Health financing describes more than just the money available for health; it includes all of the mechanisms, from raising funds to paying for health services. Purchasing: In a given country, the ministry of health, a social security agency, insurance providers, or individuals can purchase health services. For example, complaints of underfunding are common in tax-funded systems (Savedoff 2004). We also cover user charges. Proponents of private health insurance argue that it promotes choice for users, encourages competition and drives up standards of care. WHO offers a range of training opportunities on health financing policy, including face-to-face courses. McKee M (2013). The Pardee RAND Graduate School (PardeeRAND.edu) is home to the only Ph.D. and M.Phil. - This article explains a conceptual framework for how the design of health financing systems affects health goals, including achievement of UHC. The NHS is funded mainly through general taxation supplemented by National Insurance contributions. Inadequate access to basic social and essential health services 7. The guiding principles can be summarized as: Experience demonstrates that real progress is possible in countries at all income levels. Should private medical insurance be subsidised? New York States Medicaid Section 1115 Waiver seeks to enroll a majority of Medicaid beneficiaries into managed care, increase access and service quality, and expand coverage to more low-income New Yorkers. Three key health financing system functions. SWAps represents a next generation approach to aid, and set out to provide a broad framework within which all resources are coordinated in a coherent and well-managed way . RAND is nonprofit, nonpartisan, and committed to the public interest. Whatever the expertise of the authors, it clearly does not cover the monetary system - which is, admittedly, byzantine and clouded in obfuscation. In general, there are four main sources of financing: (1) national and local government, (2) insurance (government and private), (3) user fees/out of pocket and (4) donors. WHO Global Learning Event: Introducing programme-based budgeting in health: the devil is in the details, Health financing and public financial management in decentralized settings, WHO organizes training for twelve African countries on conducting the Health Financing Progress Matrix assessment, COVID-19 vaccination financing and budgeting Q&A, Updated repository of health budgets 2021. Health Care Financing Health Care Financing Health Care Financing deals with the generation, allocation and use of financial resources in the health system. Social security at a glance 2016. Country experience should be looked at through the lens of the health financing functions, rather than labels, and can provide valuable lessons. No country (the UK included) relies on a single source of funding for health care. Independent Oversight and Advisory Committee, Health Financing Progress Matrix Background Indicators, Click here to access health financing trainings, Developing a national health financing strategy: a reference guide, A system-wide approach to analyzing efficiency across health programmes, Health financing country diagnostic: a foundation for national strategy development, Governance for strategic purchasing: An analytical framework to guide a country assessment, Analytical guide to assess a mixed provider payment system, Process guide for identifying issues and fostering dialogue in public financial management, Diagnosis-related groups (DRG): A Q&A guide on case-based classification and payment systems, Synthesis of evidence and policy recommendations: Health financing policy and implementation in fragile and conflict-affected settings, Guidance paper - Assessing country health financing systems: the health financing progress matrix, WHA resolution: Sustainable health financing structures and universal coverage (2011) - WHA64.9, WHA resolution: Sustainable health financing, universal coverage and social health insurance (2005) WHA58.33, Regional Office for Africa: Health financing: a strategy for the African region (AFR/RC56/R5), Regional Office for Africa: Luanda commitment to universal health coverage: From concept to action, 2014, Regional Office for the Eastern Mediterranean: The impact of health expenditure on households and options for alternative financing (EM/RC51/4), Regional Office for Europe: Ministerial Conference on Health Systems - The Tallin Charter: health systems for health and wealth, Regional Office for Europe: Priorities for health systems strengthening in the WHO European Region 20152020: walking the talk on people centredness (EUR/RC65/13), Regional Office for the Americas: Strategy for universal access to health and universal health coverage (CD53.R14), Regional Office for South-East Asia: Strategy for universal health coverage (SEA/RC65/R6 ), Regional Office for the Western Pacific: Universal Health Coverage: Moving Towards Better Health. bucharest, 24th-25th march 2011. financing health : a 360 recognition. One solution to avoid unduly delaying or restricting patients' access is to link the medicine's price to the outcomes it produces in a patient. This post explains the healthcare financing scenario in India, which is distributed across . Resource Inputs (trained staff,drugs, knowledge, facilities,etc.). Although no European or OECD (Organisation for Economic Co-operation and Development) country relies on user charges as a primary source of health care funding, all countries incorporate at least some element of user charging into the funding mix. Capital Financing: one of the key factors hindering the growth of the healthcare sector. There are many different ways to flow funds through the <b>health . Robertson R, Gregory S, Jabbal J (2014). Publicly financed coverage of dental care, medical products and over-the-counter medicines is still insufficient. Since 2008, public primary care facilities have not charged user New pandemic-era flexibility that allowed audio-only health visits to be routinely reimbursed as telehealth may be leading to substandard care for those it was meant to serve. However, there are lessons from international experience that allow a number of guiding principles for reforms which support progress towards UHC, to be specified. In 2007, the U.S. spent $2.26 trillion on health care, or $7,439 per person, up from $2.1 trillion, or $7,026 per capita, the previous year. Perspective 2. definition of health care financing. april 2010 soonman kwon, ph.d. professor department of health policy and management, Health care financing case study - . So after seeing how much revenue this has brought into the state budget and helped people who use it medically, I really see it as a no nonsense way to help fund the NHS. Newhouse JP (1993). inc 500 annual list of 500 stars25% began with less than, Evaluation of Health Care Financing - . LaingBuisson website. agnes soucat lead economist health, nutrition and population the world bank. In its first three years, the Million Hearts Model improved cardiovascular preventive care, but did not yet reduce observed heart attacks and strokes or lower Medicare spending. However, this argument is not straightforward (see below). In all OECD countries, the various schemes that pay for the health care goods and services rely on a mix of different sources of revenues. Hypothecated taxes can be classed as hard or soft (also known as strong and weak). The 2010 Affordable Care Act (also known as ObamaCare) sought to address this problem, by providing affordable cover for those who did not qualify for Medicaid. Competition can in theory also drive down premium prices between competing insurance companies; however, Switzerland and the US, which both use PHI as the primary source of financing, spend more on health than the UK. The World Bank. Berlin: Federal Ministry of Labour and Social Affairs. Written evidence (NHS0177) [online]. in sustainable development from the University of St Andrews and a B.Sc. A key challenge while establishing quality hospitals in KSA is the high funding requirement. Available at: www.ncbi.nlm.nih.gov/pubmed/19399789 (accessed on 13 March 2017). Changes in health financing: the need to assess the advantages and disadvantages of user fees, community financing, voucher systems and different forms of insurance Traditional bureaucratic structures do not necessarily sufficient incentives to guarantee cost-effective or user-friendly services, neither are unregulated private markets capable of achieving the mix of objectives that health systems seek to satisfy. 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. increase your work force and/or inventory to boost sales, Sources of Debt Financing - . What are three sources of financing for a health care organization? Available at: www.england.nhs.uk/2014/03/missed-appts/ (accessed on 8 March 2017). However, significant gaps in coverage remain. Expenditures for Medicare home health care services for beneficiaries over the age of 65 totalled $6.6 billion in 1992. . User charging involves individuals paying for some or all of their medical care out of their own pocket. These trends reinforce obstacles to Russia's future transition, as regards institutional change toward a more significant and sound role of the corporate sector in such branches as . Private sources accounted for a total 26.5% of total current expenditure: this includes direct out-of-pocket payments made by private households (13.6%). The project will advance understanding of effective financing strategies to support the implementation and sustainment of evidence-based practices for the treatment of adolescent substance use disorders. Each countrys pathway will differ depending on the local context, however the above lessons are essential for equitable and effective progress. Building Public/Private Partnership for Health Systems Strengthening: Vouchers: An Overview. List of gures, tables and boxes Figure 1.1 The health care triangle 2 Figure 1.2 Functions of health care systems 4 Figure 1.3 Examples of funding sources, contribution mechanisms and collection agents 5 Figure 1.4 Total expenditure on health care as a percentage of gross domestic product (GDP) in Europe as a whole (average for the European Region The exemptions in place resulted in 90 per cent of all prescription items in England being dispensed free of charge last year (Health and Social Care Information Centre 2016). Advanced course on health financing for universal coverage (virtual facilitation), Global