Inshorar lafiya
Inshorar lafiya ko inshorar likita (wanda kuma aka sani da taimakon likita a Afirka ta Kudu) wani nau'in inshora ne wanda ke rufe gaba ɗaya ko wani ɓangare na haɗarin mutum ya jawo kuɗin magani. Kamar sauran nau'ikan inshora, ana raba haɗari tsakanin mutane da yawa. Ta hanyar ƙididdige haɗarin haɗarin lafiya gabaɗaya da kuɗin tsarin kiwon lafiya akan wuraren haɗari, mai insurer zai iya haɓaka tsarin kuɗi na yau da kullun, kamar ƙimar kuɗi na kowane wata ko harajin biyan kuɗi, don samar da kuɗin biyan fa'idodin kiwon lafiya da aka ƙayyade a cikin inshora. yarjejeniya. Ƙungiya ta tsakiya ce ke gudanar da wannan fa'idar, kamar hukumar gwamnati, kasuwanci mai zaman kansa, ko mahaɗan mara riba.
![](http://upload.wikimedia.org/wikipedia/commons/thumb/c/c7/Insurance_Law_and_Practice.jpg/220px-Insurance_Law_and_Practice.jpg)
A cewar Ƙungiyar Inshorar Lafiya ta Amurka, an ayyana inshorar lafiya a matsayin "launi wanda ke ba da biyan kuɗin fa'idodin sakamakon rashin lafiya ko rauni. Ya haɗa da inshora don asarar hatsarori, kuɗin likita, nakasa, ko mutuwa mai haɗari da lalacewa".[1]:225
Tarihi
gyara sasheManufar inshorar lafiya ita ce:
- Kwangila tsakanin mai ba da inshora (misali kamfanin inshora ko gwamnati) da mutum ko mai ɗaukar nauyinsa (wato ma'aikaci ko ƙungiyar al'umma). Kwangilar na iya zama sabuntawa (shekara-shekara, kowane wata) ko tsawon rai a cikin yanayin inshora na sirri. Hakanan yana iya zama wajibi ga duk 'yan ƙasa a cikin yanayin tsare-tsaren ƙasa. Nau'i da adadin kuɗin kula da lafiyar da mai ba da inshorar kiwon lafiya zai rufe an ƙayyade su a rubuce, a cikin kwangilar memba ko ɗan littafin "Shaidar Taimako" don inshora mai zaman kansa, ko a cikin [manufofin kiwon lafiya] na ƙasa don inshorar jama'a.
- (Amurka ta musamman) A cikin Amurka, akwai nau'ikan inshorar lafiya iri biyu - masu biyan haraji da kuma masu zaman kansu. Misalin tsarin inshora mai zaman kansa ya haɗa da shirin ERISA mai ɗaukar nauyin mai aiki (Aikin Tsaron Samun Kuɗin Ma'aikata na 1974). Yawanci, waɗannan kamfanoni suna haɓaka kansu azaman suna da alaƙa da manyan masu ba da inshora. Duk da haka, a cikin mahallin shirin ERISA, waɗannan kamfanonin inshora ba sa shiga cikin ayyukan inshora; maimakon haka, suna gudanar da ayyukan gudanarwa. Saboda haka, tsare-tsaren ERISA ba a keɓance su daga dokokin jihohi kuma sun faɗi ƙarƙashin ikon tarayya, wanda Ma'aikatar Kwadago ta Amurka (USDOL) ke kulawa. Ana iya samun takamaiman bayanai game da fa'idodi ko ɗaukar hoto a cikin Takaitaccen Bayanin Shirin (SPD). Idan ana buƙatar roko, tsarin yawanci ya ƙunshi ƙaddamar da shi ta hanyar kamfanin inshora sannan kuma kai ga Fiduciary Plan na Ma'aikata. Idan har yanzu ba a cimma matsaya ba, za a iya ƙara matsayar zuwa USDOL don dubawa don tabbatar da bin ka'idodin ERISA, kuma, idan ya cancanta, ana iya ɗaukar matakin shari'a ta hanyar shigar da ƙara a kotun tarayya.
wajibcin wanda ke da inshora na iya ɗaukar nau'i da yawa:
- Premium: Adadin da mai riƙe manufofin ko mai ɗaukar nauyinsu (misali ma'aikaci) ke biya wa tsarin kiwon lafiya don siyan ɗaukar hoto. (Amurka ta musamman) Dangane da dokar kiwon lafiya, ana ƙididdige ƙima ta amfani da takamaiman dalilai guda 5 game da wanda ke da inshora. Waɗannan abubuwan sune shekaru, wuri, shan taba, ɗaiɗai da rajista na iyali, da kuma nau'in tsarin da inshora ya zaɓa. Ƙarƙashin Dokar Kulawa mai araha, gwamnati tana biyan kuɗin haraji don biyan wani ɓangare na ƙimar ga mutanen da suka sayi inshora na sirri ta wurin Kasuwar Inshora.: TS 4:03
- Deductible: Adadin da mai inshorar dole ne ya biya daga aljihu kafin mai inshorar lafiya ya biya kason sa. Misali, masu rike da manufofin za su iya biyan $7500 deductible a kowace shekara, kafin duk wani kiwon lafiyar su ya rufe shi ta hanyar inshorar lafiya. Yana iya ɗaukar ziyarar likita da yawa ko sake cika takardar sayan magani kafin mai insho ya kai ga abin da za a cire kuma kamfanin inshora ya fara biyan kuɗi. Bugu da ƙari, yawancin tsare-tsare ba sa amfani da kuɗin haɗin gwiwa don ziyarar likita ko takardun magani a kan abin da za a cire ku.
- Biyan kuɗi: Adadin da mai inshorar dole ne ya biya daga aljihu kafin mai inshorar lafiya ya biya don wata ziyara ko sabis. Misali, mutumin da ke da inshora zai iya biyan $45 haɗin gwiwa don ziyarar likita, ko don samun takardar sayan magani. Dole ne a biya haɗin gwiwa a duk lokacin da aka sami takamaiman sabis.
- Haɗin kai: Maimakon, ko ban da, biyan ƙayyadaddun adadin gaba (biyan haɗin gwiwa), inshorar haɗin gwiwa kashi ne na jimlar kuɗin da mai insho zai iya biya. Misali, memba na iya biyan kashi 20% na kudin tiyata sama da biyan hadin gwiwa, yayin da kamfanin inshora ya biya sauran kashi 80%. Idan akwai babban iyaka akan tsabar kuɗi, mai riƙe manufofin zai iya ƙare bashi kaɗan, ko yawa, ya danganta da ainihin farashin ayyukan da suke samu.
- Keɓewa: Ba duk sabis ke rufe ba. Abubuwan da aka biya kamar amfani-da-jifa, haraji, da sauransu. Ana sa ran masu inshora gabaɗaya za su biya cikakken kuɗin ayyukan da ba a rufe su daga aljihunsu.
- Ƙimar ɗaukar hoto: Wasu manufofin inshora na kiwon lafiya suna biyan kuɗin kula da lafiya har zuwa wani adadin dala. Ana iya tsammanin mutumin da ke da inshora ya biya duk wani cajin da ya wuce iyakar tsarin kiwon lafiya na takamaiman sabis. Bugu da ƙari, wasu tsare-tsaren kamfanonin inshora suna da maxima na shekara-shekara ko na rayuwa. A cikin waɗannan lokuta, tsarin kiwon lafiya zai dakatar da biyan kuɗi lokacin da suka kai iyakar fa'ida, kuma mai riƙe da manufofin dole ne ya biya duk sauran farashin
- Matsakaicin aljihu: Mai kama da iyakokin ɗaukar hoto, sai dai a wannan yanayin, wajibcin biyan mai insho ya ƙare lokacin da suka kai matsakaicin mafi girman aljihu, kuma inshorar lafiya yana biyan duk ƙarin farashin da aka rufe. Matsakaicin mafi girman aljihu za a iya iyakance shi zuwa takamaiman nau'in fa'ida (kamar magungunan likitanci) ko kuma yana iya amfani da duk ɗaukar hoto da aka bayar yayin takamaiman shekara ta fa'ida.
- Capitation: Adadin da mai insurer ya biya ga ma'aikacin kiwon lafiya, wanda mai ba da sabis ya yarda ya kula da duk membobin mai insurer. Mai Ba da Sadarwar Sadarwar
- Sadarwa: (Lokacin Amurka) Ma'aikacin kiwon lafiya a cikin jerin masu samarwa wanda mai insurer ya zaɓa. Mai insurer zai ba da rangwamen kuɗi ko biyan kuɗi, ko ƙarin fa'idodi, ga memba na shirin don ganin mai ba da hanyar sadarwa. Gabaɗaya, masu samarwa a cikin hanyar sadarwa sune masu samarwa waɗanda ke da kwangila tare da mai inshorar don karɓar ƙimar ƙarin rangwame daga cajin "na al'ada da na al'ada" mai insurer yana biya ga masu samar da hanyar sadarwa.
- Out-of-Network Provider: Ma'aikacin kiwon lafiya wanda bai kulla yarjejeniya da shirin ba. Idan ana amfani da mai ba da hanyar sadarwar da ba ta da hanyar sadarwa, mai yiwuwa majiyyaci ya biya cikakken farashin fa'idodi da sabis ɗin da aka karɓa daga mai badawa. Ko don sabis na gaggawa, masu ba da hanyar sadarwa na iya yin lissafin majiyyata don wasu ƙarin farashi masu alaƙa.
