka sun yi jayayya cewa kashe kuɗin kula da lafiya na rigakafi na iya adana ɗaruruwan biliyoyin daloli a kowace shekara saboda kulawar lafiya ta jama'a za ta amfani ma'aikata da masu amfani, cewa ma'aikata za su amfana daga tarin abokan ciniki masu yawa kuma masu ɗaukar ma'aikata za su iya biyan ƙasa da haka, za a kare su daga kuɗaɗen gudanarwa, kuma rashin daidaito tsakanin ma'aikata zai ragu. Babban dalilin da ya sa Amurkawa ke ba da kuɗi mai yawa shine babban dalilin da ya sa Amurkawa ke ba da matsalolin samun kulawar lafiya. [47] A sama da miliyan 27, adadin mutanen da ba su da inshorar lafiya a Amurka yana ɗaya daga cikin manyan damuwar da masu fafutukar sake fasalin kiwon lafiya ke fuskanta. Rashin inshorar lafiya yana da alaƙa da ƙaruwar mace-mace - kimanin mace-mace 60,000 da za a iya hanawa kowace shekara, ya danganta da binciken. [48] Wani bincike da aka yi a Makarantar Likitanci ta Harvard tare da Cambridge Health Alliance ya nuna cewa kusan mace-mace 45,000 a shekara suna da alaƙa da rashin inshorar lafiyar marasa lafiya. Binciken ya kuma gano cewa Amurkawa masu aiki marasa inshora suna da haɗarin mutuwa kusan kashi 40% mafi girma idan aka kwatanta da Amurkawa masu inshorar sirri.

Masu tallafawa masu biyan kuɗi ɗaya ko Medicare for All sun lura cewa tsiraru da talakawa, da kuma mazauna karkara gabaɗaya, ba su da ƙarfin biyan inshorar lafiya mai zaman kansa, kuma waɗanda za su iya dole ne su biya manyan kuɗaɗen da za a cire daga asusun inshorar lafiya da kuma biyan kuɗi na haɗin gwiwa waɗanda ke barazana ga iyalai da lalacewar kuɗi. [49] [50] Masu fafutuka sun kiyasta tanadi na dogon lokaci wanda ya kai kashi 40% na duk kuɗaɗen kiwon lafiya na ƙasa saboda tsawaita lokacin kula da lafiyar rigakafi, kodayake ƙididdiga daga Ofishin Kasafin Kuɗi na Majalisa da Jaridar New England ta Medicine sun gano cewa kulawar rigakafi ta fi tsada saboda ƙaruwar amfani da ita. [51]

Duk wani tsarin ƙasa za a biya shi ta hanyar haraji wanda zai maye gurbin kuɗin inshora, amma masu fafutuka kuma sun yi imanin cewa za a cimma tanadi ta hanyar kulawa ta rigakafi da kuma kawar da kuɗaɗen kamfanin inshora da kuɗin biyan kuɗi na asibiti. [52] Wani bincike na 2008 game da lissafin mai biyan kuɗi ɗaya da Likitoci suka yi don Shirin Lafiya na Ƙasa ya kiyasta cewa tanadin nan take zai kai dala biliyan 350 a kowace shekara. Asusun Commonwealth ya yi imanin cewa, idan Amurka ta amince da tsarin kula da lafiya na duniya baki ɗaya, adadin mace-mace zai inganta kuma ƙasar za ta adana kusan dala biliyan 570 a shekara. [53]

Manufofi da shawarwari na ƙasa

[gyara sashe | gyara masomin]

Gwamnati na ƙara shiga cikin kashe kuɗin kula da lafiya na Amurka, tana biyan kusan kashi 45% na dala tiriliyan 2.2 da ƙasar ta kashe kan kula da lafiyar mutane a shekarar 2004. Duk da haka, bincike ya nuna cewa kason da gwamnati ke bayarwa na kiwon lafiya a Amurka na iya kusan kusan kashi 60% a shekarar 2002.

A cewar masanin tattalin arziki a fannin lafiya na Jami'ar Princeton, Uwe Reinhardt, masanin tattalin arziki na Medicare, Medicaid, da kuma Shirin Inshorar Lafiyar Yara na Jiha (SCHIP) suna wakiltar "nau'ikan ' inshorar zamantakewa ' tare da tsarin isar da lafiya mai zaman kansa" maimakon nau'ikan " maganin zamantakewa ". Sabanin haka, ya bayyana tsarin kula da lafiyar Tsohon Soji a matsayin cikakken nau'in maganin zamantakewa saboda "gwamnati ce ke da shi, ke gudanarwa kuma tana ba da kuɗi."

