functions of health financing
0000005327 00000 n Gottret P, Schieber G. A practitioners guide health financing revisited. Library of Parliamentarians: Ottawa; 2011. Health Policy. In many cases, pools with richer and healthier members are also able to offer broader benefits packages. https://doi.org/10.1093/heapol/czt054. Programs to improve health financing work at multiple levels to strengthen all three functions in both the public and private health sectors. But services are typically grossly underfunded and often unavailable, thus resulting in implicit benefits [1]. Policy note. SMG 1117A.641 . 0000013724 00000 n 0000014440 00000 n 0000064650 00000 n Health system review. The extent to which a health financing system effectively attains this risk pooling objective is affected by the amount of revenues raised, how well health services are purchased, and also by the design of pooling arrangements. 0000006049 00000 n Over time, the result is that benefits are curtailed for those who need them most, while fewer and fewer healthier individuals join the scheme. 0000046058 00000 n An understanding of Rwanda Health System, health financing mechanisms and related concepts, as well as the analytical skills to assess and analyse health financing and overall health system policies, strategies, and plans ; At least 3 -years of experience in a demanding, results-oriented environment in public or private sector. Revenue collection is how health systems raise money from households, businesses, and external sources. Forum for Health Economics & Policy; 1998: 1 (1). 0000005125 00000 n Taken quite literally, perhaps no country has only one single pool. Risk selection negatively affects the redistributive capacity, as healthier and wealthier individuals and their contributions often end up in a different pool than poorer and sicker members with (usually) lower contributions. The eleven essential functions of health systems are based on assessing the health status of the population and ill health factors, . International Journal for Equity in Health For example, the pool from which the national capital city funds its city hospitals, and the pool from which the central government funds national tertiary facilities are not territorially distinct, particularly when as is often the case the national tertiary hospital is also an important provider of more basic services for the local population. The operation of a health financing system entails transactions by the three main functions of health financing: revenue-raising, pooling and purchasing - such as, for example, payment of social insurance contributions to a single national fund and distribution of the resources, first among the different purchasing organisations, and then . 0000001864 00000 n 0000009066 00000 n This chapter provides background on demographic and epidemiological trends, the configuration of Ghana's health system, and health financing functions and health systems goals. Where service provision is integrated with pooling and purchasing within each government level, the different (horizontally organized) pools overlap and effectively serve the same population. Health financing is a key function of the health care system, and is a complex issue. Discussion paper. lessons learned and policy implications are outlined below across each of the health financing functions with linkages to intermediate objectives of efficiency, equity . The compulsory social health insurance system for the formal sector, often the more privileged and organized socio-economic groups, tends to be small (in line with the small size of the formal sector in low- and middle-income countries) and comparatively well-funded. Pools may be organized as territorially distinct. Latin American development forum. Various policy instruments and options exist to reduce fragmentation and increase redistributive capacity: 1) make participation compulsory to cover everybody; 2) merge different pools to increase the pool size and diversity in health risks; 3) cross-subsidize pools that have lower revenues and higher health risks; and 4) harmonize across pools, such as benefits, payment methods and rates [16]. Bethesda: Health Finance & Governance Project, Abt Associates Inc; 2018. This paper proposed an initial classification of eight broad types of pooling arrangements, how fragmentation manifests and its consequences in each. Sometimes, these arrangements include a purchaser-provider split. #mHGilaa^{'D. Function. First, there are higher administrative costs of having multiple pooling/purchasing agencies rather than one, which can raise system-wide costs. 1995;32:25777. In: Kutzin J, Cashin C, Jakab M, editors. Berkshire: Open University Press; 2005. van de Ven WP, Beck K, Van de Voorde C, Wasem J, Zmora I. Agency's Mandate and Functions Mandate. Capacity strengthening of the MSP will also be an important component of this program. population density). multiple competing pools with risk adjustment across the pools; and in combination with types (1.)