- Izini na Farko: Takaddun shaida ko izini wanda mai inshorar ke bayarwa kafin aikin likita ya faru. Samun izini yana nufin cewa mai insurer ya wajaba ya biya sabis, yana ɗaukan ya yi daidai da abin da aka ba izini. [an gardama - tattauna] Yawancin ƙananan, ayyuka na yau da kullum ba sa buƙatar izini.
- Formulary: jerin magungunan da tsarin inshora ya yarda ya rufe. Bayanin fa'idodi: Takaddun da mai insurer zai iya aikawa ga majiyyaci yana bayanin abin da aka rufe don sabis na likita, da yadda aka ƙayyade adadin biyan kuɗi da adadin alhakin haƙuri. Game da lissafin kuɗin dakin gaggawa, ana sanar da marasa lafiya a cikin kwanaki 30 bayan sabis. Ba kasafai ake sanar da marasa lafiya farashin sabis na dakin gaggawa a cikin mutum ba saboda yanayin marasa lafiya da sauran kayan aiki har sai an sami wannan wasiƙar.[2]
Shirye-shiryen magani wani nau'i ne na inshora da ake bayarwa ta wasu tsare-tsaren inshorar lafiya. A cikin Amurka, majiyyaci yawanci yana biyan kuɗin kwas ɗin kuɗi da ɓangaren inshorar magani ko duk ma'auni na magungunan da aka rufe a cikin tsarin tsarin. Misali, a lardin Quebec, Kanada, ana buƙatar inshorar likitancin magani a duk duniya a matsayin wani ɓangare na tsarin inshorar lafiyar jama'a, amma ana iya siye da gudanar da shi ta hanyar tsare-tsare masu zaman kansu ko na ƙungiya, ko ta tsarin jama'a.
Wasu, idan ba mafi yawa ba, ma'aikatan kiwon lafiya a Amurka za su yarda su yi lissafin kamfanin inshora idan majiyyata suna son sanya hannu kan yarjejeniyar cewa za su ɗauki nauyin kuɗin da kamfanin inshora bai biya ba. Kamfanin inshora yana biya daga masu samar da hanyar sadarwa bisa ga cajin "masu hankali da na al'ada", wanda zai iya zama ƙasa da kuɗin da mai bayarwa ya saba. Hakanan mai bayarwa na iya samun kwangila daban tare da mai insurer don karɓar abin da ya kai adadin rangwame ko ƙima zuwa daidaitattun cajin mai bayarwa. Gabaɗaya yana kashe majiyyaci kaɗan don amfani da mai ba da hanyar sadarwa.
Kwatance
gyara sasheAsusun Commonwealth, a cikin bincikensa na shekara-shekara, "Mirror, Mirror on the Wall", ya kwatanta aikin da tsarin kula da lafiya a Australia, New Zealand, United Kingdom, Jamus, Canada da kuma Amurka bincikensa na 2007 ya gano cewa, ko da yake Tsarin Amurka shine mafi tsada, koyaushe yana kasa aiki idan aka kwatanta da sauran ƙasashe. Bambanci ɗaya tsakanin Amurka da sauran ƙasashen da ke cikin binciken shine cewa Amurka ce kaɗai ƙasa da ba ta da inshorar lafiya na duniya. [abubuwan da ake bukata]
Asusun Commonwealth ya kammala binciken manufofin kiwon lafiya na shekara-shekara na goma sha uku a cikin 2010. Binciken binciken "ya sami bambance-bambance masu yawa a cikin samun dama, nauyin farashi, da matsaloli tare da inshorar lafiya da ke da alaƙa da ƙirar inshora". Daga cikin kasashen da aka gudanar da binciken, sakamakon ya nuna cewa, mutane a Amurka sun fi kashe kudaden da ba a aljihu ba, suna da takaddama da kamfanonin inshora fiye da sauran kasashe, da kuma kin biyan kudin inshora; Har ila yau, aikin takarda ya kasance mafi girma duk da cewa Jamus tana da matakan rubutu iri ɗaya.[5]
Ostiraliya
gyara sasheAna kiran tsarin kula da lafiyar jama'a na Australiya Medicare, wanda ke ba da damar samun damar jiyya na asibiti kyauta da tallafin jinya daga asibiti. Ana ba da kuɗaɗen harajin harajin kashi 2% akan duk masu biyan haraji, ƙarin harajin 1% akan masu samun kuɗi masu yawa, da kuma kudaden shiga na gabaɗaya. [abubuwan da ake bukata]
Ƙungiyoyin inshorar lafiya masu zaman kansu suna samun kuɗin tsarin kiwon lafiya masu zaman kansu. Mafi girma daga cikin waɗannan shine Medibank Private Limited, wanda ya kasance, har zuwa 2014, wata hukuma ce ta gwamnati, lokacin da aka mayar da ita kuma aka jera ta a kasuwar hada-hadar hannayen jari ta Australiya. [abubuwan da ake bukata]
Kudaden lafiyar Australiya na iya zama ko dai 'don riba' gami da Bupa da nib; 'Mutual' gami da Hadin kan Australiya; ko 'marasa riba' gami da GMHBA, HCF da Inshorar Lafiya ta HBF. Wasu, kamar Kiwon Lafiyar ƴan sanda, suna da memba an iyakance ga ƙungiyoyi na musamman, amma galibi suna da buɗe memba. Kasancewa cikin mafi yawan kuɗin kiwon lafiya kuma ana samun su ta hanyar gidajen yanar gizon kwatanta. Waɗannan rukunin yanar gizon kwatancen suna aiki ne bisa hukuma ta hanyar yarjejeniya tare da kuɗin kiwon lafiya masu shiga. Ombudsman na Inshorar Lafiya mai zaman kansa kuma yana aiki da gidan yanar gizon kyauta wanda ke ba masu amfani damar bincika da kwatanta samfuran masu inshorar lafiya masu zaman kansu, wanda ya haɗa da bayanai kan farashi da matakin rufewa.[6]
Yawancin nau'ikan inshorar lafiya masu zaman kansu a Ostiraliya ana tsara su ta Dokar Inshorar Lafiya ta Masu zaman kansu ta 2007. Korafe-korafe da bayar da rahoto na masana'antar kiwon lafiya masu zaman kansu wata hukuma ce ta gwamnati mai zaman kanta, mai kula da inshorar lafiya mai zaman kanta. Jami'in kare hakkin jama'a yana wallafa rahoton shekara-shekara wanda ya bayyana adadi da yanayin korafe-korafe a kowane asusun kiwon lafiya idan aka kwatanta da kason kasuwarsu.
Tsarin kiwon lafiya mai zaman kansa a Ostiraliya yana aiki ne bisa “ƙididdigar al’umma”, ta yadda ƙimar kuɗi ba ta bambanta kawai saboda tarihin likitancin mutum na baya, yanayin lafiyar da ake ciki a yanzu, ko (gaba ɗaya) shekarun su (amma duba Cover Life Life Cover a ƙasa) . Daidaita wannan lokutan jira ne, musamman don yanayin da aka rigaya (yawanci ana magana a cikin masana'antar a matsayin PEA, wanda ke tsaye ga "cutar da ta riga ta kasance"). Kudade suna da hakkin sanya wa'adin jira har zuwa watanni 12 akan fa'idodin kowane yanayi na likita alamun da alamun da suka wanzu a cikin watanni shidan da suka ƙare a ranar da mutumin ya fara ɗaukar inshora. Har ila yau, suna da damar sanya wa'adin watanni 12 don fa'idodin jiyya da suka shafi yanayin haihuwa, da kuma lokacin jira na watanni 2 don duk sauran fa'idodin lokacin da mutum ya fara ɗaukar inshora na sirri. Kudade suna da ikon rage ko cire irin waɗannan lokutan jira a lokuta ɗaya. Har ila yau, suna da 'yanci ba su tilasta su ba, don farawa, amma wannan zai sanya irin wannan asusu cikin haɗari na "zaɓi mara kyau", yana jawo adadin mambobi masu yawa daga wasu kudade, ko kuma daga ƙungiyar mambobi masu niyya waɗanda watakila sun shiga. sauran kudade. Hakanan zai jawo hankalin mutanen da ke da yanayin kiwon lafiya, waɗanda ƙila ba za su ɗauki inshora kwata-kwata ba saboda musun fa'idodin na tsawon watanni 12 saboda Dokar PEA. Ribar da aka biya na wadannan sharudda zai haifar da matsin lamba ga duk mambobin asusun, wanda hakan zai sa wasu su yi watsi da zama membobinsu, wanda hakan zai haifar da karin hauhawar kudaden da ake biya, kuma za a fuskanci muguwar dabi’a ta masu karbar kudaden shiga. [abubuwan da ake bukata]
Gwamnatin Ostiraliya ta bullo da wasu abubuwan karfafa gwiwa don karfafa manya su dauki inshorar asibiti masu zaman kansu. Waɗannan sun haɗa da:
- Rufin Lafiya na Rayuwa: Idan mutum bai ɗauki murfin asibiti mai zaman kansa ba ta 1 ga Yuli bayan cikar su na 31st, sannan lokacin (kuma idan) sun yi hakan bayan wannan lokacin, ƙimar su dole ne su haɗa da ɗaukar nauyin 2% a kowace shekara na kowace shekara. sun kasance ba su da murfin asibiti. Don haka, mutumin da ya ɗauki murfin sirri a karon farko yana da shekaru 40 zai biya nauyin kashi 20 cikin ɗari. Ana cire lodin bayan shekaru 10 na ci gaba da rufewar asibiti. Load ɗin ya shafi ƙimar kuɗi ne kawai don murfin asibiti, ba ga murfin ƙara (kari) ba.