A cikin wata takarda da aka yi nazari a kanta da aka buga a cikin Annals of Internal Medicine, masu bincike na RAND Corporation sun ba da rahoton cewa ingancin kulawar da marasa lafiya na Tsohon Soji suka samu ya fi yawa a jimilla fiye da ma'auni makamancin haka ga marasa lafiya da ke amfani da Medicare na Amurka a halin yanzu. [54]

Dokar Medicare for All wani tsari ne da aka daɗe ana amfani da shi a Majalisar Wakilai ta Amurka wanda a wancan lokacin, John Conyers (D-MI) ya gabatar sau da yawa a Majalisar Wakilai ta Amurka . Dokar za ta kafa tsarin kula da lafiya na kowa da kowa wanda ke biyan kuɗi ɗaya a Amurka, wanda yayi daidai da Medicare na Kanada, Hukumar Lafiya ta Ƙasa ta Burtaniya, da Ofishin Inshorar Lafiya ta Ƙasa na Taiwan, da sauran misalai. An fara gabatar da dokar a shekarar 2003 kuma an sake gabatar da ita a kowace Majalisa tun daga lokacin. [55] A lokacin muhawarar kula da lafiya ta 2009 game da dokar da ta zama Dokar Kare Marasa Lafiya da Kulawa Mai Sauƙi, ana sa ran Majalisar za ta yi muhawara a kanta kuma ta kaɗa ƙuri'a a kan HR 676 a watan Satumba na 2009, amma ba a taɓa yin muhawara a kanta ba. [56] Bayan yakin neman zaɓen shugaban ƙasa na Bernie Sanders na 2016, inda aka nuna himma ga kula da lafiya ta duniya, shawarwarin masu biyan kuɗi ɗaya sun sami karɓuwa. Conyers ya sake gabatar da kudirinsa a Majalisar Wakilai a watan Janairun 2017. Bayan watanni hudu, kudirin ya samu goyon bayan masu tallafawa 112, wanda ya zarce kashi 25% na tallafin hadin gwiwa. [57] A watan Satumba na wannan shekarar, Sanders da kansa, tare da masu tallafawa 16, sun gabatar da kudirin Medicare-for-all a Majalisar Dattawa (S. 1804). [58]

Wani bincike da aka gudanar a Cibiyar Mercatus kan shawarar da masanin tattalin arziki Jeffrey Sachs ya gabatar a shekarar 2017 ya gano cewa "ya kammala da gaskiya kuma kai tsaye cewa M4A za ta samar da ƙarin inshorar lafiya a farashi mai rahusa fiye da yadda take a yanzu, yana hasashen raguwar kashe kuɗin kiwon lafiya na ƙasa da dala tiriliyan 2 a cikin shekaru 10 (2022-2031), yayin da kuma ke ba da damar ƙara yawan inshorar kiwon lafiya." Duk da haka, masanin Mercatus Robert Graboyes ya nuna cewa binciken ya ɗauki zato na masu fafutukar kudirin da gangan don kawai a yi jayayya: "Idan M4A ta samar da kowace fa'ida da kuma tanadin da Sanders ya yi hasashen zai faru, ta yaya kuɗaɗen gwamnatin tarayya za su canza?" Ya ci gaba da cewa: "Sanders ya ɗauka cewa za mu iya sukar likitoci, ma'aikatan jinya, asibitoci, kamfanonin magunguna, da sauransu da rage albashi mai yawa, amma duk da haka muna tsammanin za su samar da ayyuka da kayayyaki da farin ciki fiye da yadda suke yi yanzu. Ya kuma ɗauka cewa ma'aikatan gwamnati na tarayya ... za su zama abin koyi ga ingantaccen gudanarwa."

Ofishin Kasafin Kudi na Majalisa da hukumomin gwamnati masu alaƙa sun ƙididdige kuɗin tsarin kula da lafiya mai biyan kuɗi ɗaya sau da yawa tun daga 1991. Ofishin Kula da Hakkin Gwamnati ya buga wani rahoto a 1991 yana lura da cewa "[Idan] Amurka za ta koma ga tsarin kula da lafiya na duniya da mai biyan kuɗi ɗaya, kamar yadda yake a Kanada, tanadin kuɗaɗen gudanarwa [kashi 10 cikin 100 na kashe kuɗi na lafiya] zai isa ya rage kuɗin kula da lafiya na duniya."

Babban Bankin Duniya ya ƙididdige kuɗin a shekarar 1991, yana mai lura da cewa "yawan mutanen da ba su da inshora a halin yanzu za a iya biyan su ba tare da ƙara yawan kuɗin da ake kashewa a ƙasa kan lafiya ba" kuma "dukkan mazauna Amurka za su iya samun inshorar lafiya na kusan matakin kashe kuɗi na yanzu ko ma ƙasa da haka, saboda tanadi a cikin kuɗaɗen gudanarwa da ƙarancin kuɗin biyan kuɗi don ayyukan da masu inshorar masu zaman kansu ke amfani da su."

Rahoton CBO a shekarar 1993 ya bayyana cewa "[[t]] kuɗaɗen da ake kashewa wajen cimma tsarin inshorar duniya a ƙarƙashin wannan tsarin biyan kuɗi ɗaya zai zama mara kyau" a wani ɓangare saboda "kuɗin da masu amfani za su biya don lafiya zai faɗi da $1,118 ga kowane mutum, amma haraji dole ne ya ƙaru da $1,261 ga kowane mutum" domin biyan kuɗin shirin. Wani sakamako na watan Yulin 1993 ya kuma haifar da sakamako mai kyau, inda CBO ta bayyana cewa, "[a]s shirin ya fara aiki a mataki na farko, tanadin gudanarwa daga canzawa zuwa tsarin biyan kuɗi ɗaya zai daidaita yawancin buƙatun ayyukan kiwon lafiya da ake buƙata."

