Health financing is a key building block of a health system. Spending on HP was much lower, given that only 2.9% of THE was used for HP; spending on HP was a mere US $1.6 and US $2.1 per capita, respectively, in countries in Africa and Southeast Asia. Assessment of financing health care indicates that poor countries in Africa and Southeast Asia, facing resource restrictions, spent merely US $55.4 and US $69.9 per capita, respectively, on the health of their population in 2003. Changes in healthcare financing, telecommunication, service orientation, and office efficiency are simultaneously creating a more conducive environment for EHPs to run well and thrive. Allocation of monies within the total health expenditures means selection from many alternatives. health care insurance is represented by several modalities and is discussed in the context of fiscal impact. Patients will begin to have more choice and authority in spending for healthcare as rules for use common in managed care settings apply less and less, and restrictions are loosened as a result. Foster quality improvement through system improvements. Accessed 2/19/2020. Usually this is under some form of democratic accountability, the right of access to which are set down in rules applying to the whole population contributing to the fund or receiving benefits from it. This will be a more common orientation as the financial transaction between physicians and patients becomes more direct. They are certainly not pro-competitive. TABLE 11.3. The most fundamental change is the departure from a dyadic doctor–patient relationship. National health expenditures are derived from government and non-government sources and are used to finance a wide array of programs and services. Developed countries that spend between 8 and 18 percent of GNP on health care have made a value judgment. Some practices, such as limiting who may serve on panels, may be in restraint of trade. Responsibilities Manage four health financing associates and lead all health financing workstreams Support the government to apply resource Clinton Health … Journal of the American College of Cardiology, Federal, state and local government general revenues; mainly from taxes: income, excise, resources, business, inheritance, value added, capital gains, property, special taxes, Dedicated taxes: cigarettes, alcohol, gambling. Globally, information on the level and sources of spending on HP is scarce, despite advocacy for more financial resources going to HP by several charters on health promotion. Health Care Financing Health systems require financial resources to accomplish their goals. Therefore the focus on governance should be on financing functions in detail—collection of funds, pooling of resources, and purchasing or payment for health services. In the interest of efficiency or economy these transformations might seem warranted, but the practices we are currently witnessing in the name of managed care must themselves be subjected to ethical scrutiny. The Cooperative Cardiovascular Project in 1992 was the first national quality improvement project under HCQIP. Health financing before the 19th century was mainly comprised of out-of-pocket spending, with Community Based Health Financing (CBHF) has emerged in developing countries as a response to the existing challenges in the health financing system which include low economic growth, constraints on the public sector and low organizational capacity (Carrin 2003). This concept of direct exchange between the buyer and the seller is not repudiated by the existence of credit. Health financing is fundamental to the ability of health systems to maintain and improve human welfare. A comparison of total national health expenditures is seen in Table 11.4. The transformation of medicine from a profession to a trade by the Federal Trade Commission was justified as a cost-saving measure on the grounds that increasing consumer choice (through advertising) would lower costs. Results indicate a wide variation in HC6 spending across regions, from US $1.6 per capita in the African region, to US $36.9 in the European region (see Table 3). But this depends on adequacy of total financing and rational allocation policies to promote equitable access to services and a balance between one service sector and another. We assume that spending on HP is 2.94% of THE for those countries where information on HP is absent, in order to estimate expenditure on HP per capita. • Health financing system is, therefore, more than merely an approach to mobilize funds for health care • WHO definition of health financing: –Health financing is the function of a health system concerned with the mobilization, accumulation and allocation of money to cover the health Those systems that allow meso-level planning authorities, such as regions, to avoid the excesses of both central control and local capture by unrepresentative interests, often have the capacity to square the circle in terms of incentives, as long as attention is paid to steering the system to achieve desired outcomes. For example, physicians' associations, insurers' associations, and the state will thrash out deals in a corporatist manner, with corporatism meaning (in this context) the institutionalization of major social interests into a reasonably stable decision-making machinery overseen by – but not dominated by – the state. Health insurance may cover doctor's visits, medical procedures, prescription drugs, and so forth. A greater supply of surgeons generates more surgery. The analysis indicates that HC6, an average of the percentages computed for the 120 data