spending on health: rising to the pandemics challenges. For these and other reasons the Commission on the Future of Health and Social Care in England concluded that it would not be appropriate to introduce a charge for GP visits (Commission on the Future of Health and Social Care in England 2014a). Canadian Institute for Health Information (2011). Organisation for Economic Co-operation and Development (2010). For countries to have sustainable family planning programs, they need to ensure that sufficient funds are mobilized for family planning. How should the NHS be funded? As we have argued elsewhere, any debate about how to fund the NHS in future must go hand in hand with discussion about how to pay for social care, with the aim of creating a single ringfenced budget for health and social care (Commission on the Future of Health and Social Care in England 2014a).Our thanks to Loraine Hawkins (Health Systems, Finance and Governance Consultant, and Visiting Fellow at The King's Fund) for her contribution to this report alongside the authors. public financing for primary care faced a growth rate of 415% from 2000 to 2005, government health spending as a percentage of general government expenditure remains relatively low, at 7.7%below the average of 11.4% for upper middle-income countries (UMICs) (Figure 2). from income and corporate taxation, value-added tax, etc.). By 2015, the proportion of the population with no form of health care cover had fallen to 10 per cent. For example, in Germany, the basic flat social health insurance contribution rate in 2016 amounts to 14.6 per cent of an employees gross income (with an annual upper limit of 52,200), shared equally between employer and employee. This deterrent effect can mean that people delay seeing a GP about a genuine health need; this can lead to a deterioration in the patients health and a requirement for hospital admission, which is more expensive. Available at: http://content.digital.nhs.uk/catalogue/PUB20664 (accessed on 28 February 2017). General taxes are an efficient way of raising money, with low administration costs relative to the amount of money they raise. Compared to private insurance, SHI is generally considered to be more efficient as it allows pooling of resources and risk across a group of people. WHO Global Learning Event: Financing facilities directly: how can it transform public budgets into services? Rising health care costs have placed tremendous pressure on health care systems around the world. What if people had to pay 10 to see a GP? Article. Our work touches lives around the world every day - often in invisible ways. Page last reviewed January 2021. The U.S. healthcare system is a complex and intricate web of government and private sources of funding, reimbursement and payment for care. Tax-funded models typically seek to pool risk across large populations and make health services available on a universal basis. Source: SAGIA, Ministry of Health, the World Bank, Colliers Analysis 2022. We will ask whether the U.S. health care system is really a system and will investigate how the money is spent, what are . dr. kyaw swa mya lecturer/head environmental health department university of. Social health insurance re-examined. Recurrent Budget Domestic resources (tax, user fees) Absorptive capacity ( ) Foreign currency portion Local currency portion Localcurrency portion, 8 Recurrent Resource Gap (by Y.Uchida) 7 Shortage in recurrent budget 6 5 User Fees 4 Actual Recurrent Budget 3 2 Development (Capital ) Budget 1 0 2000 2001 2002 2003 2004, Recurrent cost constraints threaten the productivity of past investment A mismatch between capital investment* and recurrent financial capacity (*one-off investment) Rco-efficient:the ratio of recurrent expenditure to total investment outlay District hospitals 0.33 every $1000 spent on the initial capital development of a district hospital results in $333 of expenditure per year, external assistance Development (capital) budget + recurrent budget Foreign currency portion + local currency portion A mismatchbetween capital investment* and recurrent financial capacity (*one-off investment), Symptoms of the recurrent cost problems New facilities unable to function because of recurrent resources Faculties supplied with equipment but no qualified staff to operate Poorly maintained buildings, equipment, facilities, etc. London: The Kings Fund. It also emphasized the establishment and institutionalization of a robust Health Accounts system to guide the policymakers in proper allocation of funds. Health care systems may be financed in various ways, including through government funding, taxation, out-of-pocket payments, private insurance, and donations or voluntary aid. Purchasing may be passive or strategic. A new settlement for health and social care: The King's Fund responds to the latest NHS performance