Chris Van Es

لا تحاكوا نموذج الرعاية الصحية الأميركي

تورنتو ــ مع استعداد المحكمة العليا في الولايات المتحدة للبدء في دراسة قانون الرعاية الميسورة التكلفة (إصلاح الرعاية الصحية التاريخي الذي سخر منه الخصوم فأطلقوا عليه وصف "أوباما كير")، فمن الجدير بالملاحظة أن عدد الأميركيين المحرومين من التأمين الصحي بلغ أعلى مستوياته على الإطلاق في عام 2010، أي في نفس عام صدور القانون. فنحو خمسين مليون أميركي (واحد من كل ستة أميركيين) يدفعون من جيوبهم الخاصة لتغطية نفقاتهم الطبية.

ولم يكن الركود الاقتصادي في عام 2008 السبب الوحيد وراء هذا الرقم المروع؛ فالعديد من الخيارات السياسية والخططية البعيدة الأمد مسؤولة أيضا. وعلى المستوى العالمي، ولكن بالنسبة للاقتصادات السريعة النمو بشكل خاص، كان الدرس بسيطا: ضرورة تجنب نموذج الرعاية الصحية الخاصة المتبع في أميركا.

إن الولايات المتحدة واحدة من الدول المرتفعة الدخل القليلة التي لا تمول الرعاية الصحية من خلال نظام الدفع المسبق الممول حكوميا. ففي المتوسط، تنفق الدول الأكثر ثراءً نحو 11% من ناتجها المحلي الإجمالي على الصحة، حيث تتولى الحكومة تمويل أكثر من 80% من الرعاية الصحية في حين لا تزيد الشريحة التي تدفع رسوماً في مقابل الخدمة عن 14%. ويتحمل التمويل العام (أو في بعض الحالات صناديق التأمين التعاوني التي تتولى الحكومة تنظيمها) أغلب تكاليف الخدمات الطبية التقديرية، في حين يعمل التأمين الخاص كمكمل فقط للخدمات الإضافية في أضيق الحدود.

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