sets, accounts for 2.94% of THE (range, 0.02–8.24%). Office-initiated contact can influence outcomes by ensuring adequate follow-up on important test abnormalities, behavior and lifestyle changes, exercise and stress management, medication options and management, and guidance on specialist referral, tests, and treatment. An alternative use of the concept is that macroeconomics planning may serve a general interest at the expense of the individual patient. Health, United States, 2011: with special feature on socioeconomic status and health. Turning a blind eye to corruption is a clear example of bad governance, whereas myopia and tunnel vision, the other two failings, are not. Where financing of health care is centralized, a potential exists for rational allocation of resources. Poor governance undermines the quality of services and the acquisition and spending of public funds. This places a great financial burden on public health services, which are generally underfunded in comparison to clinical services. These funds can be used for Consolidated Omnibus Budget Reconciliation Act (COBRA) premiums, healthcare coverage while receiving unemployment compensation, and long-term care insurance premiums.15 Thus, HSAs seem to be a very positive and attainable option for many patients and their employers. The facile use of modern communication equipment also provides new opportunities to improve health outcomes with executives. grants, loans)Pooling deals with collection and management of revenues so that members of the pool share collective health risksPurchasing … In this scenario, the employer ultimately pays lower premiums for higher-deductible catastrophic medical insurance, and the patient has a means to use tax-exempt dollars to directly purchase healthcare services, evaluations, tests, and treatment. The public will more actively participate in decision making with regard to the tests, treatment, medications, and other services they will have available to them. Under such circumstances, public health services very often become oriented to provision of basic services for people excluded from health benefits because of lack of health insurance. The array of information exchange seems almost limitless. We describe these trends as a “health financing transition” to provide a conceptual framework for … Health care costs were about $3.6 trillion dollars in 2018 (1). It might constitute an attempt at rational policy making, that is, an attempt to provide a basis for scientific consensus among the key actors holding power in either the policy process generally or government in particular. Sources: Testimony of A. Bruce Steinwald before the Subcommittee on Health, Committee on Energy and Commerce, House of Representatives; 2006. Canada also experienced high rates of cost increase in health during the 1970s and 1980s, but managed to reduce the rate of increase and moved from the second leading country in per capita health expenditures to fourth place after the USA, Germany, and France. TABLE 11.4. Doctors in the new environment are being transformed into ‘providers,’ patients into ‘consumers,’ and any number of ‘third parties’ claim an interest in what goes on in that relationship. Capone’s law – Al Capone, a well-known gangster, planning the division of Chicago among his colleagues, said: “You take the north side and I’ll take the south side”, i.e., let’s divide things up according to our mutual interest. In consequence, in considering structures, attention ought to be paid to the central structure, that is, how the political level is and is not distinguished in terms of governance from the top management, that is, health executive level. Manager, Health Financing, Ouagadougou for dependents & spouses of employees based in Burkina Faso, at this time. In the economic model of marketplace transactions, much more is at stake than how the payment is to be allotted. Hyattsville, MD: NCHS; 2012. The supply of hospital beds is a key determinant of utilization, especially where the public has health insurance benefits covering hospitalization. The market solution has been a nonsolution to this point in that it has only succeeded in lowering costs without adequately addressing quality of service or the distribution and allocation of services. There is competition for funds in any system, and the way in which money is allocated affects not only the way the services are provided but also setting of priorities, as indicated in the “laws” of health economics in Box 11.7. Those spending between 4 and 5 percent of GNP may try to have universal coverage, but often achieve this through low staff salaries, inadequate equipment, and spreading limited resources too thinly. HCQIP looks to partner with practitioners, beneficiaries, providers, plans and other purchasers to improve Medicare beneficiaries' health. While all systems are likely to be hybrids, it is important to ensure that the dominant incentives, geared to achieving the most important objectives agreed by government on behalf of society, are not stymied by cross-cutting policies with separate incentives. They have placed health care among the vital priorities in their societies. The Commonwealth Fund reports that the USA is the highest spender on health care but ranks below many other nations in terms of health indicators (Commonwealth Fund, 2012; OECD, 2012, 2013). Figure 11.4 shows the breakdown of health insurance coverage in the USA. Sources of insurance coverage in the USA, 2011. ¢K¨ É' ¦¿Uf¯ø$íQñá,5ïéÿ üxpßÄd:¬ñ9Ák?FñßoUÃ|öºcó_Â3þÐnð±ÏTyqtpÂÂK¥L\©Zú?`±ÒQGõ'ÿ D(ãøÈ,³$´ÅEûyEÿ &8Îýzé&¶>ñÇíà 4Ùßź´D¡µÑØtaÚKÖ ã÷BbUûð?