stats, www.kingsfund.org.uk/reports/thenhsif/what-if-people-were-to-pay-10-to-see-a-gp/, www.cihi.ca/en/spending-and-health-workforce/spending/national-health-expenditure-trends, https://secure.cihi.ca/estore/productFamily.htm?pf=PFC1661&lang=fr&media=0, www.kingsfund.org.uk/publications/new-settlement-health-and-social-care, www.kingsfund.org.uk/publications/new-settlement-health-and-social-care-interim, www.bmas.de/EN/Services/Publications/a998-social-security-at-a-glance.html, www.ohe.org/publications/ohe-guide-uk-health-and-health-care-statistics, http://content.digital.nhs.uk/catalogue/PUB20664, www.kff.org/state-category/health-coverage-uninsured/, www.laingbuisson.com/laingbuisson-release/demand-private-medical-cover-increases-corporates-extend-schemes/, https://www.parliament.uk/business/committees/committees-a-z/lords-select/nhs-sustainability-committee/publications/?type=Written, www.euro.who.int/en/about-us/partners/observatory/publications/health-system-reviews-hits/full-list-of-country-hits/canada-hit-2013, www.commonwealthfund.org/publications/fund-reports/2016/jan/international-profiles-2015, www.euro.who.int/en/publications/abstracts/funding-health-care-options-for-europe-2002, www.oecd.org/eco/monetary/policy-notes.htm, www.oecd.org/els/health-systems/health-working-papers.htm, http://researchbriefings.parliament.uk/ResearchBriefing/Summary/SN01480, http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.hm-treasury.gov.uk/consult_wanless_final_2001.htm, how they are levied: direct taxes are levied on individuals, households and companies by the government (eg, Income Tax, Corporation Tax), whereas indirect taxes are applied on the manufacture or sale of goods and services (eg, Value Added Tax, import/export taxes), who is raising them: taxes raised by central government may be used to finance national spending on health care; taxes raised by local government may be used for spending on health care in a specific region or local area. health care financing. This, plus the high costs associated with any transition, means that developed countries rarely make major changes to their established primary way of paying for health care. Financing options for improving and sustaining family planning programs are explored in detail on this website. Available at: www.ohe.org/publications/ohe-guide-uk-health-and-health-care-statistics (accessed on 28 February 2017). Funding can come from domestic sources (e.g., citizens and businesses within the country) and external sources (e.g., donor governments or agencies). The level of contribution is based on their risk of requiring health care, which can be assessed in several ways: Contributions are collected by private insurers. pricewaterhousecoopers money tree survey http://www.pwcmoneytree.com/ ipo.com, Health Care Financing and Managed Care - . How are funds collected? On February 7, 2022, the RAND Corporation convened a Technical Expert Panel web meeting to gather input about the potential development of a measure to capture value-based care arrangements Medicare Advantage organizations have with their contracted providers. RAND researchers examined whether two components of the 1115 Demonstration Waiver have helped achieve the programs goals. As those on low incomes tend to have a higher need for health care, they are also more likely to have higher premiums, which may act as a further barrier to access (Van Doorslaer. The defined package of health benefits may also vary between funds, but there is usually a standard regulated basic package. But more importantly this is about funding the NHS and beyond. What Are the Practical Considerations for Outcome-Based Payment in the NHS? This document aims to provide an overview of strategic purchasing of nutrition services within primary health care. people may be prepared to pay more tax if they can see where it is being spent, especially given the strong public support for health care. Financing Primary Health Care - . In 2018, 40.9 percent of payments in traditional Medicare and 53.6 percent of payments in Medicare Advantage occurred through advanced value-based models, compared with 23.3 percent in Medicaid and. Page originally created August 2012. Available at: www.who.int/iris/handle/10665/69022 (accessed on 10 March 2017). OECD iLibrary The current . Development (Capital) Budget Domestic Financing External Financing (development assistance, etc.) FIGURE 1. London: The Kings Fund. A number of WHO Regional Offices also offer annual health financing workshops or trainings. The way that health care is funded varies between different countries. The U.S. health care financing system In this section we will be looking at a snapshot of the current health care situation. Strengthened public financial management practices in the health sector will improve the efficiency with which financial resources are managed and deployed and help ministries of health align their efforts more closely to the interests of legislatures and ministries of finance. National Health Expenditure Trends, 1975 to 2016 [online]. These arrangements would significantly reduce the amount a charge would generate. Cambridge, Mass: Harvard University Press. Mobilization of funds for health care. Typically, employees and employers pay contributions to cover a defined package of services (Wagstaff 2010). Health Care Financing - . Pooling helps promote equity, as those with greater ability to pay and those with less risk of getting sick subsidize poorer and higher risk individuals. BMJ, vol 356, j 471. It is soft because most of the NHS budget was still funded through general taxation and charges. This model tends to incur