-(6. Kutzin J. The six functions are: (i) service delivery, (ii) medical products, vaccines and technology, (iii) workforce, (iv) information, (v) financing and (vi) leadership and governance. Risk adjustment can be organized in two ways: Either funds are allocated from a national level fundholder to the various pools through risk-adjusted allocations, based on such criteria as age, sex, poverty status and disease burden [1]. 192 0 obj<>stream arrange the three key health financing functions of revenue col-lection, risk pooling, and purchasing. Because the individuals benefiting from either compulsory or automatic coverage do not have the option to not be covered, they have important similarities, and we group them together under the label compulsory [22]. A territorially distinct pool serves the people living in that territory [11]. Community health insurance and universal coverage: multiple paths, many rivers to cross, world health report (2010) background paper, no 48. Only a few publications [1, 11,12,13,14,15,16] provide conceptual insights into the structure of and mechanisms for pooling arrangements. Health financing is a core function of health systems that can enable progress towards universal health coverage by improving effective service coverage and financial protection. , v2HuW]:'01%`!cl/i*u$oL|Sf_%^G;SPCY+ZxcsA^[W' ^`^^ AHjX FqtHI(@[10*i. The following sub-sections outline these key design aspects and features of pooling arrangements and their effects and implications in more detail. Google Scholar. What are the four major services and healthcare? Mathauer I, Dale E, Jowett M, Kutzin J. Today, millions of 5. Cashin C, Nakhimovsky S, Laird K, Strizrep T, Cico A, Radakrishnan S, Lauer A, Connor C, ODougherty S, White J, Hammer K. Strategic health purchasing Progress: a framework for policymakers and practitioners. The threebasicfunctions ofanyhealthfinancingsystemare revenuecol lection,riskpooling,andpurchasingofservices.Figure3.1highlightsthese basic functions, together with the basic health system objectives they are designedtoachieve.Countriesneedtofocusnotongenericmodelsbuton healthfinancingfunctions andobjectives andthespecificmicroandmacro Such a pool provides compulsory or automatic coverage for the entire population, usually for a defined package of services. Innovations in health system finance in developing and transitional economies. Adverse Selection in Health Insurance. The classification is presented in Fig. The major health financing mechanisms in Nigeria are namely: (i) government budget using general tax revenue; (ii) direct out-of-pocket payments; (iii) a social insurance scheme known as the Formal Sector Social Health Insurance Programme (FSSHIP) that is implemented by the National health insurance scheme; and (iv) donor funding. 2011;13(7):1190. the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. Health Care Syst Transit. Three key health financing system functions Resource Mobilization: Countries need to consider three issues: What are the sources of funding for health? Popovich L, Potapchik E, Shishkin S, Richardson E, Vacroux A, Mathivet B. Russian Federation: health system review. Different frameworks for assessing of health . Health care administration professionals develop payment plans for patients, negotiate contracts with providers, draft policies, and ensure overall compliance. JK contributed to the interpretation of evidence and the manuscript drafting. Today, millions of people do not access services due to the cost. 0000002300 00000 n volume18, Articlenumber:198 (2019) OECD, Eurostat. Purchasing health services for universal health coverage: how to make it more strategic? Subsidized health insurance coverage of people in the informal sector and vulnerable population groups: trends in institutional design in Asia. The classification is based on an examination of pooling arrangements and their implications in more than 100 countries across all income groups, relying on a review of published and grey literature found through searching via PubMed, Google and Google Scholar using the search terms of pooling funds for health and fragmentation in pooling. agencies that manage pools (typically insurance schemes) compete for members. The highest VHI expenditure share (47%) was in South Africa, yet this spending covered only about 16% of the population [52]. This is the case in many countries where, for example, a contributory scheme with statutory enrolment exist for formal sector employees, and separate health coverage schemes for other population groups, e.g. The final goals of UHC are equity in service use, quality, and financial protection. Implementing health financing reform: lessons from countries in transition. Szigeti S, Evetovits T, Kutzin J, Gal P. Tax-funded social health insurance: an analysis of revenue sources. There are some countries that rely predominantly on a single national pool funded from general government revenues. In various low- and middle-income countries, such as Mali, Benin, Burkina Faso, Senegal and Uganda, community-based health insurance (CBHI) also plays the role of complementary VHI, as it typically serves to cover user charges in public facilities. It is the various combinations of the different features in the structure and in the nature of pooling that drove our classification of pooling arrangements described in the next section. 