- Medicare Levy Surcharge: Mutanen da kuɗin shiga na haraji ya fi ƙayyadaddun adadin (a cikin shekara ta 2011/12 $ 80,000 ga marasa aure da $ 168,000 ga ma'aurata) kuma waɗanda ba su da isasshen matakin murfin asibiti masu zaman kansu dole ne su biya ƙarin 1% akan sama. na daidaitattun 1.5% Medicare Levy. Ma'anar ita ce, idan aka tilasta wa mutanen da ke cikin wannan rukunin kuɗi don biyan ƙarin kuɗi ta wata hanya ko wata, yawancin za su zabi sayen inshora na asibiti tare da shi, tare da yiwuwar samun fa'ida idan suna buƙatar kulawar asibiti mai zaman kansa - maimakon biya shi a ciki. nau'in karin haraji da kuma samun biyan kuɗin asibiti masu zaman kansu.
- Gwamnatin Ostiraliya ta sanar a watan Mayun 2008 cewa ta ba da shawarar ƙara ƙofofin, zuwa $100,000 ga marasa aure da $150,000 ga iyalai. Waɗannan canje-canje na buƙatar amincewar majalisa. An gabatar da kudirin sauya dokar amma majalisar dattawa ba ta zartar da shi ba. An yi gyaran fuska a ranar 16 ga Oktoba, 2008. An yi ta sukar cewa sauye-sauyen za su sa mutane da yawa su yi watsi da inshorar kiwon lafiya na sirri, wanda zai haifar da wani nauyi a kan tsarin asibitocin gwamnati, da karuwar kudaden kuɗi ga wadanda ke zaune tare da masu zaman kansu.
- Ragowar Inshorar Lafiya ta Masu zaman kansu: Gwamnati tana ba da tallafin kuɗi don duk murfin inshorar lafiya masu zaman kansu, gami da asibiti da ƙari (ƙari), da 10%, 20% ko 30%, ya danganta da shekaru. Gwamnatin Rudd ta sanar a watan Mayun 2009 cewa tun daga watan Yuli 2010, rangwamen zai zama abin gwadawa, kuma ana ba da shi akan sikelin zamiya. Yayin da wannan yunkuri (wanda zai bukaci a samar da doka) ya sha kaye a Majalisar Dattawa a lokacin, a farkon shekarar 2011 gwamnatin Gillard ta sanar da shirin sake bullo da dokar bayan 'yan adawa sun rasa ma'aunin iko a majalisar dattawa. ALP da Greens sun dade suna adawa da rangwame, suna mai nuni da shi a matsayin "jindadin aji na tsakiya".
Kanada
gyara sasheKamar yadda yake a cikin Kundin Tsarin Mulki na Kanada, kula da lafiya galibi alhakin gwamnatin lardi ne a Kanada (babban keɓantawa shine alhakin gwamnatin tarayya na ayyukan da aka bayar ga mutanen ƙabilar da aka yi yarjejeniya, da Royal Canadian Mounted Police, Sojoji, da Membobin Majalisa) . Saboda haka, kowane lardi yana gudanar da nasa tsarin inshorar lafiya. Gwamnatin tarayya tana rinjayar inshorar lafiya ta hanyar ikonta na kasafin kuɗi - tana tura tsabar kuɗi da wuraren haraji zuwa larduna don taimakawa wajen biyan kuɗin shirye-shiryen inshorar lafiya na duniya. A karkashin Dokar Kiwon Lafiya ta Kanada, gwamnatin tarayya ta ba da umarni da aiwatar da buƙatun cewa duk mutane suna da damar yin amfani da abin da ake kira "ayyukan da ake buƙata na likita," waɗanda aka ayyana da farko a matsayin kulawar da likitoci ke bayarwa ko a asibitoci, da kuma ɓangaren reno na mazaunin dogon lokaci. kula. Idan larduna sun ƙyale likitoci ko cibiyoyi su cajin majiyyata don ayyukan da suka dace na likitanci, gwamnatin tarayya ta rage yawan kuɗin da take yi wa larduna da adadin kuɗin da aka haramta. Gaba ɗaya, tsarin inshorar lafiyar jama'a na lardin Kanada ana kiransa da Medicare akai-akai. Wannan inshorar jama'a ana samun kuɗin haraji ne daga kuɗin shiga na gabaɗaya na gwamnati, kodayake British Columbia da Ontario suna ɗaukar ƙimar kuɗi na wajibi tare da ɗimbin ƙima ga daidaikun mutane da iyalai don samar da ƙarin kudaden shiga - a zahiri, surtax. Ana ba da izinin inshorar lafiya mai zaman kansa, amma a cikin gwamnatocin larduna shida kawai don ayyukan da tsare-tsaren kiwon lafiyar jama'a ba su rufe (misali, ɗakuna masu zaman kansu ko masu zaman kansu a asibitoci da shirye-shiryen magani). Larduna huɗu suna ba da izinin inshora don ayyukan da Dokar Lafiya ta Kanada ta ba da izini, amma a aikace, babu kasuwa don sa. Duk 'yan Kanada suna da 'yanci don amfani da inshora na sirri don zaɓaɓɓun sabis na likita kamar aikin gyaran hangen nesa na laser, tiyatar kwaskwarima, da sauran hanyoyin kiwon lafiya marasa tushe. Wasu 65% na mutanen Kanada suna da wani nau'i na ƙarin inshorar lafiya masu zaman kansu; yawancinsu suna samun ta ta hannun masu aikinsu. Ayyukan kamfanoni masu zaman kansu da gwamnati ba ta biya su kusan kashi 30 cikin 100 na jimillar kashe kuɗin kula da lafiya.
A shekara ta 2005, Kotun Koli ta Kanada ta yanke hukunci, a Chaoulli v. Quebec, cewa haramcin da lardin ya yi game da inshora mai zaman kansa don kula da lafiya wanda tsarin lardin ya rigaya ya saba wa Yarjejeniya ta Quebec na 'Yanci da 'Yanci, kuma musamman, sassan da ke hulɗa da 'yancin rayuwa da tsaro, idan akwai lokuta masu tsawo da ba za a yarda da su ba don jinya, kamar yadda aka yi zargin a cikin wannan harka. Hukuncin bai canza tsarin inshorar lafiya gabaɗaya ba a duk faɗin Kanada, amma ya haifar da yunƙurin magance mahimman batutuwan wadata da buƙata da tasirin lokutan jira..[7]
China
gyara sasheCyprus
gyara sasheA cikin 2020 a Cyprus an gabatar da Tsarin Kiwon Lafiya na Gabaɗaya (GHS, wanda kuma aka sani da GESY) wanda asusun inshora ne mai zaman kansa wanda za a biya asibitoci, likitoci masu zaman kansu, likitocin magunguna, dakunan gwaje-gwaje, dakunan gwaje-gwaje na microbiological, da likitocin physiotherapists don ba da kulawar likita. mazaunan Cyprus na dindindin waɗanda za su ba da gudummawa ga wannan asusu. [abubuwan da ake bukata]
Baya ga GESY, fiye da kamfanonin inshora na gida da na waje 12 (misali Bupa, Aetna, Cigna, Metlife) suna ba da tsare-tsaren inshorar likita na mutum da na rukuni. An raba tsare-tsare zuwa manyan nau'ikan tsare-tsare guda biyu da ke ba da ɗaukar hoto daga kuɗin marasa lafiya (watau asibiti, ayyuka) da tsare-tsaren da suka shafi kuɗin marasa lafiya da marasa lafiya (kamar ziyarar likita, magunguna, hanyoyin kwantar da hankali). [ ambato
Faransa
gyara sasheAn kafa tsarin inshorar lafiya na ƙasa a cikin 1945, jim kaɗan bayan ƙarshen yakin duniya na biyu. An yi sulhu tsakanin Gaullist da wakilan kwaminisanci a majalisar dokokin Faransa. Gaullist masu ra'ayin mazan jiya sun yi adawa da tsarin kula da kiwon lafiya na jihohi, yayin da 'yan gurguzu ke goyan bayan cikakkiyar ba da kulawar kiwon lafiya ta ƙasa tare da samfurin Beveridge na Biritaniya. [abubuwan da ake bukata]
Sakamakon shirin ya dogara ne akan sana'a: ana buƙatar duk mutanen da ke aiki su biya wani kaso na abin da suke samu zuwa asusun inshora na kiwon lafiya mara riba, wanda ke daidaita haɗarin rashin lafiya, kuma wanda ke mayar da kuɗin likita a farashi daban-daban. Yara da ma'auratan masu inshora sun cancanci fa'ida, haka nan. Kowane asusu yana da ’yanci don gudanar da kasafin kuɗin kansa, kuma ana amfani da shi don biyan kuɗin aikin likita gwargwadon yadda ya ga ya dace, amma bayan gyare-gyare da yawa a cikin shekarun baya-bayan nan, yawancin kuɗi suna ba da matakin biyan kuɗi da fa'idodi iri ɗaya. [ ambato
Gwamnati tana da ayyuka biyu a cikin wannan tsarin.
