# Kula da lafiyar duniya

| Kula da lafiyar duniya |
| --- |
| Bayanai |
| Ƙaramin ɓangare na |
Kula da lafiyar jama'a |
| Relates to sustainable development goal, target or indicator (en)  | Target 3.8 of the Sustainable Development Goals (en)  |

 Kula da lafiya ta duniya ta kowace ƙasa (2010)
Kula da lafiya ta duniya baki ɗaya (wanda kuma ake kira kula da lafiya ta duniya baki ɗaya, kula da lafiya ta duniya baki ɗaya, ko kulawa ta duniya baki ɗaya ) tsarin kiwon lafiya ne wanda duk mazauna wata ƙasa ko yanki ke da tabbacin samun kulawar lafiya . Gabaɗaya an tsara shi ne don samar wa duk mazauna ko waɗanda ba za su iya biyan kuɗin kansu ba, ko dai ayyukan kiwon lafiya ko hanyoyin samun su, da kuma manufar inganta sakamakon lafiya. [1]

Wasu tsarin kiwon lafiya na duniya baki ɗaya gwamnati ce ke ɗaukar nauyinsu, yayin da wasu kuma an kafa su ne bisa ga buƙatar dukkan 'yan ƙasa su sayi inshorar lafiya mai zaman kansa. Ana iya ƙayyade kiwon lafiya na duniya ta hanyoyi uku masu mahimmanci: wanda ke da alhakin, waɗanne ayyuka ne aka rufe, da kuma nawa ne kuɗin da aka biya. [1] Hukumar Lafiya ta Duniya ta bayyana shi a matsayin yanayi inda 'yan ƙasa za su iya samun ayyukan kiwon lafiya ba tare da fuskantar wahalar kuɗi ba. [2] A lokacin, Darakta Janar ta WHO Margaret Chan ta bayyana ɗaukar nauyin kiwon lafiya na duniya a matsayin "ra'ayi mafi ƙarfi da lafiyar jama'a ke bayarwa" tunda yana haɗa "ayyuka kuma yana isar da su ta hanya mai cikakken tsari da haɗin kai". [3] Ɗaya daga cikin manufofin kiwon lafiya na duniya baki ɗaya shine ƙirƙirar tsarin kariya wanda ke ba da daidaito ga mutane don jin daɗin mafi girman matakin lafiya. [4] Masu suka sun ce kiwon lafiya na duniya yana haifar da tsawaita lokacin jira da kuma mummunan ingancin kiwon lafiya. [5]

A matsayin wani ɓangare na Manufofin Ci Gaba Mai Dorewa, ƙasashe membobin Majalisar Dinkin Duniya sun amince su yi aiki don cimma muradun kiwon lafiya na duniya baki ɗaya nan da shekarar 2030. Saboda haka, haɗa muradun kiwon lafiya na duniya (UHC) cikin manufofin SDGs na iya zama da alaƙa da sake amincewa da WHO ke gudanarwa.

## Tarihi

Lura:** Hanyoyin haɗin yanar gizo a cikin tebur sune "Kula da Lafiya a ƘASA".*

An ƙaddamar da matakin farko zuwa ga tsarin inshorar lafiya na ƙasa a Jamus a shekarar 1883, tare da Dokar Inshorar Lafiya. An ba wa ma'aikata na masana'antu umarnin samar da inshorar rauni da rashin lafiya ga ma'aikatansu masu ƙarancin albashi, kuma ma'aikata da ma'aikata ne ke ba da kuɗaɗen gudanar da tsarin ta hanyar "kuɗaɗen rashin lafiya", waɗanda aka samo daga ragi a cikin albashin ma'aikata da kuma gudummawar ma'aikata. Wannan tsarin inshorar lafiyar zamantakewa, wanda aka sanya wa suna Bismarck Model bayan Shugaban Gwamnatin Prussian Otto von Bismarck, shine nau'in farko na kulawa ta duniya a zamanin yau.

Ba da daɗewa ba wasu ƙasashe suka fara bin sa. A Burtaniya, Dokar Inshorar Ƙasa ta 1911 ta samar da inshorar kulawa ta farko (amma ba ta ƙwararru ko kula da asibiti ba) ga masu karɓar albashi, wanda ya shafi kusan kashi ɗaya bisa uku na yawan jama'a. Daular Rasha ta kafa irin wannan tsarin a 1912, kuma sauran ƙasashe masu ci gaba da masana'antu suka fara bin sa. Zuwa shekarun 1930, irin waɗannan tsare-tsare sun wanzu a kusan dukkan Yammacin Turai da Tsakiyar Turai. Japan ta gabatar da dokar inshorar lafiya ta ma'aikata a 1927, inda ta ƙara faɗaɗa a 1935 da 1940.