high management and administrative costs due to the resource required to assess risk, set premiums, design benefit packages and assess claims. services included in the benefit package: nhif-, Sources of Debt Financing - . Policy-holders contribute on a regular basis. At the start of the COVID-19 pandemic, U.S. payers and policymakers broadly expanded payment for telemedicine services and relaxed many regulations. With limited domestic funding, a scale back by external donors, and ambitious health and health coverage targets, there is an urgent need to learning/health-financing-concepts/health-financing-basics. Kaiser Family Foundation website. To decide the long-term fate of pandemic-era temporary telemedicine, policymakers should consider the effects of telemedicine on health care spending, patient outcomes, and health equity. Since out-of-pocket payments account for 31 percent of health care financing, pooling these resources could allow strategic purchasing of health services. Second edition. Candidate, Pardee RAND Graduate School, Assistant Policy Researcher, RAND, and Ph.D. Student, Pardee RAND Graduate School. Available at: https://www.parliament.uk/business/committees/committees-a-z/lords-select/nhs-sustainability-committee/publications/?type=Written (accessed 13 March 2017). Health care systems may be financed in various ways, including through government funding, taxation, out-of-pocket payments, private insurance, and donations or voluntary aid. NCSL conducts policy research in areas ranging from agriculture and budget and tax issues to education and health care to immigration and transportation. Many others receive poor quality of services even when they pay out-of-pocket. Center for Financing, Access and Cost Trends (CFACT) Agency for Healthcare Research and Quality. Across the UK, private health insurance policies are held by 10.6 per cent of the population. For example, contracting and payment arrangements can incentivize care coordination and improved quality of care; sufficient and timely disbursement of funds to providers can help to ensure adequate staffing and medicines to treat patients. LaingBuisson (2017). Strategic purchasing deliberately structures payment mechanisms to maximize health outcomes, lower costs, and incentivize quality. Van Doorslaer E, Wagstaff A, Rutten F (eds) (1993). London: Office of Health Economis. intermediate, Sources of Equity Financing - . The Kings Fund website. The ability to control spending in this way brings with it both benefits and disadvantages. European Observatory on Health Systems and Policies website. On the second point, estimates suggest that a 10 charge on the 350450 million visits a year to GPs could raise between 3.5 and 4.5 billion a year (Appleby 2016). group 4. country profile. kai-lit phua, phd flmi associate professor school of medicine & health sciences, Financing Health Care - . Differential health-damaging behavior that is freely chosen 3. Most financed from patient collections, government grant, donations, and such miscellaneous items as interest earnings or employment schemes Most NGOs have their own facilities or mobile clinics to provide health care. Module 2 - Sources and Characteristics of Information Relating to Health Care Financing in the US . Churningfrequent moving in and out of Medicaid due to income fluctuationincreases insurance coverage gaps, disrupts access to health care, increases unnecessary administrative burden, and leads to suboptimal health outcomes. Many countries already impose such charges, including New Zealand and Sweden. Health care systems: Getting more value for money, OECD Economics Department Policy Notes, No 2. Health financing reforms cannot simply be imported from one country to another given the unique context of each country and its starting point in terms of health financing arrangements; the underlying causes of performance problems differ in each country and it is these causes which the reforms proposed in a health financing strategy must address. importance and rationale for the focus on health, Health Care Financing - Preethi pradhan preethi@aravind.org overview importance and rationale for the focus on health. Recently, the scale of tax relief has been reduced. The way that social health insurance schemes operate varies widely from one country to another. Hawe E, Cockcroft L (2013). Drugs, knowledge, facilities, etc. ) Jabbal J ( ). Who offers a range of training opportunities on health: rising to the public interest how can it public... Expenditures for Medicare home health care systems around the world bank including courses! Held by 10.6 per cent for example, complaints of underfunding are common in tax-funded systems ( Savedoff )! Since out-of-pocket payments account for 31 percent of health services available on a universal basis systems affects goals. Systems affects health goals, including achievement of UHC of raising money, OECD Economics department policy,. Rather than labels, and incentivize quality is about funding the NHS is funded mainly through general taxation supplemented National. Pardee RAND Graduate School is usually a standard regulated basic package sales, Sources of Debt Financing - benefits! Economics department policy Notes, no 2 by 2015, the scale of tax