Canjin kiwon lafiya

Gyaran kiwon lafiya shine mafi yawan manufofin gwamnati wanda ke shafar kasar don samun kiwon lafiya a wuri wuri. Sauye-sauyen kiwon lafiya yawanci yana ƙoƙari ya:

* fadada yawan mutanen da ke karɓar kulawar kiwon lafiya ta hanyar shirye-shiryen inshora na jama'a ko Kamfanonin inshora masu zaman kansu
* Ka faɗaɗa jerin masu ba da kiwon lafiya masu amfani zasu iya zaɓar tsakanin
* Inganta damar samun kwararru na kiwon lafiya
* Inganta ingancin kiwon lafiya
* Ka kara kula da 'yan ƙasa
* Rage farashin kiwon lafiya

## Tsarin gyaran kiwon lafiya
Duk da yake an amince da manufofi na ƙarshe, tsarin daban-daban suna ba da shawarar manufofi daban-daban na tsakiya, kamar daidaito, yawan aiki, aminci, kirkire-kirkire, da zabi.

### Ka'idar maɓallin sarrafawa

A cikin "Getting Health Reform Right: A Guide to Improving Performance and Equity,"  Marc Roberts, William Hsiao, Peter Berman, da Michael Reich na Harvard T.H. Chan School of Public Health suna da niyyar samar da masu yanke shawara da kayan aiki da tsarin sake fasalin tsarin kiwon lafiya. Sun ba da shawarar "ƙuƙwalwar sarrafawa" guda biyar na sake fasalin kiwon lafiya: kuɗi, biyan kuɗi, tsari, da halayyar. Wadannan maɓallan sarrafawa suna nufin "mechanisms da matakai da masu gyara zasu iya daidaitawa don inganta aikin tsarin". Marubutan sun zaɓi waɗannan maɓallan sarrafawa a matsayin wakilin mahimman abubuwan da mai tsara manufofi zai iya aiki don ƙayyade sakamakon tsarin kiwon lafiya.

Hanyarsu ta jaddada muhimmancin "bayyana manufofi a bayyane, gano abubuwan da ke haifar da rashin aiki a hankali, da kuma tsara gyare-gyare waɗanda za su haifar da canje-canje na gaske a cikin aikin". Marubutan suna kallon tsarin kiwon lafiya a matsayin hanyar kawo karshen. Dangane da haka, marubutan suna ba da shawara ga manufofi uku na tsarin kiwon lafiya wanda za'a iya daidaita shi ta hanyar maɓallin sarrafawa. Wadannan manufofi sun hada da:

# Matsayi na kiwon lafiya: Wannan burin yana nufin lafiyar jama'ar da aka yi niyya, wanda aka tantance ta hanyar ma'auni kamar tsawon rayuwa, nauyin cutar, da / ko rarraba waɗannan a duk faɗin ƙananan jama'a.
# *Farin cikin abokan ciniki:* Wannan burin ya shafi matakin gamsuwa da tsarin kiwon lafiya ke samarwa tsakanin yawan mutanen da aka yi niyya.
# *Kariyar haɗarin kuɗi:* Wannan burin yana nufin ikon tsarin kiwon lafiya na kare yawan mutanen da aka yi niyya daga nauyin kuɗi na rashin lafiya ko cututtuka.

Marubutan sun kuma ba da shawarar matakan aiki na tsakiya guda uku, waɗanda ke da amfani wajen ƙayyade aikin burin tsarin, amma ba manufofi na ƙarshe ba ne. Wadannan sun hada da:

# *Inganci:*
## Kwarewar fasaha: matsakaicin fitarwa ta kowane farashi
## Allocative inganci: kasafin kuɗi da aka ba shi yana haɓaka gamsuwa da tsarin kiwon lafiya ko wasu manufofi da aka ƙayyade
# *Samun dama:* ingancin samuwa wanda marasa lafiya ke karɓar kulawa
# *Ingancin kulawa:* la'akari da matsakaicin inganci da rarraba inganci