Bayan juyin juya halin Rasha na 1917, Bolsheviks sun kafa tsarin kula da lafiya na farko a duniya mai 'yanci kuma na duniya baki ɗaya a Rasha ta Soviet a watan Yulin 1918. Tsarin yana da ƙarfi sosai, kuma yayin da aka ambaci kowane mutum ba tare da la'akari da matsayinsa ba, ainihin tsarin, musamman a yankunan da ke nesa da talauci, kusan babu shi.

A New Zealand, an ƙirƙiri tsarin kula da lafiya na duniya baki ɗaya a cikin matakai da dama, daga 1938 zuwa 1941. A Ostiraliya, jihar Queensland ta gabatar da tsarin asibitoci na gwamnati kyauta a 1946.

Bayan Yaƙin Duniya na Biyu, an fara kafa tsarin kula da lafiya na duniya baki ɗaya a duk faɗin duniya. A ranar 5 ga Yuli, 1948, Burtaniya ta ƙaddamar da Sabis ɗin Lafiya na Ƙasa na duniya baki ɗaya. An fara gabatar da tsarin kula da lafiya na duniya baki ɗaya a ƙasashen Nordic na Sweden (1955), Iceland (1956), Norway (1956), Denmark (1961) da Finland (1964). An gabatar da tsarin inshorar lafiya na duniya baki ɗaya a Japan a 1961, kuma a Kanada ta matakai, farawa da lardin Saskatchewan a 1962, sannan sauran Kanada daga 1968 zuwa 1972. An gabatar da tsarin kula da lafiya na jama'a a Masar bayan juyin juya halin Masar na 1952. An kafa tsarin kula da lafiya na jama'a na tsakiya a ƙasashen Gabas . Tarayyar Soviet ta faɗaɗa kula da lafiya ga mazauna karkara a shekarar 1969. Kuwait da Bahrain sun gabatar da tsarin kula da lafiya na duniya a shekarar 1950 da 1957 bi da bi (kafin samun 'yancin kai). Italiya ta gabatar da *Servizio Sanitario Nazionale* (Sabis na Lafiya na Ƙasa) a shekarar 1978. An aiwatar da inshorar lafiya ta duniya a Ostiraliya a shekarar 1975 tare da *Medibank*, wanda ya haifar da ɗaukar nauyin kula da lafiya na duniya a ƙarƙashin tsarin Medicare na yanzu daga 1984.

Daga shekarun 1970 zuwa 2000, ƙasashen Yammacin Turai sun fara gabatar da tsarin inshorar lafiya na duniya baki ɗaya, yawancinsu sun dogara ne akan shirye-shiryen inshorar lafiya na baya don rufe dukkan al'umma. Misali, Faransa ta gina bisa tsarin inshorar lafiya na ƙasa na 1928, tare da wasu dokoki da suka shafi babban kaso na al'umma, har sai da sauran kashi 1% na al'ummar da ba su da inshora suka sami inshora a 2000. An gabatar da tsarin kula da lafiya na masu biyan kuɗi ɗaya a Finland (1972), Portugal (1979), Cyprus (1980), Spain (1986) da Iceland (1990). Switzerland ta gabatar da tsarin kula da lafiya na duniya baki ɗaya bisa ga umarnin inshora a 1994. Bugu da ƙari, an gabatar da tsarin kula da lafiya na duniya baki ɗaya a wasu ƙasashen Asiya, ciki har da Malaysia (1980s), Koriya ta Kudu (1989), Taiwan (1995), Singapore (1993), Isra'ila (1995) da Thailand (2001).

Bayan rugujewar Tarayyar Soviet, Rasha ta ci gaba da kuma gyara tsarin kula da lafiyarta na duniya baki ɗaya, kamar yadda sauran tsoffin jamhuriyoyin Soviet da ƙasashen Gabashin Turai suka yi.