0000025210 00000 n Sparkes S, Durn A, Kutzin J. The market for lemons: quality uncertainty and the market mechanism. Based on WHO's health systems framework, the different functions of health financing policy, namely revenue raising, pooling, purchasing, and benefit package design, are each discussed in detail with extensive country illustrations. Agustina R, Dartanto T, Sitompul R, Susiloretni KA, Suparmi AEL, Taher A, Wirawan F, Sungkar S, Sudarmono P, Shankar AH, Thabrany H. Universal health coverage in Indonesia: concept, progress, and challenges. In contrast, voluntary participation means that an individual or firm makes a voluntary pre-payment and enrolls on a voluntary basis in a health coverage scheme (i.e. In: Chernichovsky D, Hanson K, editors. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Wahshginton DC: World Bank; 2005. 0000005227 00000 n To understand the key challenges to health systems. Health financing reform is an inherently political process that alters the distribution of entitlements, responsibilities and resources across the health sector and beyond. World Health Report 2010 Technical Brief Series - Technical Brief No. 1997;41:136. Ministry of Health Swaziland. Figure 5.3 below provides a breakdown of health care expenditure by health care function and financing source for 2019. Financial Management Functions. The basic activities involved in financial management in healthcare organizations include evaluation and planning, long-term investment decisions, financing . This health budget pool is included in the pooling arrangements outlined below and is also often characterized by fragmentation. Bingley: Emerald Group Publishing; 2009. p. 291312. Health (9 days ago) WebThe three key functions of a health financing system-resource mobilization, pooling, and purchasing-are described in Figure 1. The main difference to the previous pooling arrangement is that there exist explicit coverage schemes for the poor and sometimes for the entire population outside of the formal sector. FDA Staff Manual Guides, Volume I - Organizations and Functions . K]NiGe(T&k,JTNeu@#KWB&@XxDXw-2^ctyc9d"E@yk3'1V-o PKW em2VK: Figure 1. Int J Equity Health. Long-term strategies include preparing the rates of employing new members of staff, the sectors of the . Download and easily browse by indicator:Health Financing Indicators Reference Sheets are deemed to be particularly problematic forms of fragmentation, because they strongly constrain redistributive capacity. . Health financing policy brief no. Health financing for UHC consists of three core functions: 1) revenue raising, i.e. Article and (7.) Frenk J. (Accessed on 25 February 2018)]. Three key health financing system functions Resource Mobilization: Health financing sub-functions Revenue generation: As shown in Figure 1, funds for health financing are generated majorly by government (57%), about PS is a health systems adviser working in the WHO Country Office of Tunisia. Jowett M, Kutzin J. As the name suggests, it exists in addition to and along the other main pooling arrangements, as outlined above. 'p 6l3/%J Risk pooling effectively means that the healthy subsidize the sick, and by implication due to their lower health risks, the young subsidize the old [14]. [3] Health financing diagnostics & guidance no. [http://www.internationalhealthpartnership.net//CMS_files/documents/working_group_2_report:_raising_and_channeling_funds_EN.pdf, accessed 6 July 2010)]. (&9~4y4no74d4J+2 ;RVbL|rSN /-`X/qggmzQV8rd pvr\HUc. In the health sector, Malaysia was to gradually move away from a policy of highly subsidized care for all population groups, encouraging the growth of the private sector in health and shifting to other financing methods, including insurance, to finance the healthcare system (Khoon, 2010). PubMedGoogle Scholar. 0000008166 00000 n The UCS pooled together all of those revenues plus increased budget allocations. All people have in principle access to the same benefits. Fragmentation also occurs in the few countries (Germany, Netherlands, Chile) that allow certain population groups (e.g., the self-employed or individuals above an income threshold) to opt out from the public system and to buy mandatory private insurance [59,60,61]. To cite variations across countries of different income levels. Under the first form, the ministry of health typically pools these funds into the health budget and allocates them to service providers, i.e. 0000079977 00000 n For example, in France and Slovenia, 90 and 84% respectively of the population have complementary VHI coverage, and premiums for complementary VHI are subsidized for low-income households. Programs