þáû|(ÒóƳñ»Äðª¼Ú§ÄM. This has progressed in most industrialized countries towards governmental financing through social security or general taxation, supplemented by private and non-governmental organizations (NGOs) (Table 11.3), and personal out-of-pocket expenditures. Medical Dictionary for the Health Professions and Nursing © Farlex 2012 Health care finance is a branch of finance that helps patients and health care beneficiaries pay for medical expenses in the short and long terms. Where funds are allocated to regional or local health authorities, the potential for shifting resources to meet local needs should be greater. Regulation and supplemental funding by government are needed and required to prevent inequity between socioeconomic groups and between urban and rural populations. current health expenditure) including personal health care (curative care, rehabilitative care, long-term care, ancillary services and medical goods) and collective services (prevention and public health services as well as health administration), but excluding spending on investments. Meaning of termsRevenue Collection is the way health systems raise money from households (e.g. Otherwise, there is a divorce in the policy dialogue between what might be termed technocrats (such as economists), on the one hand, and political scientists on the other. The USA addresses this issue by promotion of national (and state) health targets, guidelines, accreditation systems, and strong professional organizations and medical centers with high levels of research capacity, but still lacks universal coverage for health care. Corruption eats away at the foundation of health-care finance, diverting funds during collection of premiums, undermining procurement rules in the purchase of inputs, and allowing funds to disappear between the point of collection and points of delivery. raising funds for health; reducing financial barriers to access through prepayment and subsequent pooling of funds in preference to direct out-of-pocket payments; and. Health Care Financing in the United States. Applicants will need a letter of admission to the course and proof of sponsorshi… Government funding is necessary also for services that insurance plans avoid or are inefficient in reaching, including as community-oriented services and groups at special risk, such as infants and women (see Chapter 13). Although lists of eligible expenses have been drafted, none are currently definitive. Total Health Expenditures as a Percentage of Gross Domestic Product and Per Capita Health Expenditures in Dollars, by Selected Countries: Selected Years, 1970–2011, Note: Data for 2010 and 2011 are rounded as from WHO Global Health Expenditure Data. The discussion, however, has been mainly limited to “traditional” issues of cost-effectiveness, quality of care, and, lately, patient involvement. Market systems rely on either private markets that have evolved historically or on the creation of market structures and incentives within (formerly) publicly planned systems. FIGURE 11.4. Although employers traditionally cover the costs for higher level executives to have executive physicals, HSAs make executive examinations more accessible to executives, managers, directors, and employees who are not generally eligible for a company-funded executive-level physical. While recognizing that resources are finite, the ethical physician must struggle to do the best possible for individual patients without compromising integrity. From World Health Organization (2006b) World Health Report 2006: Working Together for Health. Visit the Nuffic website for the latest information on visa requirements. allocating or using funds in a way that promotes efficiency and equity. Problems are accentuated when a disproportionately large hospital system and excessive supply of physicians create a siphoning effect on health care spending, or when resources are concentrated in cities although most of the population is rural. We use cookies to help provide and enhance our service and tailor content and ads. Additionally, PROs are required to provide quality improvement consultation to providers, including data analysis, educational materials, quality improvement consulting, custom assistance with local quality improvement activities, the dissemination of quality indicators and data collection instruments, and provider collaboration opportunities to improve care and reduce expenditures. The economic consequences of decisions made in resource allocation are major determinants of health care economics. If more funds are available for treatment services, and preventive care is relatively underfunded, then treatment will have greater emphasis than prevention. V. Tangcharoensathien, ... S. Buasai, in International Encyclopedia of Public Health, 2008. These functions include setting policy and standards, monitoring health status indicators, and determining health targets with funding to promote national priorities. Citizens of most EU or European Free Trade Association (EFTA) countries do not need a visa to enter the Netherlands. UK, A stralia GCC HEALTH Financing SYSTEM MODELS • Provincial / Regional Government Single Pa er S stem (e g •Direct payment (out-of-pocket) at point of service ( e.g., prevailing system in most low income countries) 15 u , countries, Finland, Italy, Greece, Sweden,…) y y . Incentives for improving health performance measures, including: Universal coverage through social security or tax-based system, Financing within national means for social benefits, Adequate overall financing (> 6 percent GNP), Shift from supply-side planning to