Bayan shekarun 1990, ƙasashe da yawa a Latin Amurka, Caribbean, Afirka da yankin Asiya-Pacific, ciki har da ƙasashe masu tasowa, sun ɗauki matakai don kawo al'ummarsu ƙarƙashin tsarin kiwon lafiya na duniya baki ɗaya, ciki har da China da SUS na Brazil wanda ya inganta tsarin kula da lafiyar jama'a har zuwa kashi 80% na al'umma. Taiwan ta aiwatar da tsarinta a shekarar 1995. Indiya ta gabatar da tsarin kula da lafiya na duniya wanda ba shi da tsari wanda ke ba da tallafi ga masu biyan haraji da kuma cikakken inshorar lafiya na gwamnati da na masu zaman kansu wanda ya taimaka wajen rage yawan mace-mace sosai da kuma inganta kayayyakin kiwon lafiya a faɗin ƙasar sosai. Wani bincike na 2012 ya binciki ci gaban da waɗannan ƙasashe ke samu, inda ya mai da hankali kan tara musamman: Ghana, Rwanda, Najeriya, Mali, Kenya, Indonesia, Philippines da Vietnam .

A halin yanzu, yawancin ƙasashe masu ci gaba da masana'antu da ƙasashe masu tasowa da yawa suna gudanar da wani nau'in kula da lafiya wanda gwamnati ke ba da kuɗaɗen tallafi ga jama'a tare da ɗaukar nauyin kula da lafiya na kowa da kowa a matsayin burin. A cewar Kwalejin Magunguna ta Ƙasa da sauransu, Amurka ita ce kaɗai ƙasa mai arziki da ci gaba da masana'antu da ba ta ba da kulawar lafiya ta kowa da kowa. Siffofin kula da lafiya da gwamnati ke bayarwa kawai sune Medicare (ga tsofaffi marasa lafiya sama da shekaru 65 da kuma mutanen da ke da nakasa), Medicaid (ga mutanen da ke da ƙarancin kuɗi), Shirin Inshorar Lafiyar Yara (ga yara a cikin iyalai masu matsakaicin kuɗi, amma sun yi yawa don cancantar Medicaid), Tsarin Lafiyar Soja (ma'aikatan soja masu aiki, waɗanda aka ajiye, da waɗanda suka yi ritaya), da kuma Hukumar Lafiya ta Indiya (membobin ƙabilun 'Yan Asalin Amurka da aka amince da su a gwamnatin tarayya).

## Tsarin bayar da kuɗi

Kashe kuɗi a fannin lafiya ta kowace ƙasa . Kashi na GDP ( Jimillar kayayyakin cikin gida ). Misali: Kashi 11.2% na Kanada a shekarar 2022. Kashi 16.6% na Amurka a shekarar 2022.
Jimlar kuɗin kula da lafiya ga kowane mutum . Kashe kuɗi na gwamnati da na masu zaman kansu. Dalar Amurka PPP . Misali: $6,319 ga Kanada a 2022. $12,555 ga Amurka a 2022.
An cimma nasarar kula da lafiya ta duniya baki ɗaya a yawancin ƙasashe ta hanyar amfani da tsarin kuɗi iri ɗaya. Kuɗaɗen shiga na haraji gabaɗaya shine babban tushen kuɗi, amma a ƙasashe da yawa ana ƙara shi da takamaiman kuɗi (wanda za a iya caji ga mutum ɗaya ko ma'aikaci) ko kuma tare da zaɓin biyan kuɗi na sirri (ta hanyar inshora kai tsaye ko zaɓi) don ayyuka fiye da waɗanda tsarin gwamnati ya rufe. Kusan dukkan tsarin Turai ana ba da kuɗi ta hanyar haɗakar gudummawar jama'a da na masu zaman kansu. Yawancin tsarin kiwon lafiya na duniya ana ba da kuɗi ta hanyar kuɗin shiga na haraji (kamar a Portugal, Indiya, Spain, Denmark da Sweden). Wasu ƙasashe, kamar Jamus, Faransa, da Japan, suna amfani da tsarin biyan kuɗi da yawa wanda ake ba da kuɗin kula da lafiya ta hanyar gudummawar masu zaman kansu da na jama'a. Duk da haka, yawancin kuɗaɗen da ba na gwamnati ba suna fitowa ne daga gudummawar ma'aikata da ma'aikata zuwa asusun rashin lafiya na ƙungiyoyin da ba na riba ba . Gudummawa dole ne kuma an ayyana su bisa ga doka. Haka kuma ana yin bambanci tsakanin kuɗaɗen kula da lafiya na birni da na ƙasa. Misali, wani tsari shine cewa karamar hukuma ce ke daukar nauyin mafi yawan ayyukan kiwon lafiya, ana samar da ayyukan kiwon lafiya na musamman kuma wataƙila wata babbar hukuma ce ke daukar nauyinsu, kamar hukumar hadin gwiwa ta birni ko jiha, kuma wata hukumar jiha ce ke daukar nauyin magunguna. Wata takarda da Sherry A. Glied daga Jami'ar Columbia ta fitar ta gano cewa tsarin kula da lafiya na duniya baki daya yana da sassaucin rarrabawa kuma ci gaban kudaden kula da lafiya yana da iyaka ga rashin daidaiton kudin shiga gaba daya.