Ƙungiyoyin sarrafawa guda biyar da aka gabatar suna wakiltar hanyoyin da matakai waɗanda masu tsara manufofi zasu iya amfani da su don tsara ingantaccen gyare-gyaren kiwon lafiya. Wadannan maɓallan sarrafawa ba kawai mahimman abubuwa ne na tsarin kiwon lafiya ba, amma kuma suna wakiltar bangaren da za a iya daidaita shi da gangan ta hanyar sake fasalin don shafar canji. Ƙungiyoyin sarrafawa guda biyar sune: 

# Kudi, wanda ya ƙunshi duk hanyoyin da ayyukan da aka tsara don tara kuɗi don tsarin kiwon lafiya. Dangane da hanyoyin, maɓallin kuɗi ya haɗa da haraji masu alaƙa da kiwon lafiya, kudaden inshora da kudaden da ba na aljihu da sauransu. Ayyuka suna nufin ƙungiyar ma'aikata da ke tattara da rarraba kuɗi ga mahalarta a bangaren kiwon lafiya. A wasu kalmomi, kudi game da albarkatun da ke akwai ga tsarin kiwon lafiya, wanda ke sarrafa su kuma wanda ke karɓar su. Tsarin kuɗi yana da tasiri sosai ga yanayin kiwon lafiya na yawan jama'a da wasu kungiyoyi a ciki, da kuma samun damar kula da kiwon lafiya da kariya daga haɗarin kuɗi da waɗannan kungiyoyi, da yawan jama'ar gaba ɗaya, ke da shi. Ƙungiyar kuɗi ta ƙunshi hanyoyin kuɗi da yawa waɗanda ya kamata a zaɓa bisa ga dabi'un zamantakewar ƙasa da siyasa.
# Biya yana nufin hanyoyin da matakai ta hanyar da tsarin kiwon lafiya ko marasa lafiya ke rarraba ***Biyan kuɗi*** ga masu ba da sabis, gami da kudade, capitation da kasafin kuɗi daga gwamnati da kudaden da marasa lafiya suka biya. Biya shine game da rarraba albarkatun da ke akwai ga masu ba da sabis na kiwon lafiya. Gyaran kiwon lafiya na iya aiwatar da tsare-tsaren karfafawa iri-iri ga masu ba da sabis da marasa lafiya ta hanyar inganta iyakantaccen albarkatu.
# Tsarin tsarin kiwon lafiya yana nufin tsarin masu samarwa, matsayinsu, ayyukansu da ayyukan su. Ainihin, ***Ƙungiya*** ta bayyana yadda aka kafa kasuwar kiwon lafiya: wanene masu ba da sabis, wanene masu amfani, wanene abokan hamayya, da kuma wanda ke gudanar da su. Canje-canje a cikin tsarin kiwon lafiya suna faruwa a matakai da yawa a duka layin gaba da matakin gudanarwa.
# Dokar tana nufin ayyuka a matakin jiha wanda ke canzawa ko canza halayyar 'yan wasa daban-daban a cikin tsarin kiwon lafiya. 'Yan wasan kwaikwayo na iya haɗawa da masu ba da kiwon lafiya, ƙungiyoyin kiwon lafiya، masu amfani da mutum, wakilai na inshora, da sauransu. Dokokin suna da tasiri ne kawai lokacin da aka tilasta su, saboda haka dokokin da ke "a kan littattafai" amma ba a aiwatar da su a aikace ba suna da tasiri kaɗan a kan tsarin gaba ɗaya.
# ***Halin*** masu kula da kiwon lafiya ya haɗa da ayyukan masu ba da sabis (misali, halayyar likitoci) da marasa lafiya (misali، kamfen ɗin hana shan sigari) kuma ya haɗa da "canja halayyar mutum ta hanyar tsoma baki na yawan jama'a". Gyaran kiwon lafiya dangane da halayyar yana kewaye da halayen da za a iya amfani da su don inganta sakamakon da aikin tsarin kiwon lafiya. Wadannan halaye sun hada da halayyar neman kiwon lafiya, halayyar kwararru / likitoci, bin magani, da salon rayuwa da halayar rigakafi.