costs per capita, Categorical grants to promote national objectives and specific health target programs, Increase financing at national, state, and local government levels (7–10 percent GNP), Define “basket of services” and consumer rights, Reduce acute care beds to < 3 per 1000 population, District health authorities with capitation funding, Disincentives for excess hospitalization, surgery. Virtually all developed countries have recognized the importance of national health and the role of financing systems to make health care universally available. However, the USA provides some US$100 billion in “uncompensated care” for the poor and large families, and these costs are built into the budgets. The methods of financing health care include tax supported, social security supported, employer–employee financed, charitable organizations, or consumer payment at the time of service. Corrine Propas Parver JD, PT, in Physical Rehabilitation's Role in Disability Management, 2005. Many practices of managed care are more subtly unethical, such as misleading advertising or incomplete disclosure. Expenditure on HP has been more or less stable at 3% of THE over the 5-year period from 1999 to 2003, with no significant change. Source: ASPE Issue Brief. These include having (1) an organized asthma team with clear goals and defined program leadership roles; (2) regular and accurate data reports to review processes and health outcomes; (3) well-defined initiatives and goals; and (4) continuous funding from multiple sources. 1. Publicly funded healthcare is a form of health care financing designed to meet the cost of all or most healthcare needs from a publicly managed fund. Statist systems have replaced the market with public planning, whether it is dominated by politics, the public, or experts. As healthcare financing moves away from a fee-for-service model toward innovative payment models, including capitation, a healthcare system’s success will rest on its ability to proactively manage the health of its patient population. Managed care is an ethically unstable response to the healthcare financing dilemma and must be subjected to thoroughgoing ethical evaluation. financing, health equity, resource allocation, public-private mixes and pharmaceutical regulation. Based on information about National Health Accounts (NHA) available to the WHO, during the 5-year period from 1999 to 2003, there were a total of 120 data sets having complete information from which we can estimate expenditure on prevention and public health services. The UK continues to operate its NHS at a relatively low percentage of GDP, as does Japan (Table 11.4). But this may be limited by lack of data or lack of analysis on a local or district basis to highlight priority areas of need. This warrants further investigation into innovative financing of HP. Statement of Director, Health Care. This trend has become even more prevalent and impending with changes in how businesses pay for their executive and employee healthcare. These financing and related payment mechanisms to providers must be regulated more effectively with a system of checks and balances without incurring high administrative and transaction acts, to attain the policy goals of effective and efficient allocation and proper utilization of scarce societal resources toward Health for All. Healthcare has become an investment opportunity where vast amounts of money have been siphoned away from service delivery into the pockets of executives and shareholders of mega-corporations. Where there are multiple sources of health financing, it is more difficult to develop effective national planning. Health care expenditure involves money spent from all sources for the entire health sector, regardless of who operates or provides the services. US Government Accountability Office. From the viewpoint of understanding how policy is actually made, however, this would only be part of the picture. Table 3. Financing of prevention and public health services. Some basic principles and recommendations for successful health care financing policies are outlined in Box 11.8. M.N. Health financing involves not only methods of raising money for health care, but also allocation of those funds. This expression in the health context is taken to mean that planning may reflect interests of providers, as opposed to that of the general public. Hence, this care is subsidized by the insured person. NHA Indicators. As WHO expresses it metaphorically, failure of stewardship can be identified with three kinds of visual limitations. A just society must demand accountability for its citizens. There are two types of financing: equity financing and debt financing. Statist systems, for example, are generally good (often too good!) HCQIP is carried out locally by PROs, which develop and implement cooperative projects with health care providers to improve the quality of care and to assist beneficiaries to make informed health care choices. (CMS) (sen'tĕrz med'i-kār med'i-kād sĕr'vi-sĕz) An agency of the U.S. Department of Health and Human Services that manages the federal health care programs of Medicare and Medicaid; before July 2001, known as the Health Care Financing Administration (HCFA). In the established market economies, on average 9.3 percent of GDP goes to health, while the former socialist economies expend 3.6 percent, and developing countries generally under 4.5 percent. National health expenditures are derived from government and non-government sources and are used to finance a wide array of programs and services. Purchasing . The extreme burden for US businesses in financing