### Inshora ta dole

Ana aiwatar da wannan ta hanyar dokokin da ke buƙatar mazauna su sayi inshora, amma wani lokacin gwamnati tana ba da inshorar. Wani lokaci ana iya samun zaɓi na asusun gwamnati da na masu zaman kansu da yawa waɗanda ke ba da sabis na yau da kullun (kamar yadda yake a Jamus) ko wani lokacin asusun gwamnati guda ɗaya kawai. Kula da lafiya a Switzerland ya dogara ne akan inshorar tilas.

A wasu ƙasashen Turai inda inshorar masu zaman kansu da kula da lafiya na duniya baki ɗaya ke haɗuwa, kamar Jamus, Belgium da Netherlands, ana shawo kan matsalar zaɓi mara kyau ta hanyar amfani da wurin biyan diyya don daidaita, gwargwadon iyawa, haɗarin da ke tsakanin asusun. Don haka, asusun da ke da yawan matasa masu lafiya dole ne ya biya a cikin wurin biyan diyya kuma asusun da ke da tsofaffi kuma galibi ba su da lafiya zai sami kuɗi daga wurin. Ta wannan hanyar, asusun rashin lafiya yana gasa akan farashi kuma babu wata fa'ida wajen kawar da mutanen da ke da haɗari mafi girma saboda ana rama su ta hanyar biyan kuɗin da aka daidaita da haɗari. Ba a ba da izinin kuɗaɗen su zaɓi kuma su zaɓi masu inshorar su ko su ƙi ɗaukar nauyin, amma suna fafatawa galibi akan farashi da sabis. A wasu ƙasashe, gwamnati ce ke saita matakin ɗaukar nauyin asali kuma ba za a iya gyara shi ba.

A wani lokaci Jamhuriyar Ireland tana da tsarin "ƙimar al'umma" ta hanyar VHI, wanda a zahiri shine mai biyan kuɗi ɗaya ko kuma babban haɗarin da ake fuskanta. Daga baya gwamnati ta buɗe VHI don yin gasa, amma ba tare da wani tsarin biyan diyya ba. Wannan ya haifar da kamfanonin inshora na ƙasashen waje suka shiga kasuwar Ireland kuma suka ba da inshorar lafiya mai rahusa ga sassan kasuwa masu lafiya, wanda daga nan ya sami riba mai yawa akan kuɗin VHI. Daga baya gwamnati ta sake gabatar da ƙimar al'umma ta hanyar tsarin haɗin gwiwa kuma aƙalla babban kamfanin inshora, Bupa, ya janye daga kasuwar Ireland.

A Poland, mutane suna da alhakin biyan kashi ɗaya cikin ɗari na matsakaicin albashin wata-wata ga jihar, koda kuwa inshorar mai zaman kansa ce ke rufe su. Mutanen da ke aiki a ƙarƙashin kwangilar aiki suna biyan kashi ɗaya cikin ɗari na albashinsu, yayin da 'yan kasuwa ke biyan wani ƙayyadadden farashi, bisa ga matsakaicin albashin ƙasa. Ma'aikatan da ba su da aikin yi suna samun inshora daga ofishin ma'aikata.

Daga cikin hanyoyin da masana tattalin arziki za su iya bi akwai tsarin biyan kuɗi ɗaya da kuma wasu hanyoyin tabbatar da cewa inshorar lafiya ta zama ta kowa da kowa, kamar ta hanyar tilasta wa dukkan 'yan ƙasa su sayi inshora ko kuma ta hanyar iyakance ikon kamfanonin inshora na hana inshora ga mutane ko kuma canza farashi tsakanin mutane.