#### Ƙuntatawa
Ba a tsara maɓallan sarrafawa guda biyar na sake fasalin kiwon lafiya don yin aiki a ware ba; sake fasalin kula da kiwon lafiya na iya buƙatar daidaita maɓallin fiye da ɗaya ko maɓallan da yawa a lokaci guda. Bugu da ƙari, babu wani tsari da aka amince da shi na juyawa don cimma takamaiman gyare-gyare ko sakamako. Gyaran kiwon lafiya ya bambanta ta hanyar saitawa da gyare-gyare daga wani mahallin bazai dace da wani ba. Ƙungiyoyin suna hulɗa tare da al'adu da abubuwan tsari waɗanda ba a kwatanta su a cikin wannan tsarin ba, amma waɗanda ke da muhimmiyar tasiri ga sake fasalin kiwon lafiya a cikin wani mahallin da aka ba su. Maimakon gabatar da shawarwari, tsarin yana bawa masu amfani damar daidaita bincikensu da ayyukansu bisa ga mahallin al'adu da dacewa da tsoma baki.

## Rage zamba na kiwon lafiya
Ɗaya daga cikin mahimman abubuwan da ke tattare da sake fasalin kiwon lafiya shine rage zamba da cin zarafin kiwon lafiya. A cikin Amurka da EU, an kiyasta cewa kusan kashi 10 cikin 100 na duk ma'amaloli da kashe kudi na kiwon lafiya na iya zama zamba.

## Kwatanta tsakanin ƙasashe
Kamar yadda aka tabbatar da yawancin tsarin kiwon lafiya daban-daban da aka gani a duk faɗin duniya, akwai hanyoyi daban-daban waɗanda ƙasa zata iya ɗauka yayin tunani game da sake fasalin. Idan aka kwatanta da Burtaniya, likitoci a Jamus suna da ikon ciniki ta hanyar kungiyoyi masu sana'a (watau, Ƙungiyar likitoci); wannan ikon tattaunawa yana shafar kokarin sake fasalin. Jamus tana amfani da kudaden rashin lafiya, wanda 'yan ƙasa ke tilasta shiga amma suna iya fita idan suna da babban kudin shiga (Belien 87). Netherlands ta yi amfani da irin wannan tsarin amma ƙofar kudi don fita ya fi ƙasa (Belien 89). Swiss, a gefe guda suna amfani da tsarin inshorar kiwon lafiya mai zaman kansa inda 'yan ƙasa ke da haɗari ta hanyar shekaru da jima'i, da sauran dalilai (Belien 90).

### Amurka
A Amurka, muhawara game da sake fasalin kiwon lafiya ya haɗa da tambayoyin haƙƙin kiwon lafiya, samun dama, adalci, dorewa, inganci da adadin da gwamnati ta kashe. Tsarin kiwon lafiya na jama'a da masu zaman kansu a Amurka shine mafi tsada a duniya, tare da kiwon lafiya da ke tsada ga kowane mutum fiye da kowane al'umma, kuma ana kashe wani ɓangare mafi girma na babban samfurin cikin gida (GDP) a kansa fiye da kowane memba na Majalisar Dinkin Duniya ban da Timor ta Gabas (Timor-Leste). 