healthcare has created a pressing need to create new ways for employees to obtain reasonable healthcare at a lower overall cost to their respective businesses. The health care market, however, is quite different. However, financing is much more than simply generating funds. There is no one answer (again, as the United Kingdom and especially England's volte faces on whether or not health ought to be managed strategically at arm's length from government or not probably show). Nevertheless, the question ought to be considered in terms of roles and functions of the different levels within a coherent governance structure: Is the system capable of articulating consistent policy? HFG has supported 52 resource tracking exercises, such as health accounts, cost-benefit analysis, and cost-effectiveness studies in 23 countries around the world. HCFA defines “physical restraints” under “Interpretive Guidance” in the State Operations Manual as: “any manual method or physical or mechanical device, material, or equipment attached or adjacent to the individual's body that the individual cannot remove easily which restricts freedom of movement or normal access to one's body.”, From: Clinical Engineering Handbook, 2004, Theodore H. Tulchinsky MD, MPH, Elena A. Varavikova MD, MPH, PhD, in The New Public Health (Third Edition), 2014. Financing health care has evolved from personal payment at the time of service delivery to financing through health insurance (prepayment) by the employer and employee at the workplace. Universal health coverage will be the overarching development goal for the health financing practices that support the health sector to achieve its goal of universal health coverage, where the population will access to health services in a timely manner and without financial hardship. The US Institute of Medicine reports that lack of adequate insurance is the cause of an estimated 20,000 excess deaths per year in the USA (IOM, 2008). Each country has to cope with similar issues in reforms to adjust for changing health needs and the economic results of previous decisions (see Chapter 13). Most health sector reform measures attempt to address health financing issues such as mobilization of funds, distribution of financial risks, allocation and utilization of services, and provider payment incentives. Available at: http://apps.who.int/nha/database/DataExplorer.aspx?ws=1&d=1 (accessed 2.1.2014). The Program in Health Care Financing seeks to develop a systematic framework for the evaluation of health systems, as well as perform interdisciplinary research focusing on the relationship between economic development and health. The above proportion of HP financed by GGR and SHI is simply applied to the estimated figure of US $16.7 per capita spending on HP, giving US $12.2 financed by GGR and US $2.0 by SHI. This has been an occupational hazard of (for example) England in recent years, arguably, with four different policy streams vying for dominance: The purchaser/provider split inherited from the 1990s' old market and deepened by the creation of Primary Care Trusts; local collaboration as an alleged third-way alternative to state control and markets; central control through myriads of targets; and the new market of patient choice implemented alongside payment by results (Paton, 2005a,b). A number of rules apply to the creation of HSAs. These accounts are effectively managed in a manner similar to individual retirement accounts.14. It is almost certain that access to physician-patient communication of this sort is an untapped opportunity to revolutionize ideal preventive healthcare for everyone. Sean Kesterson MD, Joel J. Heidelbaugh MD, in Clinical Men's Health, 2008. Medicare physician payments: trends in service utilization, spending, and fees prompt consideration of alternative payment approaches. Health care finance is a branch of finance that helps patients and health care beneficiaries pay for medical expenses in the short and long terms. Physicians become technicians, and patients become recipients of technology, with both likely to be strangers to one another. Simply stated, employee health benefits that require lower employer contributions drive down the cost of doing business. Absent physicians effectively steal from the public sector; petty theft of drugs, light bulbs, or food is just as much robbery. Healthcare Financing “Appropriate healthcare financing is a means to ensure adequate funds for health care, provide equitable access to all population groups and reduce financial barriers to utilize health services” Healthcare financing deals with generation, allocation and … That is, everyone is covered, but the better-off pay a form of insurance that is obligatory; hypothecated (earmarked) health taxation; A specific policy analysis would assess options, one by one, against identified criteria and (perhaps) incorporate a weighting procedure to rank the options. Alternatively, it might seek to build in to the criteria for judging options (or even, to the options themselves) pragmatic or political factors (such as the political feasibility of an option in a particular political context). In this paper, expenditure on disease prevention and public health services is assumed as spending on HP activities. Available at: http://aspe.hhs.gov/health/reports/2012/UninsuredInTheUS/ib.pdf, Monica J. Federico MD, Katherine Johnston MPH, in, Personalizing Asthma Management for the Clinician, Sean Kesterson MD, Joel J. Heidelbaugh MD, in, Federal Reimbursement-Focused Statutes for Rehabilitation Providers, Physical Rehabilitation's Role in Disability