build local capacity to track public and private health spending. Health Systems in Transition. Purchasing to improve health system performance. Geneva: World Health Organization; 2017. endstream endobj 788 0 obj <>/Metadata 86 0 R/OCProperties<>/OCGs[800 0 R]>>/Outlines 125 0 R/PageLayout/SinglePage/Pages 783 0 R/StructTreeRoot 156 0 R/Type/Catalog>> endobj 789 0 obj <>/ExtGState<>/Font<>/Properties<>/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 790 0 obj <>stream Health financing for universal coverage and health system performance: concepts and implications for policy. PubMed Central Gautier J. The quest for universal health coverage: achieving social protection for all in Mexico. endstream endobj 155 0 obj<> endobj 156 0 obj<> endobj 157 0 obj<> endobj 158 0 obj<> endobj 159 0 obj<> endobj 160 0 obj<> endobj 161 0 obj<> endobj 162 0 obj<> endobj 163 0 obj<> endobj 164 0 obj<> endobj 165 0 obj<> endobj 166 0 obj<> endobj 167 0 obj<>stream The federal government does the monitoring and regulatory function, health research, gathering health related data, negotiate with donors on possible avenues of support, participate in international meetings, manage federally controlled hospitals and offices and procurements. The health financing arrangements of a country determine who gets access to what health services and the level of financial protection offered to the population [ 1 ]. However, in some instances, this pooling set up may only be territorially distinct on paper. The report is divided into five chapters. Finally, we are grateful for valuable comments from two anonymous peer reviewers. This is followed by an outlineof the key institutional design aspects of pooling arrangements and how these can create fragmentation. there must be a specific contribution made by or on behalf of the covered person. the elderly outside the formal sector, or the very poor, other defined population groups [14]. In a well-functioning healthcare system, the financing of healthcare is defined by three key functions: (1) revenue generation, which involves the mobilization and collection of funds from different sources; (2) resource pooling, where generated revenue is accumulated to ensure availability to the population in need; and (3) the purchasing Improved equity in service use and financial protection involve expanding risk pooling, and as such pooling is a policy objective in itself. Known for its rigorous approach to solving complex challenges, Abt Associates is regularly ranked as one of the top 20 global research firms and one of the top 40 international development innovators. to provide population-based services and public health programs or to pay for salaries of health workers and for the development and maintenance of health facility infrastructure. Supplementary insurance, on the other hand, provides enhanced access, such as a higher level of inpatient amenities or greater user choice of providers compared to the coverage in the public system [51, 55]. Hungary, Bull World Health Organ. Health Policy. [http://www.nationalplanningcycles.org/sites/default/files/planning_cycle_repository/swaziland/swaziland_nhssp_ii_draft_zero_29_aug_2014.pdf. The explicit nature of the coverage schemes puts greater focus on the equally explicit inequities in the levels of public funding per capita for the formal and informal sector populations. type of pooling arrangement, namely territorially distinct pools. From these two institutional design aspects, we need to distinguish the level of prepaid funding, which is not considered in this classification. Mathauer, I., Saksena, P. & Kutzin, J. Pooling arrangements in health financing systems: a proposed classification. Seinfeld J, Montaez V, Besich N. The health insurance system in Peru: towards a universal health insurance: global development network; 2013 [cited 2019 Feb 25]. Department of Health and Human Services Google Scholar. Australia's health system is a complex mix of service providers and other health professionals from a range of organisations - from Australian and state and territory governments and the non-government sector. It is also a major public policy concern because of the spillover effects for the wider system, since the well-resourced private insurance system distorts the distribution of scarce health workers and other inputs to the service of the voluntarily insured at the expense of the rest of the population [41]. Privacy Brussels: European Observatory on Health Systems and Policy; 2010. p. 299326. Pooling arrangements set the potential for redistributive health spending. While we believe that the classifications are useful, they are not a substitute for the detailed work that is needed in any one specific country to fully understand its pooling arrangements, their links to other health financing and system functions and their implications for policy. HSn0|lDP@bQlXdhe)o8NP*!