#### Hawaii da Massachusetts
Dukansu Hawaii da Massachusetts sun aiwatar da wasu gyare-gyare a cikin kiwon lafiya, amma babu wata jiha da ke da cikakkiyar ɗaukar 'yan ƙasa. Misali, bayanai daga Gidauniyar Iyali ta Kaiser sun nuna cewa 5% na Massachusetts da 8% na mazaunan Hawaii ba su da inshora. Har zuwa yau, Hukumar Shari'a ta Amurka, wacce Majalisar Kwamishinoni ta Kasa ta tallafawa kan Dokokin Jiha ta Uniform ba ta gabatar da doka ta uniform ko doka ta misali game da inshorar kiwon lafiya ko sake fasalin kiwon lafiya ba.

### Ƙasar Ingila
An sake fasalin kiwon lafiya a cikin 1948 bayan yakin duniya na biyu, gabaɗaya tare da layin rahoton Beveridge na 1942, tare da ƙirƙirar Ma'aikatar Kiwon Lafiya ta ƙasa ko NHS.  An samo asali ne a matsayin wani ɓangare na sake fasalin ayyukan zamantakewar jama'a kuma tsarin inshora na ƙasa ya ba da kuɗaɗen kuɗi,] ko da yake samun kuɗin kiwon lafiya bai ta'allaka kan bayar da gudummawa ga Asusun Inshora na Ƙasa ba.  Ba a soke kula da lafiya mai zaman kansa ba amma dole ne ya yi gogayya da NHS.  Kimanin kashi 15% na duk abin da ake kashewa kan kiwon lafiya a Burtaniya har yanzu ana ba da kuɗaɗen sirri amma wannan ya haɗa da gudummawar majiyyata ga NHS da aka ba da magunguna, don haka kiwon lafiya na kamfanoni masu zaman kansu a Burtaniya kaɗan ne.  A wani bangare na sake fasalin samar da zamantakewar al'umma, tun da farko an yi tunanin cewa za a mai da hankali sosai kan rigakafin rashin lafiya kamar yadda ake magance cututtuka.  NHS[2] alal misali za ta rarraba madarar madarar jarirai da aka ƙarfafa da bitamin da ma'adanai a ƙoƙarin inganta lafiyar yaran da aka haifa a shekarun baya-bayan nan da kuma sauran abubuwan da ake amfani da su kamar su kodin hanta da malt.  Yawancin cututtuka na yara na yau da kullun kamar kyanda, mumps, da pox kaji an kawar da su tare da tsarin rigakafi na ƙasa.

NHS  ta kasance ta hanyar sauye-sauye da yawa tun 1974. Gwamnatocin Conservative Thatcher sun yi ƙoƙari su kawo gasa a cikin NHS ta hanyar haɓaka matsayin mai ba da sabis / mai siye tsakanin asibitoci a matsayin masu ba da sabis da hukumomin kiwon lafiya a matsayin masu siye. Wannan ya bukaci cikakken farashin ayyukan, wani abu da NHS ba ta taɓa yin irin wannan daki-daki ba, kuma wasu sun ji ba dole ba ne. Jam'iyyar Labour gabaɗaya ta yi adawa da waɗannan canje-canje, kodayake bayan jam'iyyar ta zama Sabon Labour, Gwamnatin Blair ta riƙe abubuwa na gasa har ma ta faɗaɗa shi, ta ba da damar masu ba da kiwon lafiya masu zaman kansu su nemi aikin NHS. Wasu cibiyoyin magani da bincike yanzu kamfanoni masu zaman kansu ne ke gudanar da su kuma ana tallafawa a karkashin kwangila. Koyaya, girman wannan keɓancewar aikin NHS har yanzu ƙarami ne, kodayake ya kasance mai kawo rigima. Gwamnatin ta ba da ƙarin kuɗi ga NHS ta ɗaga shi zuwa kusan matakin kuɗi iri ɗaya kamar matsakaicin Turai kuma a sakamakon haka, akwai babban fadadawa da shirin sabuntawa da lokutan jira sun inganta.