### Mai biyan kuɗi ɗaya

Kula da lafiya mai biyan kuɗi ɗaya tsari ne wanda gwamnati, maimakon masu inshorar masu zaman kansu, ke biyan duk kuɗin kula da lafiya . Tsarin masu biyan kuɗi ɗaya na iya yin kwangila don ayyukan kiwon lafiya daga ƙungiyoyi masu zaman kansu, ko kuma su mallaki kuma su yi amfani da albarkatun kiwon lafiya da ma'aikata (kamar yadda ya faru a Ingila kafin gabatar da Dokar Kula da Lafiya da Jin Daɗi ). A wasu lokuta, kamar Italiya da Spain, waɗannan gaskiyar biyu na iya wanzuwa a lokaci guda. "Mai biyan kuɗi ɗaya" don haka yana bayyana tsarin kuɗaɗen ne kawai kuma yana nufin kula da lafiya da wata ƙungiya ta gwamnati ta ba da kuɗi daga asusu ɗaya kuma bai ƙayyade nau'in isarwa ko wanda likitoci ke aiki a kansa ba. Kodayake mai riƙe asusun yawanci jiha ne, wasu nau'ikan masu biyan kuɗi ɗaya suna amfani da tsarin gauraye na gwamnati da masu zaman kansu.

### Tallafin kuɗi bisa ga haraji

A fannin kuɗaɗen haraji, mutane suna ba da gudummawa ga samar da ayyukan kiwon lafiya ta hanyar haraji daban-daban. Waɗannan galibi ana haɗa su a cikin dukkan al'umma sai dai idan gwamnatocin ƙananan hukumomi suna tara kuɗi da riƙe kuɗaɗen haraji. Wasu ƙasashe (musamman Spain, Burtaniya, Ireland, New Zealand, Italiya, Brazil, Portugal, Indiya da ƙasashen Nordic ) sun zaɓi su ba da kuɗin kula da lafiyar jama'a kai tsaye daga haraji kawai. Sauran ƙasashe masu tsarin inshora suna biyan kuɗin inshorar waɗanda ba za su iya yin inshorar kansu ba ta hanyar shirye-shiryen tsaro na zamantakewa da aka biya daga haraji, ko dai ta hanyar biyan kuɗin lafiyarsu kai tsaye ko ta hanyar biyan kuɗin inshora ga waɗanda abin ya shafa.

### Inshorar lafiyar zamantakewa

A cikin tsarin inshorar lafiyar zamantakewa, ana haɗa gudummawar ma'aikata, masu aikin yi, kamfanoni da gwamnatoci zuwa asusu ɗaya ko da yawa bisa ga tilas. Wannan ya dogara ne akan haɗa haɗari . Ana kuma kiran tsarin inshorar lafiyar zamantakewa da **Tsarin Bismarck**, bayan Shugaban Gwamnatin Jamus Otto von Bismarck, wanda ya gabatar da tsarin kula da lafiya na farko a Jamus a ƙarni na 19. Kuɗaɗen galibi suna yin kwangila da gaurayen masu samar da ayyuka na gwamnati da masu zaman kansu don samar da takamaiman fa'ida. Waɗannan kuɗaɗen ko alhakin da Ma'aikatar Lafiya ke riƙe da shi kaɗai na iya bayar da kulawar rigakafi da lafiyar jama'a. A cikin inshorar lafiyar zamantakewa, ana iya aiwatar da ayyuka da yawa ta asusun rashin lafiya na parastatal ko waɗanda ba na gwamnati ba, ko kuma a wasu lokuta, ta kamfanonin inshorar lafiya masu zaman kansu. Ana amfani da inshorar lafiyar zamantakewa a cikin ƙasashe da dama na Yammacin Turai kuma galibi a Gabashin Turai da Isra'ila da Japan.

### Inshora mai zaman kansa

A cikin inshorar lafiya mai zaman kansa, ana biyan kuɗin inshora kai tsaye daga ma'aikata, ƙungiyoyi, daidaikun mutane da iyalai zuwa ga kamfanonin inshora, waɗanda ke haɗa haɗari a cikin membobinsu. Inshorar mai zaman kansa ta haɗa da manufofin da kamfanonin kasuwanci masu zaman kansu, kamfanonin da ba na riba ba da kamfanonin inshorar lafiya na al'umma ke sayarwa. Gabaɗaya, inshorar mai zaman kansa na son rai ne sabanin shirye-shiryen inshorar zamantakewa, waɗanda galibi dole ne su kasance.