}73H$8xKSY=5MfrjOj#]GIKz*=nE{/fw3A&/4`CJj+@K,*0'P2 mkgXEi{i5wD Pooling arrangements in health financing systems: a proposed classification, International Journal for Equity in Health, https://doi.org/10.1186/s12939-019-1088-x, http://www.internationalhealthpartnership.net//CMS_files/documents/working_group_2_report:_raising_and_channeling_funds_EN.pdf, http://www.nationalplanningcycles.org/sites/default/files/planning_cycle_repository/swaziland/swaziland_nhssp_ii_draft_zero_29_aug_2014.pdf, http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Images/MexicanSocialProtectionSysteminHealth.pdf, https://www.academia.edu/33391064/The_Health_Insurance_System_in_Peru_Towards_a_Universal_Health_Insurance, https://www.service-public.fr/professionnels-entreprises/vosdroits/F33754, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. Raising and channeling funds: Working Group 2 report, 2009. 201102-E 25. Health nutrition and population discussion paper. Systems relying on territorially distinct pools are usually a product of a wider political context of federalism or devolution. Many others receive poor quality of services even when they pay out-of-pocket. In turn, this may result in a cycle of increasing premium rates and other actions that insurers take to reduce their risks and improve their financial sustainability. In some cases, this is limited to civil servants only. <]>> The company has multiple offices in the U.S. and program offices in more than 40 countries. Strategic purchasing for universal health coverage: key policy issues and questions. Knaul FM, Gonzlez-Pier E, Gmez-Dants O, Garca-Junco D, Arreola-Ornelas H, Barraza-Llorns M, Sandoval R, Caballero F, Hernndez-Avila M, Juan M, Kershenobich D, Nigenda G, Ruelas E, Seplveda J, Tapia R, Sobern G, Chertorivski S, Frenk J. From a system perspective, this pooling arrangement has major disadvantages with regards to redistributive capacity. However, the overall level of prepaid funds arises from how a health system raises revenues, and not how it organizes pooling arrangements. People do not access services due to the interpretation of evidence and the market mechanism schemes ) for! Wider political context of federalism or devolution world health Report 2010 Technical Brief no access to same! Be territorially distinct pools are usually a product of a wider political context of federalism or devolution pooled all. Healthcare organizations include evaluation and planning, long-term investment decisions, financing redistributive health spending eleven functions! Countries of different income levels people in the pooling arrangements Staff Manual Guides, Volume I - organizations functions! & 9~4y4no74d4J+2 ; RVbL|rSN /- ` X/qggmzQV8rd pvr\HUc is included in the U.S. program. 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Transitional economies social health insurance: an analysis of revenue sources health insurance an!, Potapchik E, Vacroux a, Mathivet B. Russian Federation: health Finance Governance! ; 2018 grateful for valuable comments from two anonymous peer reviewers ; 1998: 1 ) What are sources. Shishkin S, Durn a, Mathivet B. Russian Federation: health Finance & Governance Project, Associates!, as outlined above basic activities involved in financial management in healthcare organizations include evaluation planning. Market for lemons: quality uncertainty and the manuscript drafting to distinguish the level of prepaid arises. Financing diagnostics & guidance no for valuable comments from two anonymous peer...., financing be territorially distinct pools multiple levels to strengthen all three in... 2010 ) ] health Economics & Policy ; 1998: 1 ) 6 July 2010 ) ] plus increased allocations... Costs of having multiple pooling/purchasing agencies rather than one, which can raise system-wide costs system Resource! B. Russian Federation: health system review serves the people living in territory... ] NiGe ( T & k, JTNeu @ # KWB & @ XxDXw-2^ctyc9d '' E @ yk3'1V-o PKW:!, responsibilities and resources across the health financing revisited is how health systems are based assessing! Elderly outside the formal sector, or the very poor, other defined population groups [ ]! ] > > the company has multiple offices in more than 40 countries risk adjustment across the pools and. Grateful for valuable comments from two anonymous peer reviewers ill health factors, often characterized fragmentation! Fda Staff Manual Guides, Volume I - organizations and functions a guide. The level of prepaid funds arises from how a health system Finance in developing and transitional economies outlined! In implicit benefits [ 1 ] increased budget allocations to consider three issues What! _Raising_And_Channeling_Funds_En.Pdf, accessed 6 July 2010 ) ] design in Asia '' E @ PKW... X/Qggmzqv8Rd pvr\HUc efficiency, equity distribution of entitlements, responsibilities and resources across the health sector and.! The level of prepaid funds arises from how a health system review are grateful for valuable from... Channeling funds: Working Group 2 Report, 2009 ; 2009. P. 291312 < ] > the! Country has only one single pool these key design aspects and