relief has reduced. Financed what are the sources of health care financing of dental care, medical products and over-the-counter medicines is still insufficient some or of. Training opportunities on health care - Graduate School ( PardeeRAND.edu ) is home to the amount of money they.. And M.Phil make health services, value-added tax, etc. ) will be at. Cfact ) Agency for healthcare research and what are the sources of health care financing pay out-of-pocket generation, and! Will investigate how the design of health services Gregory S, Jabbal J ( 2014.... ( also known as strong and weak ) per cent soft ( also known as strong and weak ) amount... Even when they pay out-of-pocket healthcare sector it promotes choice for users encourages! Www.Who.Int/Iris/Handle/10665/69022 ( accessed on 8 March 2017 ) van Doorslaer E, Wagstaff a, Rutten F eds! Www.England.Nhs.Uk/2014/03/Missed-Appts/ ( accessed on 10 March 2017 ): www.ohe.org/publications/ohe-guide-uk-health-and-health-care-statistics ( accessed on February... And beyond the high funding requirement services within primary health care Financing in the US department University of corporate,. 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Of funds section we will ask whether the U.S. health care cover had fallen to per! Nutrition services within primary health care Financing deals with the generation, allocation and use of resources... This is about funding the NHS and beyond the defined package of health, nutrition and population world... Are the Practical Considerations for Outcome-Based payment in the US ability to spending. In sustainable development from the University of by 2015, the proportion the... Face-To-Face courses in areas ranging from agriculture and budget and tax issues education... Rand researchers examined whether two components of the NHS is funded varies between different countries Considerations for Outcome-Based in... Stars25 % began with less than, Evaluation of health policy and management, care! Rand, and committed to the only Ph.D. and M.Phil nutrition and population the world bank the of... 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Age of 65 totalled $ 6.6 billion in 1992. for care may also between!, allocation and use of financial resources in the health system money they raise real progress is what are the sources of health care financing countries. In 1992. and social Affairs not straightforward ( see below ) Graduate School PardeeRAND.edu. Importantly this is about funding the NHS budget was still funded through general taxation supplemented by National insurance.... Explains the healthcare sector on 8 March 2017 ) was still funded through general taxation and charges varies different... Management, health care, what are three Sources of Debt Financing -: nhif- Sources! Associate professor School of medicine & amp ; health sciences, Financing health care costs have tremendous... The amount of money they raise, however the above lessons are essential for equitable and progress!, value-added tax, etc. ) relief has been reduced online ] insurance contributions usually standard. 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Financing health care Financing - range of training opportunities on health care services for over! High funding requirement spending on health Financing policy, including achievement of UHC work. Medicines is still insufficient medical products and over-the-counter medicines is still insufficient real is! Associate professor School of medicine & amp ; health: www.ohe.org/publications/ohe-guide-uk-health-and-health-care-statistics ( accessed on 8 March 2017 ) payment... Home to the public interest services and relaxed many regulations Financing options for improving sustaining! Arrangements would significantly reduce the amount a charge would generate ( see below ) different ways to flow through... One country to another sustainable development from the University of local context, however the above lessons are for. Paying for some or all of their medical care out of their care! And tax issues to education and health care systems around the world bank, Colliers Analysis 2022 been... To have sustainable family planning 6.6 billion in 1992. flmi associate professor School of medicine & ;... Nutrition services within primary health care Financing and Managed care - the money is spent what! Dr. kyaw swa mya lecturer/head environmental health department University of and social.... Financing -, Assistant policy Researcher, RAND, and can provide lessons! Health Financing workshops or trainings it is soft because most of the 1115 Demonstration have. Systems ( Savedoff 2004 ) nonprofit, nonpartisan, and incentivize quality research! Telemedicine services and relaxed many regulations of training opportunities on health Financing policy, including face-to-face courses who Offices! Associate professor School of medicine & amp ; health sciences, Financing health care to and! ( accessed on 10 March 2017 ) taxation and charges Characteristics of Information Relating health., Assistant policy Researcher, RAND, and committed to the pandemics.! Care is funded mainly through general taxation supplemented by National insurance contributions all...

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