- Hakkin gwamnati na farko shine daidaita adadin da ya kamata a tattauna farashin kiwon lafiya, kuma yana yin hakan ta hanyoyi biyu: Ma'aikatar Lafiya kai tsaye tana tattauna farashin magani tare da masana'antun, bisa ga matsakaicin farashin sayarwa da aka lura a kasashe makwabta. Kwamitin likitoci da masana sun yanke shawara idan maganin yana ba da fa'idar kiwon lafiya mai mahimmanci don a biya shi (an biya mafi yawan magunguna, gami da homeopathy). A layi daya, gwamnati ta gyara kudin biyan kuɗi don ayyukan kiwon lafiya: wannan yana nufin cewa likita yana da 'yanci ya caji kuɗin da yake so don tuntuɓar ko gwaji, amma tsarin tsaro na jama'a zai biya shi ne kawai a farashin da aka riga aka saita. Ana saita waɗannan haraji a kowace shekara ta hanyar tattaunawa tare da kungiyoyin wakilan likitoci.
- Hakki na biyu na gwamnati shine kula da asusun inshorar lafiya, don tabbatar da cewa suna gudanar da kudaden da suka karɓa daidai, da kuma tabbatar da kula da cibiyar asibitin jama'a.
A yau, wannan tsarin yana da yawa ko kaɗan. Duk 'yan ƙasa da mazauna ƙasashen waje na doka na Faransa suna da ɗaya daga cikin waɗannan shirye-shirye na wajibi, waɗanda ke ci gaba da samun tallafi ta hanyar sa hannu na ma'aikata. Koyaya, tun 1945, an gabatar da manyan canje-canje masu yawa. Na farko, kuɗaɗen kula da lafiya daban-daban (akwai guda biyar: Gabaɗaya, Mai zaman kansa, Aikin Noma, ɗalibi, ma’aikatan gwamnati) yanzu duk suna biyan kuɗi iri ɗaya. Na biyu, tun daga shekara ta 2000, gwamnati a yanzu tana ba da kiwon lafiya ga waɗanda ba gwamnati ta tilastawa (waɗanda ba su taɓa yin aiki ba kuma waɗanda ba ɗalibai ba ne, ma'ana masu hannu da shuni ko talakawa). Wannan tsarin mulki, ba kamar na ma’aikata ba, ana samun kuɗaɗe ne ta hanyar haraji na gama-gari tare da ramawa a mafi girma fiye da tsarin tushen sana’a ga waɗanda ba za su iya yin bambanci ba. A ƙarshe, don magance hauhawar farashin kiwon lafiya, gwamnati ta tsara tsare-tsare guda biyu, (a cikin 2004 da 2006), waɗanda ke buƙatar mutanen da ke da inshora su ayyana likita mai ba da izini don a biya su gaba ɗaya don ziyarar ƙwararrun, kuma waɗanda suka sanya haɗin gwiwar dole. - biya € 1 don ziyarar likita, € 0.50 ga kowane akwati na magani da aka tsara, da kuma kuɗin € 16-18 kowace rana don zaman asibiti da kuma hanyoyin tsada. [citati
Wani muhimmin abu na tsarin inshora na Faransa shine haɗin kai: yawan rashin lafiyar mutum ya zama ƙasa da biyan kuɗi. Wannan yana nufin cewa ga mutanen da ke fama da cututtuka masu tsanani ko na yau da kullum, tsarin inshora yana mayar musu da kashi 100 cikin 100 na kudaden kuɗi, kuma ya janye kudaden haɗin gwiwar su. [abubuwan da ake bukata]
A ƙarshe, don kuɗaɗen da tsarin na tilas bai cika ba, akwai ɗimbin kewayon tsare-tsare na ƙarin inshora masu zaman kansu. Kasuwar waɗannan shirye-shiryen tana da fa'ida sosai, kuma sau da yawa ana ba da tallafi daga ma'aikata, wanda ke nufin cewa ƙimar kuɗi yawanci suna da matsakaici. Kashi 85% na mutanen Faransa suna amfana daga ƙarin inshorar lafiya masu zaman kansu.
Jamus
gyara sasheJamus tana da tsarin inshorar lafiyar jama'a mafi tsufa a duniya, tare da tushen asalin Otto von Bismarck's Sickness Law na 1883.
Da farko da 10% na ma'aikatan blue-collar a 1885, inshora na wajibi ya fadada; a cikin 2009, inshora da aka sanya wajabta a kan duk 'yan ƙasa, tare da masu zaman kansu inshora inshora ga kai aiki ko sama da wani samun kudin shiga kofa. Tun daga 2016, 85% na yawan jama'a yana rufe ta wajibi ne Inshorar Kiwon Lafiya ta Doka (SHI) (Gesetzliche Krankenversicherung ko GKV), tare da ragowar inshorar masu zaman kansu (Private Krankenversicherung ko PKV). Tsarin kiwon lafiya na Jamus ya kasance kashi 77% na gwamnati kuma kashi 23 cikin 100 an ba da kuɗaɗen sirri tun daga 2004. Yayin da gudummawar inshorar lafiyar jama'a ta dogara ne akan kuɗin shiga na mutum, gudummawar inshorar kiwon lafiya masu zaman kansu sun dogara ne akan shekarun mutum da yanayin lafiyarsa. [8] [9]
Maidawa yana kan tsarin biyan kuɗi don sabis, amma adadin likitocin da aka yarda su karɓi Inshorar Lafiya ta Doka a cikin wani yanki da gwamnati da ƙungiyoyin ƙwararru ke tsara su. [abubuwan da ake bukata]
An gabatar da kuɗin haɗin gwiwa a cikin 1980s a ƙoƙarin hana amfani da yawa. Matsakaicin tsawon zaman asibiti a Jamus ya ragu a cikin 'yan shekarun nan daga kwanaki 14 zuwa kwanaki 9, har yanzu ya fi tsayi fiye da matsakaicin zama a Amurka (kwanaki 5 zuwa 6). Wani ɓangare na bambancin shine babban abin la'akari don biyan kuɗin asibiti shine adadin kwanakin asibiti sabanin tsari ko ganewar asali. Farashin magunguna ya karu sosai, yana tashi kusan kashi 60 cikin 100 daga 1991 zuwa 2005. Duk da yunƙurin ɗaukar farashi, yawan kuɗaɗen kula da lafiya ya karu zuwa 10.7% na GDP a 2005, kwatankwacin sauran ƙasashen yammacin Turai, amma ƙasa da wanda aka kashe a Amurka. (kusan 16% na GDP). [10]
Ana ba wa Jamusawa nau'ikan inshorar tsaro nau'i uku da suka shafi yanayin jikin mutum kuma waɗanda ma'aikata da ma'aikata ke ba da kuɗi tare: inshorar lafiya, inshorar haɗari, da inshorar kulawa na dogon lokaci. Inshorar kulawa na dogon lokaci (Gesetzliche Pflegeversicherung) ya fito a cikin 1994 kuma ya zama dole. Inshorar haɗari (gesetzliche Unfallversicherung) mai aiki ne ya rufe shi kuma yana ɗaukar dukkan haɗari don tafiya zuwa aiki da wurin aiki.
Girka
gyara sasheTsarin Kiwon Lafiya na Ƙasa a Girka ya ƙunshi duka waje da jiyya a cikin marasa lafiya. Ana gudanar da maganin marasa lafiya ta hanyar tsarin gudanarwa na zamantakewa kamar haka:
- EOPPY (Kungiyar Kasa don Bayar da Ayyukan Lafiya): masu ba da kiwon lafiya masu zaman kansu da aka kwangila
- Rukunin PEDY (National Primary Healthcare Network): kiwon lafiya na jama'a
- Asibitocin jihohi, yankunan karkara da yankuna, cibiyoyin kiwon lafiya na ESY (National Health System)
- Kwararrun masu kiwon lafiya masu zaman kansu: Kwararrun likitoci da sabis ɗin da ba a kwangila da su ba tare da EOPYY.
Yakasan ce Ana gudanar da maganin marasa lafiya ta hanyar:
- Asibitocin Jiha na Tsarin Lafiya na Kasa (ESY).
- Cibiyoyin asibitoci masu zaman kansu da aka kwangila tare da Kamfanin Kiwon Lafiya na Kasa (EOPYY)
- Asibitoci masu zaman kansu da asibitoci waɗanda ba su da kwangila tare da Mai Kula da Lafiya na Kasa.
A Girka kowa zai iya biyan kuɗin asibiti ta amfani da tsarin inshora mai zaman kansa, wanda kowane kamfani na inshora na gida ko na ƙasa da ƙasa da ke aiki a yankin zai iya siya (misali Metlife, Interamerican, Aetna, IMG).[11]
Indiya
gyara sasheA Indiya, samar da sabis na kiwon lafiya ya bambanta a cikin hikimar jiha. Ayyukan kiwon lafiyar jama'a sun shahara a yawancin jihohin, amma saboda rashin isassun kayan aiki da gudanarwa, yawancin jama'a sun zaɓi ayyukan kiwon lafiya masu zaman kansu. [abubuwan da ake bukata]
Don inganta wayar da kan jama'a da ingantattun wuraren kula da lafiya, Hukumar Kula da Inshorar Inshorar da Ci Gaban Indiya da Babban Kamfanin Indiya na gudanar da yakin neman lafiya ga daukacin jama'a. A cikin 2018, ga 'yan ƙasa masu gata, Firayim Minista Narendra Modi ya sanar da ƙaddamar da sabon asusun inshorar lafiyar jama'a mai suna Ayushman Bharat Yojana kuma gwamnati ta yi iƙirarin cewa sabon tsarin zai yi ƙoƙarin isa ga mutane sama da miliyan 500. [abubuwan da ake bukata]
A kasar ta Indiya, yakasan ce ana ba da inshorar lafiya galibi a cikin nau'o'i biyu ne kawai:
- Tsarin Indemnity yana ɗaukar nauyin kuɗin asibiti kuma yana da nau'ikan nau'ikan kamar Inshorar Mutum, Inshorar Falo na Iyali, Inshorar Babban Jama'a, Inshorar Maternity, Inshorar Likitan Rukunin.