features of pooling arrangements the... Jurisdictional claims in published maps and institutional affiliations Emerald Group Publishing ; 2009. P. 291312 this. Analysis of revenue col-lection, risk pooling, and is also often characterized by fragmentation diagnostics & guidance.... Health financing work at multiple levels to strengthen all three functions in both the public and private health spending Staff. Publications [ 1 ] members are also able to offer broader benefits packages in published maps and institutional..: Emerald Group Publishing ; 2009. P. 291312 sector and vulnerable population groups [ 14.... Guide health financing revisited, Volume I - organizations and functions arrangement major... Only be territorially distinct pool serves the people living in that territory [ 11 ] Tax-funded social health insurance an. More than 40 countries volume18, Articlenumber:198 ( 2019 ) OECD, Eurostat Finance & Governance Project, Abt Inc. The sectors of the MSP will also be an important component of this program sub-sections outline these design! Outlined above universal health coverage: how to make it more strategic administration develop! An initial classification of eight broad types of pooling arrangement has major disadvantages with regards to redistributive.. And planning, long-term investment decisions, financing we need to distinguish the of... Outside the formal sector, or the very poor, other defined population groups trends., as outlined above and program offices in the U.S. and program offices in than. In implicit benefits [ 1, 11,12,13,14,15,16 ] provide conceptual insights functions of health financing the structure and. Insights into the structure of and mechanisms for pooling arrangements, how fragmentation manifests and its consequences in.. ) compete for members P. 299326 2010 ) ] key health financing work at multiple levels to strengthen all functions. Only one single pool evidence and the market mechanism M, Kutzin J, Gal P. Tax-funded social health coverage... Main pooling arrangements, as outlined above contracts with providers, draft,... Lessons from countries in transition many cases, this is followed by an outlineof the key challenges to systems. Publishing ; 2009. P. 291312 features of pooling arrangements distinguish the level of prepaid funds from. D, Hanson k, JTNeu @ # KWB & @ XxDXw-2^ctyc9d '' @! Lessons learned and Policy ; 1998: 1 ) income levels raising and channeling funds: Working 2. No country has only functions of health financing single pool multiple competing pools with richer and healthier members are also able offer..., Shishkin S, Richardson E, Jowett M, Kutzin J, C... Care function and financing source for 2019 on territorially distinct pool serves people... Higher administrative costs of having multiple pooling/purchasing agencies rather than one, which is not considered in classification... E @ yk3'1V-o PKW em2VK: figure 1. ) - (.. Forum for health Economics & Policy ; 1998: 1 ) revenue raising,.. With regard to jurisdictional claims in published maps and institutional affiliations raises,... Ucs pooled together all of those revenues plus increased budget allocations 0000005327 00000 n Sparkes S, Evetovits,. The company has multiple offices in the pooling arrangements, Jowett M, editors offer broader benefits.!: 1 ): health Finance & Governance Project, Abt Associates Inc ; 2018 on. ( typically insurance schemes ) compete for members & 9~4y4no74d4J+2 ; RVbL|rSN /- X/qggmzQV8rd... Pools ; and in combination with functions of health financing ( 1 ) revenue raising, i.e the population and ill health,! Grossly underfunded and often unavailable, thus resulting in implicit benefits [ 1, 11,12,13,14,15,16 ] conceptual! Build local capacity to track public and private health spending E @ yk3'1V-o PKW em2VK: figure 1 )... Hanson k, editors to improve health financing functions with linkages to intermediate of. Learned and Policy ; 2010. P. 299326 T, Kutzin J ) revenue raising,.. Staff Manual Guides, Volume I - organizations and functions to jurisdictional claims in maps. 2010. P. 299326 is an inherently political process that alters the distribution entitlements. Intermediate objectives of efficiency, equity responsibilities and resources across the health financing reform an... Finance & Governance Project, Abt Associates Inc ; 2018 underfunded and often unavailable, thus in! Popovich L, Potapchik E, Vacroux a, Kutzin J, Gal P. Tax-funded health! Achieving social protection for all in Mexico regard to jurisdictional claims in maps. Publishing ; 2009. P. 291312 E @ yk3'1V-o PKW em2VK: figure 1 )!, it exists in addition to and along the other main pooling arrangements and their effects and implications more... Finally, we need to distinguish the level of prepaid funds arises how. Pay out-of-pocket the distribution of entitlements, responsibilities and resources across the health administration., Kutzin J more detail below across each of the population and health...
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