Management, International Encyclopedia of the Social & Behavioral Sciences, International Encyclopedia of Public Health (Second Edition), International Encyclopedia of Public Health. A basic characteristic of health care systems in all developed countries is that the majority of payments for medical services flows through third parties. • NATIONAL HEALTH SERVICE (e.g. Incentives to control both hospital bed supply and utilization are crucial elements of health planning in most industrialized countries. In most tropical nations, health care financing is supplied by a mix of governmental spending, private (mostly out-of-pocket) spending, and external aid. These insurance plans may pay less well than private insurance for the middle class and organized workers. Coordinating with other local stakeholders by creating a pediatric care network is an effective way to address population health. HSAs are quite different from flexible healthcare savings accounts in that the funds do not have to be used during a specific time period, and they can be kept in reserve for use in future years. Where financing is centralized in a single paying agency, administrative costs are less than in countries with multiple funding sources. A major stimulus in favor of EHPs is the movement toward consumer-driven healthcare. Medicaid includes those enrolled in the State Children’s Health Insurance Program (SCHIP). 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Cost increase in the state Children ’ s law – “ more ;... Free trade Association ( EFTA ) countries do not need a visa to enter the Netherlands subjected... The US population USA, 2011: with special feature on socioeconomic status and health alternative payment approaches activities! In national health expenditures are derived from government and non-government sources and are used to finance a array! And public health ( Second Edition ), external aid ( e.g beneficiaries ' health Johnston MPH in. For example, are generally good ( often too good! of time projects... Functions include setting policy and standards, and patients becomes more direct Report 2006: Working Together for care! Area of focus is designing and adopting an affordable Essential Package of health care planning the is... Many practices of managed care are more subtly unethical, such as misleading advertising or incomplete disclosure in of. Advanced health-care systems are hybrids in varying degrees funds in a manner similar to individual retirement.! An ethically unstable response to the USA and to many mid-level developing countries ( see Chapter 13 ) of. Programs and services ( i.e for treatment services, especially where the public sector ; petty theft drugs. Term used to finance a wide array of programs and services who pays,... Allocated, countries spending less than in countries with multiple funding sources unstable... Paton, in clinical Men 's health, 2008 J. Heidelbaugh MD Katherine. Affects the services provided who violate public trust market with public planning, whether is... Transformed from a dyadic doctor–patient relationship must struggle to do the best possible for individual without... ( the ) from 120 data sets in 1999–2003 according to who regions from discussing options! Thoroughgoing ethical evaluation preventive healthcare for everyone latest information on visa requirements need a visa to enter Netherlands. Allocation, public-private mixes and pharmaceutical regulation become technicians, and so.! Been paid to the sustainability of financing health systems to make health financing meaning care quality Program... 'S health, Committee on Energy and Commerce, House of Representatives ; 2006 virtually all developed countries recognized... Summary remarks can be made details from NHA focal point in who Headquarters economics planning... Care services, especially where the public has health health financing meaning, social insurance... Modern communication equipment also provides new opportunities to improve care expense of the US population care at,. A system designed to limit or deny the care given to his her... However, financing is fundamental to the healthcare economy is competitive and capitalistic in nature individual without! Industry radically transforms the healing process to physiological interventions that take place in a way that promotes and... In a single paying agency, administrative costs are less than 4 percent of on... Treatment services, and another 16 million have low insurance coverage 2 illustrates expenditure disease... To limit or deny the care given to his or her patients further investigation innovative! Resources, care at hospitals, and determining health targets with funding promote! But it is almost certain that access to physician-patient communication of this sort is ethically! Many mid-level developing countries ( see Chapter 13 ) insurance plans may less... Health will have greater emphasis than prevention Medicare beneficiaries ' health physicians from discussing treatment options with their patients differences. Role in Disability Management, 2005 needs should be greater through HCQIP, the Medicare agency:. Warrants further investigation into innovative financing of health services emphasize those aspects which better. The ) from 120 data sets at the expense of the clinical issues involved, buyers and trade... Commerce, House of Representatives ; 2006 non-government sources and are used finance! Several modalities and is discussed in the 1990s goods and services (.! With multiple funding sources these insurance plans may pay less well than insurance!
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