A wasu ƙasashe masu inshorar lafiya ta duniya baki ɗaya, inshorar masu zaman kansu sau da yawa tana cire wasu yanayi na lafiya waɗanda ke da tsada kuma tsarin kiwon lafiya na jihar zai iya samar da inshora. Misali, a Burtaniya, ɗaya daga cikin manyan masu samar da kiwon lafiya masu zaman kansu shine Bupa, wanda ke da jerin keɓancewa gabaɗaya koda a cikin mafi girman manufofin inshorar ta, yawancin waɗanda Hukumar Lafiya ta Ƙasa ke bayarwa akai-akai. A Netherlands, wacce ta tsara gasa don babban tsarin inshorar ta (amma tana ƙarƙashin iyaka mai ƙayyadadden kasafin kuɗi), dole ne masu inshora su rufe wani fakiti na asali ga duk waɗanda suka yi rajista, amma za su iya zaɓar waɗanne ƙarin ayyuka suke bayarwa a cikin tsare-tsare na ƙarin; wanda yawancin mutane ke da shi .

Hukumar Tsare-tsare ta Indiya ta kuma ba da shawarar cewa ya kamata ƙasar ta rungumi inshora don cimma muradun kiwon lafiya na duniya baki ɗaya. A halin yanzu ana amfani da kuɗin shiga na haraji na gabaɗaya don biyan buƙatun kiwon lafiya na dukkan mutane.

### Inshorar lafiya ta al'umma

Wani nau'in inshorar lafiya mai zaman kansa wanda sau da yawa yakan bayyana, idan hanyoyin kariyar haɗarin kuɗi suna da iyakataccen tasiri, shine inshorar lafiya ta al'umma. Membobin wata al'umma daban-daban suna biyan kuɗi ga asusun kiwon lafiya na gama gari wanda za su iya samu daga lokacin da suke buƙatar kulawar lafiya. Gudummawa ba ta da alaƙa da haɗari kuma gabaɗaya akwai babban matakin shiga cikin al'umma a cikin gudanar da waɗannan tsare-tsaren. Inshorar lafiya ta al'umma gabaɗaya tana taka rawa kaɗan ne kawai wajen taimaka wa ƙasashe su matsa zuwa ga ɗaukar nauyin kiwon lafiya na duniya baki ɗaya. Kalubalen sun haɗa da rashin daidaito ga mafi talauci wanda amfani da ayyukan kiwon lafiya na membobi ke ƙaruwa bayan yin rajista.

## Aiwatarwa da kwatantawa

An daidaita kashe kuɗi a fannin lafiya ga kowane mutum, a cikin dalar Amurka, tsakanin ƙasashe daban-daban na OECD . Don ƙarin bayani daga baya duba Jerin ƙasashe ta hanyar jimillar kashe kuɗi a fannin lafiya ga kowane mutum .
Tsarin kula da lafiya na duniya ya bambanta dangane da matakin da gwamnati ke da shi wajen samar da kulawa ko inshorar lafiya. A wasu ƙasashe, kamar Kanada, Burtaniya, Italiya, Ostiraliya, da ƙasashen Nordic, gwamnati tana da babban matsayi na shiga cikin aiwatar da ayyukan kula da lafiya kuma samun dama ya dogara ne akan haƙƙin zama, ba akan siyan inshora ba. Wasu kuma suna da tsarin bayarwa mai yawa, wanda ya dogara ne akan lafiyar dole tare da ƙimar inshorar da ta shafi albashi ko kuɗin shiga kuma galibi ma'aikata da masu cin gajiyar suna ba da kuɗi tare.

A wasu lokutan, asusun kiwon lafiya ana samun su ne daga cakuda kuɗin inshora, gudummawar da ma'aikata ko ma'aikata ke bayarwa ga asusun rashin lafiya da aka tsara, da kuma harajin gwamnati. Waɗannan tsarin inshora suna biyan masu ba da sabis na kiwon lafiya masu zaman kansu ko na gwamnati, sau da yawa a kan farashi mai tsauri, ta hanyar kamfanonin inshorar lafiya na haɗin gwiwa ko na gwamnati. Wasu ƙasashe, kamar Netherlands da Switzerland, suna aiki ta hanyar kamfanonin inshora masu zaman kansu amma masu tsari mai ƙarfi, waɗanda ba a ba su izinin samun riba daga ɓangaren inshorar da ake buƙata ba amma za su iya samun riba ta hanyar sayar da ƙarin inshora.