- Kafaffen Tsarin Amfani yana biyan ƙayyadaddun adadin cututtukan da aka riga aka ƙaddara kamar rashin lafiya mai tsanani, ciwon daji, cututtukan zuciya, da sauransu. Hakanan yana da nau'ikansa kamar Inshorar rigakafi, Mummunan cuta da Hatsarin Mutum.
A Dangane da nau'in inshora da kamfanin da ke da alhakin bada inshorar lafiya, ɗaukar hoto ya haɗa da cajin kafin zuwa asibiti da kuma bayan asibiti, cajin motar asibiti, cajin kulawar rana, Binciken Lafiya, da sauransu.
Yana da mahimmanci a san game da keɓancewa waɗanda ba a rufe su a ƙarƙashin tsarin inshora:
- Magani da ke da alaƙa da cututtukan hakora ko tiyata
- Dukkanin cututtukan cututtukani da cutar kanjamau
- Magani Ba na Allopathic
Kadan daga cikin kamfanoni suna ba da inshora ga irin waɗannan cututtuka ko yanayi, amma hakan ya dogara da nau'in da adadin inshora.
Wasu muhimman al'amura da za a yi la'akari da su kafin zabar inshorar lafiya a Indiya sune Ra'ayin Matsala, Iyakar Inshora da iyakoki, Rufewa da asibitocin cibiyar sadarwa.
Japan
gyara sasheAkwai manyan tsare-tsaren inshora guda uku da ake samu a Japan: Inshorar Lafiya ta Ma'aikata (健康保険 Kenkō-Hoken), Inshorar Kiwon Lafiya ta Kasa (国民健康保険 Kokumin-Kenkō-Hoken), da Tsarin Kiwon Lafiyar Dattijai na Late-stege Kouki-Kourei-Iryouseido). Ko da yake akwai inshorar lafiya masu zaman kansu, duk ƴan ƙasar Japan, mazaunan dindindin, da waɗanda ba Jafananci waɗanda ke da takardar izinin shiga shekara ɗaya ko fiye ana buƙatar su yi rajista a cikin Inshorar Lafiya ta ƙasa ko Inshorar Lafiya ta Ma'aikata. An tsara Inshorar Kiwon Lafiya ta ƙasa don waɗanda ba su cancanci kowane shirin inshorar lafiya na tushen aiki ba. An tsara Tsarin Kiwon Lafiyar Dattijai na Ƙarshe don mutanen da suka kai shekaru 75 da haihuwa. [mai sabani[12]
An tsara Inshorar Kiwon Lafiya ta ƙasa bisa tsarin gida. Da zarar gida ya nema, an rufe dukan iyalin. Masu nema suna karɓar katin inshorar lafiya, wanda dole ne a yi amfani da shi lokacin karbar magani a asibiti. Akwai kuɗin da ake buƙata na wata-wata, amma an daidaita kuɗin haɗin gwiwa don haka ana sa ran masu biyan kuɗi za su biya kashi goma zuwa talatin kawai na kuɗin, gwargwadon shekaru. [Madogaran da ba na farko da ake buƙata ba] Idan farashin daga aljihu ya wuce iyakokin da aka riga aka ƙaddara, masu biyan kuɗi na iya neman ragi daga shirin Inshorar Lafiya ta Ƙasa
Inshorar Lafiyar Ma'aikata tana ɗaukar cututtuka, raunuka, da mutuwa ba tare da la'akari da ko wani lamari ya faru a wurin aiki ba. Inshorar Kiwon Lafiyar Ma'aikata ta ƙunshi iyakar kwanaki 180 na kulawar likita a kowace shekara don cututtuka masu alaƙa da aiki ko raunin da ya faru da kwanaki 180 a kowace shekara don wasu cututtuka ko raunuka. Masu ɗaukan ma'aikata da ma'aikata dole ne su ba da gudummawa daidai da inshorar Lafiya ta Ma'aikata.
Tsarin Kiwon Lafiyar Maɗaukaki na Ƙarshe ya fara ne a cikin 1983 bin Dokar Kula da Lafiya ta Tsofaffi na 1982. Ya ba da damar yawancin tsarin inshora na kiwon lafiya don ba da taimakon kuɗi ga tsofaffi. Akwai kuɗin ɗaukar hoto. Don cancanta, waɗanda inshorar dole ne su kasance ko dai: sun girmi 70, ko kuma sun girmi 65 tare da sanannen nakasa. [Saɓani] Tsarin Kiwon Lafiyar Maɗaukaki na Ƙarshe ya haɗa da rigakafi da daidaitaccen kulawar likita.
Batutuwan tsarin kiwon lafiya
gyara sasheSaboda yawan tsufa na Japan, Tsarin Kiwon Lafiyar Maɗaukakin Ƙarshe yana wakiltar kashi ɗaya bisa uku na jimlar kuɗin kula da lafiyar ƙasar. Lokacin da ma'aikatan da suka yi ritaya suka ƙaura daga Inshorar Kiwon Lafiyar Ma'aikata zuwa Tsarin Kiwon Lafiyar Ma'aikata na Ƙarshe, ana sa ran farashin inshorar lafiya na ƙasa zai ƙaru tunda farashin lafiyar mutum ɗaya yana ƙaruwa da shekaru.
Netherlands
gyara sasheA cikin 2006, sabon tsarin inshorar lafiya ya fara aiki a cikin Netherlands. Wannan sabon tsarin yana guje wa ramummuka biyu na zaɓi mara kyau da haɗari na ɗabi'a da ke da alaƙa da nau'ikan inshorar kiwon lafiya na gargajiya ta hanyar amfani da haɗe-haɗe na ƙa'ida da wurin daidaita inshora. Ana guje wa haɗarin ɗabi'a ta hanyar ba da umarni cewa kamfanonin inshora su samar da aƙalla tsari ɗaya wanda ya dace da mafi ƙarancin ma'auni na gwamnati, kuma duk mazaunan balagaggu doka ta wajaba su siyan wannan ɗaukar hoto daga kamfanin inshora da suka zaɓa. Duk kamfanonin inshora suna karɓar kuɗi daga wurin daidaitawa don taimakawa wajen biyan kuɗin wannan ɗaukar hoto na gwamnati. Ana gudanar da wannan tafki ne daga wani mai kula da shi wanda ke karbar gudummawar albashi daga masu daukar ma'aikata, wanda ke da kusan kashi 50% na duk kudaden kula da lafiya, da kuma kudade daga gwamnati don rufe mutanen da ba za su iya samun kulawar kiwon lafiya ba, wanda ya samar da karin kashi 5%.
A Sauran kashi 45% na kudaden kula da lafiya sun fito ne daga kuɗaɗen inshora da jama'a ke biya, wanda kamfanoni ke yin takara akan farashi, kodayake bambancin tsakanin masu inshora daban-daban masu fafatawa kusan kashi 5 ne kawai. Koyaya, kamfanonin inshora suna da 'yanci don siyar da ƙarin manufofi don samar da ɗaukar hoto fiye da mafi ƙarancin ƙasa. Waɗannan manufofin ba sa karɓar kuɗi daga wurin daidaitawa amma suna rufe ƙarin jiyya, kamar hanyoyin haƙori da ilimin motsa jiki, waɗanda manufar tilas ba ta biya su ba.
Ana rarraba kudade daga wurin daidaitawa ga kamfanonin inshora ga kowane mutumin da suka tabbatar a ƙarƙashin manufar da ake buƙata. Koyaya, mutane masu haɗari suna samun ƙari daga tafkin, kuma masu karamin karfi da yara a ƙarƙashin 18 an biya inshorar su gaba ɗaya. Saboda wannan, kamfanonin inshora ba su sake samun inshorar mutane masu haɗari a matsayin shawara mara kyau, guje wa yuwuwar matsalar zaɓi mara kyau. [abubuwan da ake bukata]
A baya ga hakan, Ba a ƙyale kamfanonin inshora su sami haɗin kai, iyakoki, ko cirewa, ko hana ɗaukar hoto ga duk mutumin da ke neman wata manufa, ko cajin wani abu ban da ƙayyadaddun ƙima na ƙasa da aka buga. Don haka, duk mutumin da ke siyan inshora zai biya farashin daidai da kowa da kowa yana siyan manufofin iri ɗaya, kuma kowane mutum zai sami mafi ƙarancin ɗaukar hoto. Wannan ya shafi duk mutanen da ke zaune da aiki na dindindin a cikin Netherlands. Daliban ƙasa da ƙasa waɗanda suka ƙaura zuwa Netherlands don dalilai na karatu dole ne su ɗauki inshorar lafiya na Dutch idan kuma sun yanke shawarar yin aiki (kwangilolin sa'o'i ba a haɗa su ba) ko yin horon da aka biya yayin zaman su. A wannan yanayin, za su buƙaci fitar da ainihin fakitin inshorar lafiya na Dutch. Ita inshorar ku Ƙarin inshora na da wani zaɓi ne, ya danganta da bukatun ɗalibin.