Gwamnatin Gordon Brown ta ba da shawarar sabbin gyare-gyare] don kulawa a Ingila.  Daya shine a mayar da NHS zuwa ga rigakafin lafiya ta hanyar magance matsalolin da aka sani suna haifar da rashin lafiya na dogon lokaci.  Mafi girma daga cikinsu shine kiba da cututtukan da ke da alaƙa irin su ciwon sukari da cututtukan zuciya da jijiyoyin jini.  Gyara na biyu shine don sanya NHS ya zama sabis na sirri, kuma yana tattaunawa da likitoci don samar da ƙarin ayyuka a wasu lokuta mafi dacewa ga majiyyaci, kamar a maraice da kuma a karshen mako.  Wannan ra'ayin sabis na sirri zai gabatar da duban lafiya na yau da kullun don a duba yawan jama'a akai-akai.  Likitoci za su ba da ƙarin shawarwari game da rigakafin rashin lafiya (misali ƙarfafawa da taimaka wa marasa lafiya don sarrafa nauyinsu, abinci, motsa jiki, daina shan taba da sauransu) don haka magance matsalolin kafin su ƙara girma.  Lokacin jira, wanda ya faɗi da yawa a ƙarƙashin Blair (lokacin jira na tsaka-tsaki shine kusan makonni 6 don zaɓin tiyata mara gaggawa) suma suna cikin mai da hankali.  An sanya manufa daga Disamba 2008, don tabbatar da cewa babu wani mutum ya jira fiye da makonni 18 daga ranar da aka tura majiyyaci zuwa asibiti zuwa lokacin tiyata ko magani.  Wannan lokacin na makonni 18 ya haɗa da lokacin shirya alƙawari na farko, lokacin yin duk wani bincike ko gwaje-gwaje don sanin musabbabin matsalar da yadda ya kamata a bi da shi.  An buga Kundin Tsarin Mulki na NHS wanda ke tsara haƙƙin doka na marasa lafiya da kuma alkawuran (ba a aiwatar da doka ba) NHS tana ƙoƙarin kiyayewa a Ingila.

### Jamus
Yawancin gyare-gyaren kiwon lafiya a Jamus sun kasance matakan doka don daidaita inshorar lafiyar jama'a tun 1983. 9 cikin 10 'yan ƙasa suna da inshorar jama'a, kashi 8 ne kawai a sirri.  Kula da lafiya a Jamus, gami da masana'anta da duk hidimomi, na ɗaya daga cikin manyan sassa na tattalin arzikin Jamus.  Jimillar kashe kuɗin da aka kashe a fannin tattalin arziƙin kiwon lafiya na Jamus ya kai kusan Yuro biliyan 287.3 a shekarar 2010, kwatankwacin kashi 11.6 cikin ɗari na jimlar yawan amfanin gida (GDP) a wannan shekara da kusan Yuro 3,510 ga kowane mutum.  Kulawar marasa lafiya kai tsaye da na marasa lafiya daidai kusan kashi ɗaya cikin huɗu na duk abin da aka kashe - ya danganta da hangen nesa.  Kudaden da ake kashewa kan magungunan harhada magunguna kusan ninki biyu na na duka sassan asibitoci.  Kudaden magunguna ya karu da matsakaicin shekara na 4.1% tsakanin 2004 zuwa 2010.

Wadannan ci gaba sun haifar da sauye-sauyen kiwon lafiya da yawa tun daga shekarun 1980. Misali na ainihi na 2010 da 2011: A karo na farko tun daga shekara ta 2004 kashewar miyagun ƙwayoyi ya fadi daga Yuro biliyan 30.2 a shekara ta 2010, zuwa Yuro biliyar 29.1 a shekara ta 2011, watau rage Yuro biliya 1.1 ko rage 3.6%. Wannan ya samo asali ne daga sake fasalin Dokar Tsaro ta Jama'a: rangwamen masana'anta 16% maimakon 6%, dakatar da farashi, kara kwangilar rangwamen, kara rangwamen ta hanyar kasuwanci da kantin magani.