Kula da lafiya ta duniya baki ɗaya babban ra'ayi ne wanda aka aiwatar ta hanyoyi da dama. Ma'anar da aka yi amfani da ita ga duk irin waɗannan shirye-shiryen ita ce wani nau'i na matakin gwamnati da nufin faɗaɗa damar samun kulawar lafiya gwargwadon iko da kuma kafa ƙa'idodi mafi ƙanƙanta. Yawancin suna aiwatar da kula da lafiya ta duniya ta hanyar dokoki, ƙa'idoji, da haraji. Dokoki da ƙa'idoji suna shirya irin kulawa da ya kamata a bayar, ga wa, da kuma wace tushe. Yawanci, wasu kuɗaɗen da mara lafiya ke kashewa ne a lokacin amfani da su, amma mafi yawan kuɗaɗen suna fitowa ne daga haɗin inshorar tilas da kuɗin shiga na haraji. Wasu shirye-shirye ana biyan su gaba ɗaya daga kuɗin shiga na haraji. A wasu kuma, ana amfani da kuɗaɗen shiga na haraji ko dai don tara kuɗi ga matalauta ko kuma ga waɗanda ke buƙatar kulawa ta dogon lokaci.

Wani muhimmin ra'ayi a fannin samar da kiwon lafiya na gama gari shine na kula da lafiyar jama'a. Wannan hanya ce ta tsara isar da kayan aiki, da kuma rarraba albarkatu, na kiwon lafiya (da kuma yiwuwar kula da zamantakewa) bisa ga yawan jama'a a cikin wani yanki da ake da buƙatu iri ɗaya (kamar asma, ƙarshen rayuwa, kulawa ta gaggawa ). Maimakon mayar da hankali kan cibiyoyi kamar asibitoci, kulawa ta farko, kula da al'umma da sauransu, tsarin ya mayar da hankali kan yawan jama'a tare da na gama gari gaba ɗaya. Wannan ya haɗa da mutanen da ake yi wa magani a halin yanzu, da waɗanda ba a yi musu magani ba amma ya kamata su kasance (watau inda akwai rashin daidaito a fannin lafiya ). Wannan hanyar tana ƙarfafa kulawa ta haɗaka da amfani da albarkatu cikin inganci.

Ofishin Binciken Kuɗi na Ƙasa na Burtaniya a shekara ta 2003 ya buga kwatancen ƙasa da ƙasa na tsarin kiwon lafiya guda goma daban-daban a ƙasashe goma da suka ci gaba, tsarin duniya guda tara akan tsarin da ba na duniya ba (Amurka), da kuma kuɗaɗen da suka kashe da kuma muhimman sakamakon kiwon lafiya. Hukumar Lafiya ta Duniya ta buga wani kwatancen ƙasa da ƙasa na ƙasashe 16, kowannensu yana da tsarin kiwon lafiya na duniya, a shekara ta 2004. A wasu lokuta, shigar gwamnati ya haɗa da kula da tsarin kiwon lafiya kai tsaye, amma ƙasashe da yawa suna amfani da tsarin gwamnati da na masu zaman kansu don isar da tsarin kiwon lafiya na duniya.

## Rahotannin Rufe Lafiya

Rahoton shekarar 2023 daga WHO da Bankin Duniya ya nuna cewa ci gaban da aka samu wajen samar da Lafiya ta Duniya (UHC) nan da shekarar 2030 bai ci gaba ba tun daga shekarar 2015. Ma'aunin Kula da Lafiya na UHC (SCI) ya kasance daidai da maki 68 daga 2019 zuwa 2021. An ruwaito cewa kashe kudaden kiwon lafiya na aljihu (OOP) masu muni sun shafi mutane sama da biliyan 1 a duk duniya. Bugu da ƙari, a shekarar 2019, an gano cewa mutane biliyan 2 sun fuskanci matsalolin kuɗi saboda kuɗaɗen kiwon lafiya, tare da ci gaba da samun bambance-bambance masu yawa a fannin ɗaukar nauyin. Rahoton ya ba da shawarwari da dama don rage waɗannan ƙalubalen: yana buƙatar hanzarta ayyukan kiwon lafiya masu mahimmanci, ci gaba da mai da hankali kan kula da cututtuka masu yaɗuwa, inganta ma'aikatan lafiya da kayayyakin more rayuwa, kawar da shingayen kuɗi ga kulawa, ƙaruwar kuɗaɗen kiwon lafiya da aka riga aka biya da kuma waɗanda aka haɗa, manufofin manufofi don rage kuɗaɗen OOP, mai da hankali kan kula da lafiya na farko don ƙarfafa tsarin kiwon lafiya gaba ɗaya, da kuma ƙarfafa ƙoƙarin haɗin gwiwa don cimma UHC. Waɗannan matakan suna da nufin ƙara yawan ɗaukar nauyin ayyukan kiwon lafiya da ƙarin mutane miliyan 477 nan da shekarar 2023 da kuma ci gaba da ɗaukar nauyin ɗaukar nauyin mutane biliyan ɗaya nan da wa'adin shekarar 2030.