New Zealand
gyara sasheTun daga 1974, New Zealand tana da tsarin inshorar lafiya mara laifi na duniya don raunin mutum ta hanyar Kamfanin Raya Hatsari (ACC). Tsarin ACC ya ƙunshi yawancin kuɗin da ke da alaƙa da jiyya na raunin da aka samu a New Zealand (ciki har da baƙi na ketare) ba tare da la'akari da yadda raunin ya faru ba, kuma yana rufe asarar samun kudin shiga (a kashi 80 cikin 100 na kudin shiga na ma'aikaci kafin rauni) da kuma farashi masu alaƙa. zuwa gyara na dogon lokaci, kamar gyaran gida da abin hawa ga waɗanda suka ji rauni sosai. Kudade daga tsarin ya fito ne daga haɗe-haɗe na haraji kan albashin ma’aikata (don raunin aiki), haraji kan kuɗin shiga na harajin ma’aikaci (don raunin da ba ya aiki ga masu karɓar albashi), haraji kan kuɗin lasisin abin hawa da man fetur (na haɗarin mota) , da kuma kuɗi daga wurin ajiyar haraji na gabaɗaya (don raunin da ba a yi ba ga yara, manyan ƴan ƙasa, marasa aikin yi, baƙi na ketare, da sauransu)
Rwanda
gyara sasheKasar Rwanda na daya daga cikin kasashe masu karamin karfi da suka aiwatar da tsare-tsare na inshorar lafiya na al'umma domin rage matsalolin kudi da ke hana talakawa neman da kuma samun ayyukan kiwon lafiya da ake bukata. Wannan tsari ya taimaka wajen kaiwa kashi 90% na al'ummar kasar da tsarin kula da lafiya.[13][14]
Singapore
gyara sasheMutanen Singapore suna daya daga cikin mafi dadewa tsawon rai yayin haihuwa a duniya. A cikin wannan doguwar rayuwa, fuskantar yanayi maras tabbas da ke buƙatar asibiti ba makawa. Inshorar lafiya ko inshorar likitanci suna ɗaukar tsadar kiwon lafiya yayin asibiti.[15]
Inshorar lafiya ga 'yan Singapore da mazauna dindindin
MediShield Life, inshorar lafiya ce ta duniya wacce ke rufe duk Jama'ar Singapore da Mazaunan Dindindin. MediShield Life yana ɗaukar farashin asibiti don zama a cikin ward B2 ko C a asibitin Jama'a. Don asibiti a asibiti mai zaman kansa, ko a unguwar A ko B1 a asibitin Jama'a, MediShield Life ana danganta shi zuwa farashin B2 ko C kuma ana buƙatar inshora don biyan sauran adadin lissafin. Za a iya biyan wannan ragowar adadin lissafin ta amfani da MediSave amma ana amfani da iyaka akan amfanin MediSave. MediShield Life ba ya ɗaukar nauyin kuɗaɗen likita na ƙasashen waje da kuma kula da munanan cututtuka da suka rigaya sun kasance waɗanda mutum ke karɓar magani a cikin watanni 12 kafin fara ɗaukar hoto na MediShield Life. MediShield Life kuma ba ta ɗaukar maganin cututtukan da aka haifa (yanayin likitanci da ke faruwa a lokacin haihuwa), tiyatar kwaskwarima, zargin da ke da alaƙa da juna biyu da tabin hankali.[50][16]
Kamar yadda fa'idodin Rayuwar MediShield aka keɓe don asibiti na B2 ko C a asibitocin jama'a, tsare-tsaren Haɗaɗɗen Garkuwa suna ba da ɗaukar hoto don asibiti a asibitoci masu zaman kansu, ko Sashen A ko B1 a asibitocin jama'a. Shirye-shiryen inshorar Garkuwan Haɗaɗɗen rufe manyan kuɗaɗen asibiti don asibitoci masu zaman kansu ko, ward A ko B1. Koyaya, har yanzu ana buƙatar mai inshora don biyan wani yanki na adadin lissafin. Wannan ya yi daidai da falsafar kiwon lafiya ta Singapore wacce ke haɓaka alhakin mutum tare da samun daidaikun mutane su raba kuɗin kiwon lafiya. Tare da wannan falsafar, ana amfani da deductible, inshorar haɗin gwiwa da haɓakawa akan yawancin tsare-tsaren Inshorar Lafiya a Singapore. Irin waɗannan tsare-tsaren inshora na kiwon lafiya suna ba da zaɓi don siyan mahayin inshorar lafiya don biyan waɗannan cajin.[17]
Inshorar lafiya ga Baƙi a Singapore
Ba kamar Jama'ar Singapore da Mazaunan Dindindin ba, MediShield Life ba ta rufe baki ta atomatik. Baƙi na iya siyan tsare-tsaren inshorar lafiya daga masu inshorar rayuwa da yawa a Singapore.[17]
Koriya ta Kudu
gyara sasheA Tsawon rayuwar Koriya ta Kudu a lokacin, haihuwa ta kai matakin 82.7 a cikin 2017, sama da matsakaicin OECD na 80.8. Tsawon rayuwar maza ya kai shekaru 79.7, sama da matsakaicin OECD na shekaru 78.1, kuma tsawon rayuwar mata ya kai shekaru 85.7, sama da matsakaicin shekaru 83.4. [18]
Inshorar Lafiya ta Kasa (NHI) ce ke ba da kulawar lafiya a Koriya ta Kudu, wanda ya zama dole. Duk wanda ke zaune a Koriya ta Kudu, ba tare da la'akari da ɗan ƙasa ko sana'a ba, zai iya siyan wannan inshora.[19]
Switzerland
gyara sasheKiwon lafiya a Switzerland na duniya ne kuma ana sarrafa shi ta Dokar Tarayya ta Switzerland akan Inshorar Lafiya. Inshorar lafiya wajibi ne ga duk mutanen da ke zaune a Switzerland (a cikin watanni uku na zama ko kuma an haife su a cikin ƙasa). Don haka daidai yake a duk faɗin ƙasar kuma yana guje wa ƙa'idodi biyu na kiwon lafiya. Ana buƙatar masu insurer su ba da wannan ainihin inshora ga kowa, ba tare da la'akari da shekaru ko yanayin likita ba. Ba a ba su damar samun riba daga wannan ainihin inshora ba, amma suna iya kan ƙarin tsare-tsare.
Ƙididdiga na wajibi na duniya yana ba da magani a yanayin rashin lafiya ko haɗari da ciki. Inshorar lafiya tana ɗaukar farashin jiyya, magani da kwantar da marasa lafiya a asibiti. Koyaya, mai inshorar yana biyan wani ɓangare na farashi har zuwa matsakaicin, wanda zai iya bambanta dangane da tsarin da aka zaɓa ɗaya ɗaya, sannan ana daidaita ƙimar kuɗi daidai. Dukkan tsarin kiwon lafiya an tsara shi ne zuwa ga maƙasudai na haɓaka lafiyar jama'a da rage farashi yayin ƙarfafa alhakin mutum. [abubuwan da ake bukata]
Tsarin kula da lafiya na Swiss haɗe ne na jama'a, tallafi masu zaman kansu da tsarin masu zaman kansu gaba ɗaya. Kudaden inshora sun bambanta daga kamfanin inshora zuwa kamfani, matakin wuce gona da iri da aka zaɓa (hanyar ikon mallakar kamfani), wurin zama na wanda ke da inshora da ƙimar ƙarin fa'ida da aka zaɓa (maganin ƙarin magani, kula da haƙora na yau da kullun, asibiti mai zaman kansa ko mai zaman kansa), da sauransu). [abubuwan da ake bukata]]
Mutumin da ke da inshorar yana da cikakken 'yancin zaɓi tsakanin kusan 60 da aka sani masu ba da kiwon lafiya waɗanda suka cancanci kula da yanayin su (a yankinsu) kan fahimtar cewa inshora yana rufe farashi har zuwa matakin jadawalin kuɗin fito na hukuma. Akwai 'yancin zaɓi lokacin zabar kamfanin inshora wanda mutum ke biyan kuɗi, yawanci kowane wata. Mutumin da ke da inshorar yana biyan kuɗin inshora don ainihin shirin har zuwa kashi 8 na kuɗin shiga na sirri. Idan kuɗin kuɗi ya fi wannan, gwamnati ta ba mai inshorar tallafin kuɗi don biyan kowane ƙarin kuɗi.
Ana iya ƙara inshorar tilas ta hanyar manufofin inshora na "madaidaitan" masu zaman kansu waɗanda ke ba da izinin ɗaukar wasu nau'ikan jiyya waɗanda ba su da inshora na asali ko don haɓaka daidaitaccen ɗaki da sabis idan an kai asibiti. Wannan na iya haɗawa da ƙarin magani, kula da haƙori na yau da kullun da kwantar da marasa lafiya masu zaman kansu, waɗanda inshorar na dole ba ya rufe.
Dangane da abin da ya shafi inshorar lafiya na wajibi, kamfanonin inshora ba za su iya saita kowane yanayi da ya shafi shekaru, jima'i ko yanayin kiwon lafiya don ɗaukar hoto ba. Ko da yake matakin ƙimar kuɗi na iya bambanta daga kamfani ɗaya zuwa wani, dole ne su kasance iri ɗaya a cikin kamfani ɗaya ga duk masu inshorar shekaru ɗaya da yanki, ba tare da la'akari da jima'i ko yanayin lafiya ba. Wannan baya shafi ƙarin inshora, inda ƙimar kuɗi ta dogara da haɗari.