Daga baya, iyaka kan ci gaban kasafin kuɗin kiwon lafiya na ƙasa zai riƙe ƙimar ci gaban kashe kuɗi ƙasa da tushen tushe." Babban Bankin Ƙasa ya kuma ba da takardar shaidar Dokar Lafiya da Tsaro ta Amurka ta Sanata Paul Wellstone ta 1993 a watan Disamba 1993, inda ya gano cewa "a shekara ta biyar (da kuma a cikin shekaru masu zuwa) sabon tsarin zai yi ƙasa da farashin tushe."

Wani bincike da aka buga a shekarar 2014 a mujallar BMC Medical Services Research ta James Kahn, da sauransu, ya gano cewa ainihin nauyin gudanarwa na kula da lafiya a Amurka shine kashi 27% na duk kuɗaɗen kiwon lafiya na ƙasa. Binciken ya binciki kuɗaɗen kai tsaye da kamfanonin inshora ke caji don riba, gudanarwa da tallatawa, amma kuma nauyin da ba na kai tsaye ba da aka ɗora wa masu samar da kiwon lafiya kamar asibitoci, gidajen jinya da likitoci saboda kuɗaɗen da suka kashe wajen aiki da kamfanonin inshorar lafiya masu zaman kansu, gami da tattaunawar kwangila, harkokin kuɗi da kuma rikodin asibiti (mai canzawa da kuma na musamman ga kowane mai biyan kuɗi).

Kahn, da sauransu, sun kiyasta cewa ƙarin kuɗin da aka kashe wa tsarin kiwon lafiyar masu zaman kansu a Amurka ya kai kimanin dala biliyan 471 a shekarar 2012 idan aka kwatanta da tsarin biyan kuɗi ɗaya kamar na Kanada. Wannan ya wakilci sama da kashi 20% na jimillar kuɗin kula da lafiya na ƙasa a shekarar 2012. Kahn ya yi iƙirarin cewa wannan ƙarin kuɗin gudanarwa zai ƙaru a ƙarƙashin Dokar Kulawa Mai Sauƙi tare da dogaro da samar da inshorar lafiya ta hanyar tsarin biyan kuɗi da yawa. [59]

Wani bincike da aka yi a watan Fabrairun 2020 wanda aka buga a jaridar The Lancet ya gano cewa dokar Medicare for All Act da aka tsara za ta ceci rayuka 68,000 da kuma dala biliyan 450 a cikin kuɗin kula da lafiya na ƙasa kowace shekara. [60] A cewar wani bincike da aka yi a shekarar 2022 da aka buga a cikin Littafin Proceedings of the National Academy of Sciences of the United States of America, tsarin kula da lafiya na duniya mai biyan kuɗi ɗaya zai ceci rayuka 212,000 kuma ya hana sama da dala biliyan 100 na kuɗin likita a lokacin annobar COVID-19 a Amurka a shekarar 2020 kawai. Kusan kashi 16% na dukkan mace-macen COVID-19 sun faru ne a Amurka, duk da cewa kashi 4% ne kawai na yawan jama'ar duniya. [61]

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  54. ↑ Asch SM, McGlynn EA, Hogan MM, et al. (December 2004). "Comparison of quality of care for patients in the Veterans Health Administration and patients in a national sample". Ann. Intern. Med. 141 (12): 938–45. doi:10.7326/0003-4819-141-12-200412210-00010. PMID 15611491. S2CID 35973709.
  55. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named "intro2013".
  56. ↑ "H.R. 676: United States National Health Care Act or the Expanded and Improved Medicare for All Act (Govtrack.us)". Archived from the original on January 31, 2010. Retrieved December 1, 2009.
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  60. ↑ Galvani, Alison P; Parpia, Alyssa S; Foster, Eric M; Singer, Burton H; Fitzpatrick, Meagan C (February 13, 2020). "Improving the prognosis of health care in the USA". The Lancet. 395 (10223): 524–533. doi:10.1016/S0140-6736(19)33019-3. PMC 8572548 Check |pmc= value (help). PMID 32061298. S2CID 211105345.
  61. ↑ Galvani, Alison P.; Parpia, Alyssa S.; et al. (2022). "Universal healthcare as pandemic preparedness: The lives and costs that could have been saved during the COVID-19 pandemic". PNAS. 119 (25). Bibcode:2022PNAS..11900536G. doi:10.1073/pnas.2200536119. PMC 9231482 Check |pmc= value (help). PMID 35696578 Check |pmid= value (help). S2CID 249645274 Check |s2cid= value (help).
  1. ↑ Diagnostic tests defined as the following: non-emergency magnetic resonance imaging (MRI) devices; computed tomography (CT or CAT) scans; and angiographies that use X-rays to examine the inner opening of blood-filled structures such as veins and arteries.
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