### Netherlands
Netherlands ta gabatar da sabon tsarin inshorar kiwon lafiya wanda ya dogara da daidaitattun haɗari ta hanyar tafkin daidaitattun hadari. Ta wannan hanyar, ana samun kunshin inshora na tilas ga dukkan 'yan ƙasa a farashi mai araha ba tare da buƙatar kamfanin inshora ya tantance shi don haɗari ba. Bugu da ƙari, masu inshorar lafiya yanzu suna shirye su ɗauki mutane masu haɗari saboda suna karɓar diyya don haɗari mafi girma.

Wani labarin 2008 a cikin mujallar Health Affairs ya ba da shawarar cewa tsarin kiwon lafiya na Dutch, wanda ya haɗu da ɗaukar nauyin duniya tare da shirye-shiryen kiwon lafiya masu zaman kansu, na iya zama abin koyi don sake fasalin Amurka.

### Rasha
 
Bayan rushewar Tarayyar Soviet, Rasha ta fara jerin gyare-gyare da nufin samar da ingantaccen kiwon lafiya ta hanyar inshorar kiwon lafiya tare da masu samar da masu zaman kansu ban da cibiyoyin da ke gudanar da gwamnati. A cewar OECD  babu wani gyare-gyare na 1991-93 da ya yi aiki kamar yadda aka tsara kuma gyare- gyare-gine sun yi muni a hanyoyi da yawa. Rasha tana da likitoci, asibitoci, da ma'aikatan kiwon lafiya fiye da kusan kowace ƙasa a duniya a kan kowane mutum, amma tun lokacin da Tarayyar Soviet ta rushe, lafiyar jama'ar Rasha ta ragu sosai sakamakon canje-canjen zamantakewa, tattalin arziki, da salon rayuwa. Koyaya, bayan Vladimir Putin">Putin ya zama shugaban kasa a shekara ta 2000 an sami ci gaba mai mahimmanci a cikin kashe kuɗi don kiwon lafiya na jama'a kuma a shekara ta 2006 ya wuce matakin kafin 1991 a cikin ainihin sharuddan. Har ila yau, tsammanin rayuwa ya karu daga 1991 zuwa 1993 matakan, yawan mutuwar jarirai ya sauka daga 18.1 a 1995 zuwa 8.4 a 2008. Firayim Ministan Rasha Vladimir Putin ya ba da sanarwar sake fasalin kiwon lafiya mai girma a cikin 2011 kuma ya yi alkawarin rarraba fiye da rubles biliyan 300 ($ biliyan 10) a cikin 'yan shekaru masu zuwa don inganta kiwon lafiya a kasar.

### Taiwan
Taiwan ta canza tsarin kiwon lafiya a cikin 1995 zuwa tsarin Inshorar Lafiya na Kasa mai kama da tsarin Medicare na Amurka don tsofaffi. A sakamakon haka, kashi 40% na mutanen Taiwan da ba su da inshora a baya yanzu an rufe su. An ce yana ba da ɗaukar hoto na duniya tare da zaɓin likitoci da asibitoci kyauta kuma babu jerin jira. An bayar da rahoton cewa kuri'un da aka yi a shekara ta 2005 sun nuna cewa kashi 72.5% na mutanen Taiwan suna farin ciki da tsarin, kuma idan ba su da farin ciki, yana da farashin firam (daidai da kasa da US $ 20 a wata). 

Ma'aikata da masu aiki da kansu suna da iyaka ta hanyar doka don biyan inshorar kiwon lafiya ta kasa (NHI) wanda yayi kama da gudummawar tsaro a wasu ƙasashe. Koyaya, NHI tsarin biyan kuɗi ne. Manufar ita ce samun kudin shiga don biyan kudin shiga. Hakanan ana tallafawa tsarin ta hanyar harajin taba sigari da gudummawa daga caca ta ƙasa.

## Dubi kuma

## Manazarta