Switzerland tana da adadin mace-macen jarirai kusan 3.6 cikin 1,000. Tsawon rayuwa gabaɗaya a cikin 2012 ya kasance na maza 80.5 shekaru idan aka kwatanta da shekaru 84.7 na mata. Waɗannan su ne mafi kyawun adadi a duniya..[20]
Ƙasar Ingila
gyara sasheSabis ɗin Kiwon Lafiya na Ƙasar Burtaniya (NHS) tsarin kiwon lafiya ne na jama'a wanda ke ba da ɗaukar hoto ga kowa da kowa mazaunin Burtaniya. Ba wai kawai tsarin inshora ba ne saboda (a) babu kuɗin da aka tattara, (b) ba a cajin farashi a matakin majiyyaci kuma (c) ba a riga an biya kuɗi daga tafkin. Koyaya, yana cimma babban manufar inshora wanda shine yada haɗarin kuɗi da ke tasowa daga rashin lafiya. Kudin tafiyar da NHS (est. £ 104 biliyan a 2007-8) ana biyan su kai tsaye daga haraji na gaba ɗaya. NHS tana ba da mafi yawan kulawar kiwon lafiya a cikin Burtaniya, gami da kulawa na farko, kula da marasa lafiya, kula da lafiya na dogon lokaci, ilimin ido, da likitan hakora.
Kiwon lafiya mai zaman kansa ya ci gaba da daidaitawa da NHS, wanda aka biya mafi yawa ta inshorar masu zaman kansu, amma ƙasa da kashi 8% na yawan jama'a ke amfani da shi, kuma gabaɗaya azaman sama da sabis na NHS. Akwai jiyya da yawa waɗanda kamfanoni masu zaman kansu ba sa bayarwa. Misali, inshorar lafiya akan ciki gabaɗaya ba a rufe shi ko an rufe shi da taƙaitaccen bayani. Yawancin keɓancewa don tsarin Bupa (da sauran masu inshorar da yawa) sun haɗa da:
tsufa, menopause da balaga; AIDS/HIV; rashin lafiyan halayen ko rashin lafiyan halayen; hana haihuwa, daukar ciki, matsalolin jima'i da canjin jima'i; yanayi na yau da kullun; rikitarwa daga keɓe ko ƙuntataccen yanayi / magani; kwantar da hankali, gyarawa da kula da jinya gabaɗaya; kwaskwarima, sake ginawa ko maganin asarar nauyi; kurma; maganin hakora/baki (kamar cikawa, cutar danko, raguwar jaw, da sauransu); dialysis; magunguna da riguna don majinyaci ko shan gida † ; magungunan gwaji da magani; gani; HRT da densitometry na kashi; matsalolin ilmantarwa, matsalolin halayya da ci gaba; jiyya a ƙasashen waje da komawa gida; kayan taimako na jiki da na'urori; abubuwan da suka rigaya ko na musamman; ciki da haihuwa; dubawa da rigakafin rigakafi; matsalolin barci da rashin lafiya; matsalar magana; wucin gadi taimako na bayyanar cututtuka. († = sai dai a cikin yanayi na musamman)
Akwai wasu kamfanoni da yawa a cikin United Kingdom waɗanda suka haɗa da, da sauransu, Chubb Limited, AXA, Aviva, Bupa, Groupama Healthcare, WPA da VitalityHealth. Ana amfani da irin wannan keɓance, dangane da manufofin da aka saya.
A cikin 2009, babban wakilin likitocin Burtaniya, kungiyar likitocin Burtaniya, sun amince da wata sanarwa da ke nuna damuwa game da ci gaba a kasuwar inshorar lafiya a Burtaniya. A cikin Taron Wakilinta na Shekara-shekara wanda Kungiyar Masu Ba da Shawarwari (watau Manyan Likitoci) suka amince a baya tare da bayyana cewa BMA "ta damu matuka cewa manufofin wasu kamfanonin inshorar kiwon lafiya masu zaman kansu suna hana ko hana marasa lafiya yin zabi game da (i) masu ba da shawara. wadanda suke kula da su; (ii) asibitin da ake kula da su; Ya shiga don "kira BMA don tallata waɗannan damuwar domin a sanar da marasa lafiya dalla-dalla yayin yin zaɓi game da inshorar kiwon lafiya masu zaman kansu." Ayyukan kamfanonin inshora suna yanke shawarar wane mashawarcin mai haƙuri zai iya gani sabanin GPs ko marasa lafiya ana kiransa Buɗaɗɗen Magana. NHS tana ba majiyyata zaɓi na asibitoci da masu ba da shawara kuma ba ta cajin ayyukanta.
An yi amfani da kamfanoni masu zaman kansu don ƙara ƙarfin NHS duk da yawancin jama'ar Biritaniya suna adawa da irin wannan sa hannun. A cewar Hukumar Lafiya ta Duniya, tallafin gwamnati ya rufe kashi 86% na kudaden kula da lafiya gaba daya a Burtaniya tun daga shekarar 2004, tare da kashe kudade masu zaman kansu wanda ya kunshi sauran kashi 14%..[21]
Kusan ɗaya cikin uku na marasa lafiya da ke karɓar kulawar asibitin NHS yana da inshorar sirri kuma yana iya samun kuɗin da mai insurer ya biya. Wasu tsare-tsare masu zaman kansu suna ba da kuɗin kuɗi ga majinyata waɗanda suka zaɓi maganin NHS, don hana amfani da wurare masu zaman kansu. Wani rahoto, na masu binciken lafiya masu zaman kansu Laing da Buisson, a cikin Nuwamba 2012, an kiyasta cewa fiye da ayyuka 250,000 an yi wa marasa lafiya da inshorar likita masu zaman kansu a kowace shekara a kan fam miliyan 359. Bugu da kari, an kashe fam miliyan 609 wajen yin magani na gaggawa ko tiyata. Inshorar likita mai zaman kanta ba ta yawanci ɗaukar magani na gaggawa ba amma ana iya biyan murmurewa na gaba idan an koma da majiyyaci zuwa rukunin majinyata masu zaman kansu.
Amurka
gyara sasheInshorar Lafiya ta gajeren lokaci
A ranar 1 ga Agusta, 2018 DHHS ta ba da doka ta ƙarshe wadda ta yi canje-canjen tarayya zuwa Gajerun Lokaci, Inshorar Kiwon Lafiya mai iyaka mai iyaka (STLDI) wanda ya tsawaita iyakar kwangilar zuwa kwanaki 364 da sabuntawa har zuwa watanni 36. Wannan sabuwar doka, a hade tare da ƙarewar hukunci ga Dokar Mutum ɗaya na Dokar Kulawa mai araha, ya kasance batun bincike mai zaman kansa. [22] [23] [24] [25] [5] [6] [7][26][27][28]
Tsarin kula da lafiya na Amurka ya dogara kacokan akan inshorar lafiya masu zaman kansu, wanda shine farkon tushen ɗaukar hoto ga yawancin Amurkawa. Tun daga 2018, 68.9% na manya na Amurka suna da inshorar lafiya masu zaman kansu, a cewar Cibiyar Kula da Cututtuka. Hukumar Bincike da Ingancin Kiwon Lafiya (AHRQ) ta gano cewa a cikin 2011, an biya inshora na zaman kansa na asibitocin marasa lafiya miliyan 12.2 na Amurka kuma ya jawo kusan dala biliyan 112.5 a cikin jimlar farashin asibitocin marasa lafiya (29% na jimlar jimlar kuɗin ƙasa). Shirye-shiryen jama'a suna ba da tushen tushen ɗaukar hoto ga yawancin manyan ƴan ƙasa da yara da iyalai masu ƙarancin kuɗi waɗanda suka cika wasu buƙatun cancanta. Shirye-shiryen jama'a na farko sune Medicare, shirin inshora na zamantakewa na tarayya don tsofaffi da wasu nakasassu; da Medicaid, wanda gwamnatin tarayya da jihohi suka ba da kuɗaɗen haɗin gwiwa amma ana gudanar da su a matakin jiha, wanda ya shafi wasu ƙananan yara da danginsu. Tare, Medicare da Medicaid sun kai kusan kashi 63 na farashin asibitocin marasa lafiya na ƙasa a cikin 2011. SCHIP haɗin gwiwa ne na tarayya da jiha wanda ke hidima ga wasu yara da iyalai waɗanda ba su cancanci Medicaid ba amma waɗanda ba za su iya biyan kuɗi na sirri ba. Sauran shirye-shiryen jama'a sun haɗa da fa'idodin kiwon lafiyar soja da aka bayar ta hanyar TRICARE da Hukumar Kula da Lafiya ta Tsohon Sojoji da fa'idodin da aka bayar ta Ma'aikatar Kiwon Lafiya ta Indiya. Wasu jihohi suna da ƙarin shirye-shirye don masu karamin karfi.