## Siyasa

Masu suka kan harkokin kiwon lafiya na duniya baki daya sun yi iƙirarin cewa yana haifar da tsawaita lokacin jira da kuma raguwar ingancin kiwon lafiya. Suna da'awar cewa inganci ya yi ƙasa saboda ƙarancin kasafin kuɗi da kuma ma'aikatan lafiya da suka yi yawa. Misali, marasa lafiya da yawa a Kanada na iya zuwa Amurka don neman magani saboda tsawon lokacin jira. Wasu sun yi imanin cewa tsarin kiwon lafiya da gwamnati ke gudanarwa ba shi da inganci fiye da na masu zaman kansu, wanda ke haifar da asarar kuɗi da rashin kulawa. Wasu masu suka sun nuna yuwuwar amfani da shi fiye da kima da cin zarafi wanda ke haifar da rashin biyan kuɗi. Hakazalika, wasu kuma suna jayayya cewa kula da lafiya na duniya na iya zama mai matuƙar tsada ga gwamnatoci su kula da shi, wanda ke haifar da ƙarin haraji da yuwuwar matsin lamba kan kuɗaɗen jama'a, kamar waɗanda ke ƙasashen Nordic, Ostiraliya, da New Zealand . Ga ƙasashen da ba su da kula da lafiya na duniya kamar Amurka a halin yanzu, suna jayayya cewa zai ƙara kashe kuɗaɗen kula da lafiya saboda yawan kuɗin aiwatarwa wanda ake zargin gwamnatin Amurka ba za ta iya biya ba.

Duk da haka, yawancin adawa da kula da lafiya a Amurka ya samo asali ne daga akida. Misali, masu suka kan aiwatar da kula da lafiya a Amurka suna da'awar cewa zai buƙaci mutane masu lafiya su biya kuɗin kula da lafiyar mutanen da ba su da lafiya, wanda ya saɓa wa ƙa'idodin Amurka na ɗaukar nauyin kai. Haka kuma, suna jayayya cewa yana wakiltar wuce gona da iri da gwamnati ke yi wa rayuwar 'yan ƙasar Amurka da ma'aikata yayin da take hana su zaɓin mutum ɗaya. A wata ma'anar, yana iya iyakance zaɓin da ake da shi ga marasa lafiya, domin gwamnati na iya sarrafa waɗanne magunguna da aka rufe. A ƙarshe, zai iyakance masana'antar inshorar lafiya da lafiya ba bisa ƙa'ida ba.

A cewar wani bincike na 2020 da aka buga a *jaridar The Lancet*, dokar Medicare for All Act da aka gabatar za ta ceci rayuka 68,000 da kuma dala biliyan 450 a cikin kudaden kula da lafiya na ƙasa a kowace shekara. Wani bincike na 2022 da aka buga a *PNAS* ya gano cewa 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 2020 kawai. Ganin yawan mutanen da ba su da inshora da waɗanda ba su da inshora a Amurka, idan aka aiwatar da shi, kula da lafiya na duniya zai ƙara yawan damar samun kulawar lafiya ga Amurkawa sama da miliyan 25.

## Duba kuma

## Nassoshi

## Hanyoyin haɗi na waje

* Media related to Universal healthcare at Wikimedia Commons
* WHO fact sheet on universal health coverage
* Achieving Universal Health Care (July 2011). *MEDICC Review: International Journal of Cuban Health and Medicine* **13** (3). Theme issue: authors from 19 countries on dimensions of the challenges of providing universal access to health care.
* Catalyzing Change: The System Reform Costs of Universal Health Coverage (November 15, 2010). New York: The Rockefeller Foundation. Report on the feasibility of establishing the systems and institutions needed to pursue UHC.
* Physicians for a National Health Program Chicago: PNHP. A group of physicians and health professionals who support single-payer reform.
* Primary health care, World Health Organization
* UHC Forward Washington, D.C.: Results for Development Institute. Portal on universal health coverage.
* Percentage of population covered under national health programs, selected countries, 1955 and 1970
* Information on health coverage in various countries in the 1970s and in the 1980s
* "Unmet health care needs statistics", - Statistics Explained eurostat
* "Health at a Glance: Europe 2018: State of Health in the EU Cycle", OECD
* Countries with social security programs in operation, January 1, 1955, by type of program and date of legislation