A ƙarshen 1990s da farkon 2000s, kamfanoni masu ba da shawara kan kiwon lafiya sun fara bayyana don taimakawa marasa lafiya su magance matsalolin tsarin kiwon lafiya. Rikicin tsarin kiwon lafiya ya haifar da matsaloli iri-iri ga jama'ar Amurka. Wani bincike ya gano cewa kashi 62 cikin 100 na mutanen da suka bayyana fatarar kudi a shekara ta 2007 suna da kuɗin da ba a biya ba na magani na dala 1000 ko fiye, kuma a cikin kashi 92 cikin 100 na waɗannan lamurra basussukan likitanci sun zarce dala 5000. Kusan kashi 80 cikin 100 da suka shigar da karar fatarar kudi suna da inshorar lafiya. An kiyasta shirye-shiryen Medicare da Medicaid nan ba da jimawa ba za su ɗauki kashi 50 cikin ɗari na duk abin da ake kashewa na lafiyar ƙasa. Wadannan abubuwan da wasu da yawa sun haifar da sha'awar sake fasalin tsarin kula da lafiya a Amurka. A cikin 2010 Shugaba Obama ya sanya hannu kan dokar Kariya da Kula da Marasa lafiya. Wannan Dokar ta ƙunshi 'waddar mutum' wanda kowane Ba'amurke dole ne ya sami inshorar likita (ko ya biya tara). Kwararru kan manufofin kiwon lafiya irin su David Cutler da Jonathan Gruber, da kuma ƙungiyar inshorar inshorar likitancin Amurka, Tsare-tsaren Inshorar Lafiya ta Amurka, sun yi iƙirarin cewa an buƙaci wannan tanadin don samar da "lalacewar garanti" da "ƙimar al'umma," wanda ke magance abubuwan da ba su da farin jini. Tsarin inshorar lafiya na Amurka kamar kima mai ƙima, keɓancewa don yanayin da aka rigaya, da kuma tantance masu neman inshora. A tsakanin 26-28 Maris, Kotun Koli ta saurari muhawara game da ingancin Dokar. An ƙaddara Dokar Kariya da Kula da Marasa lafiya don zama tsarin mulki a ranar 28 ga Yuni 2012. Kotun Koli ta ƙaddara cewa Majalisa tana da ikon yin amfani da umarnin mutum a cikin ikonta na haraji.[29]
Tarihi da juyin halitta
gyara sasheA ƙarshen karni na 19, "inshorar haɗari" ya fara samuwa, wanda ke aiki kamar inshora na nakasa na zamani. Wannan tsarin biyan kuɗi ya ci gaba har zuwa farkon karni na 20 a wasu yankuna (kamar California), inda duk dokokin da ke tsara inshorar lafiya a zahiri suna magana da inshorar nakasa.[30]
Kamfanin Assurance Lafiya na Franklin na Massachusetts ya fara ba da inshorar haɗari a cikin Amurka. Wannan kamfani, wanda aka kafa a cikin 1850, ya ba da inshora game da raunin da ya faru daga hatsarin jirgin ƙasa da jirgin ruwa. Kungiyoyi sittin sun ba da inshorar haɗari a Amurka ta 1866, amma masana'antar ta haɓaka cikin sauri nan da nan. Duk da yake akwai gwaje-gwajen da aka yi a baya, asalin ɗaukar hoto a Amurka ya dace daga 1890. An fitar da manufar ƙungiyar ta nakasa ta farko da ta ɗauki nauyin aiki a 1911.
Kafin haɓaka inshorar kuɗin likita, ana tsammanin majiyyata za su biya kuɗin kula da lafiya daga aljihunsu, a ƙarƙashin abin da aka sani da tsarin kasuwancin kuɗi-don-sabis. A tsakiyar tsakiyar zuwa ƙarshen karni na 20, inshora na nakasassu na gargajiya ya samo asali zuwa shirye-shiryen inshorar lafiya na zamani. Wani babban cikas ga wannan ci gaban shi ne cewa farkon nau'ikan injunan kiwon lafiya an umurce su da kotuna saboda karya dokar gargajiya ta hana ayyukan kamfanoni na kamfanoni masu riba. Dole ne 'yan majalisar dokoki na jihohi su shiga tsakani tare da halatta inshorar lafiya a fili a matsayin keɓanta ga wannan tsarin gargajiya. A yau, yawancin shirye-shiryen inshora na kiwon lafiya masu zaman kansu suna rufe farashin yau da kullun, rigakafi, da hanyoyin kula da lafiya na gaggawa. Har ila yau, suna rufe ko a wani ɓangare na farashin wasu magunguna da magunguna. Kamfanonin inshora suna ƙayyade irin magungunan da aka rufe bisa farashi, samuwa, da makamantan warkewa. Lissafin magungunan da shirin inshora ya yarda ya rufe ana kiransa da kayan aiki. Bugu da ƙari, wasu magunguna na iya buƙatar izini kafin shirin inshora ya yarda ya biya kuɗin sa..[31]
An gabatar da manufofin kashe kuɗin asibiti da na likita a farkon rabin ƙarni na 20. A cikin shekarun 1920s, asibitocin ɗaiɗaikun sun fara ba da sabis ga daidaikun mutane akan tsarin biyan kuɗi, daga ƙarshe ya haifar da haɓaka ƙungiyoyin Blue Cross. Magabatan Ƙungiyoyin Kula da Lafiya na yau (HMOs) sun samo asali ne tun daga 1929, zuwa 1930s kuma a lokacin yakin duniya na biyu.
Dokar Tsaron Kuɗin Kuɗi na Ma'aikata na 1974 (ERISA) ta tsara aikin tsarin fa'idar kiwon lafiya idan ma'aikaci ya zaɓi ya kafa ɗaya, wanda ba a buƙata ba. Dokar Sasantawa ta Kasafin Kuɗi ta Omnibus ta 1985 (COBRA) tana ba tsohon ma'aikaci 'yancin ci gaba da ɗaukar hoto a ƙarƙashin tsarin fa'idar kiwon lafiya na ƙungiyar mai aiki.
A cikin shekarun 1990s, tsare-tsaren inshorar kulawa da aka gudanar ciki har da ƙungiyoyin kula da lafiya (HMO), ƙungiyoyin da aka fi so, ko tsarin tsare-tsaren sabis sun karu daga kusan kashi 25% na ma'aikatan Amurka waɗanda ke da ɗaukar nauyin ɗaukar aiki zuwa mafi rinjaye. Tare da kulawa da kulawa, masu insurer suna amfani da dabaru daban-daban don magance farashi da haɓaka inganci, gami da shawarwarin farashin (masu samar da "a cikin hanyar sadarwa"), gudanarwar amfani, da buƙatu don tabbatar da inganci kamar waɗanda aka amince da su ta hanyar tsare-tsaren ba da izini kamar Hukumar Haɗin gwiwa da Hukumar Kula da Lafiya ta Amurka.[32]
Masu ɗaukan ma'aikata da ma'aikata na iya samun ɗan zaɓi a cikin cikakkun bayanai na tsare-tsare, gami da asusun ajiyar lafiya, deductible, da coinsurance. Tun daga shekara ta 2015, wani yanayi ya bayyana ga masu daukar ma'aikata don bayar da tsare-tsare masu yawa, wanda ake kira tsare-tsaren kula da lafiyar mabukaci wanda ke sanya ƙarin farashi ga ma'aikata, yayin da ma'aikata ke amfana ta hanyar biyan ƙananan kuɗi na wata-wata. Bugu da ƙari, samun babban tsari mai rangwame yana ba wa ma'aikata damar buɗe asusun ajiyar lafiya, wanda ke ba su damar ba da gudummawar ajiyar kuɗi kafin haraji don bukatun likita na gaba. Wasu ma'aikata za su ba da tsare-tsare da yawa ga ma'aikatan su..[33]
Rasha
gyara sasheKasuwancin inshora na kiwon lafiya masu zaman kansu, wanda aka sani a cikin Rashanci a matsayin "inshorar kiwon lafiya na son rai" (Rashanci: добровольное медицинское страхование, ДМС) don bambanta shi da Inshorar Likitan Dole ne na Jiha, ya sami ci gaba mai dorewa. An gabatar da shi a watan Oktoba 1992.
Taiwan
gyara sasheDubi kuma
gyara sashe
Bayanan da aka ambata
gyara sashe- ↑ How Private Insurance Works: A Primer by Gary Caxton, Institution for Health Care Research and Policy, Georgetown University, on behalf of the Henry J. Kaiser Family Foundation.
- ↑ "Bill Text - AB-1611 Emergency hospital services: Costs".
- ↑ "OECD.StatExtracts, Health, Health Expenditure and Financing, Main Indicators, Health Expenditure since 2000" (Online Statistics). Organization for Economic Co-operation and Development. OECD's iLibrary. 2013. Retrieved 23 April 2014.
- ↑ "OECD.StatExtracts, Health, Health Status, Life expectancy, Total population at birth" (Online Statistics). Organization for Economic Co-operation and Development. OECD's iLibrary. 2013. Retrieved 23 April 2014.
- ↑ Schoen C et al. (2010). How Health Insurance Design Affects Access To Care And Costs, By Income, In Eleven Countries. Health Affairs. Free full-text.
- ↑ Australian Health Insurance Information Archived 2021-05-18 at the Wayback Machine. PrivateHealth.gov.au. Retrieved on 26 October 2011.
- ↑ Hadorn, D. (2 August 2005). "The Chaoulli challenge: getting a grip on waiting lists". Canadian Medical Association Journal. 173 (3): 271–73. doi:10.1503/cmaj.050812. PMC 1180658. PMID 16076823.
- ↑ "Private or public? An introduction health insurance in Germany". allaboutberlin.com (in Turanci). Retrieved 2019-02-10.
- ↑ GmbH, Finanztip Verbraucherinformation gemeinnützige. "Finanztip : Finanztip – Das gemeinnützige Verbraucherportal". finanztip.de. Archived from the original on 1 June 2014.
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- ↑ See California Insurance Code Section 106 (defining disability insurance). Caselaw.lp.findlaw.com In 2001, the California Legislature added subdivision (b), which defines "health insurance" as "an individual or group disability insurance policy that provides coverage for hospital, medical, or surgical benefits."
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