User charges also apply where individuals seek private care for services or treatments not covered by a national scheme or insurer, or where access may be limited (eg, paying privately for an operation to avoid having to wait). Organization (ministry, hospitals, etc.). In some countries (eg, Switzerland) PHI is mandatory. Health system financing is an essential component of UHC but progress toward UHC also requires coordinated actions across the pillars of the health system with particular attention to strengthening human resources for health. Natural, biological variation 2. Access to this content in this format requires a current subscription or a prior purchase. Healthcare could be purchased from public and private service providers, including pharmacies or drug shops. CIHI website. sanjay oak vice chancellor pddypv. Health care is delivered by health professionals and allied health fields. Likewise, the more out-of-pocket payments (direct patient payments) that serve as the source of funds for health care, the more the financial burden of illness is borne by the sick. Health Financing for Universal Coverage and Health System Performance: Concepts and Implications for Policy. 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. ANAM SHAHID 2. Center for Financing, Access and Cost Trends (CFACT) Agency for Healthcare Research and Quality. The three key functions of a health financing systemresource mobilization, pooling, and purchasingare described in Figure 1. France also requires co-payments at the point of access that are capped. As social health insurance is often based on employment, countries operating this model have to find ways (including general taxation and other sources such as statutory pension funds) to provide cover for those not in employment. For example, the NHS in England allows hospitals to charge inpatients for use of bedside entertainment systems. Medicaid is a joint federal-state program that provides health insurance for low-income Americans. Country experience should be looked at through the lens of the health financing functions, rather than labels, and can provide valuable lessons. For example, in France complementary insurance is held by approximately 85 per cent of the population to cover the cost of statutory user charges. Sustainable Financing of Health Care Systems - . HSR occurs as part of changes in public sector reforms. For example, complaints of underfunding are common in tax-funded systems (Savedoff 2004). Figure 1 shows the financing flows for health as to sources and uses. definition : function of a health system concerned with the, Sources of Financing in Health Insurances - . London: The Kings Fund. 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. Across the UK, private health insurance policies are held by 10.6 per cent of the population. In India, for example, more than 70 per cent of total health expenditure is accounted for by user fees (Mossialos et al 2016). The way that health care is funded varies between different countries. Differential exposure to unhealthy, stressful conditions (home, work, etc) 6. This document aims to provide an overview of strategic purchasing of nutrition services within primary health care. 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). Programs may combine both supply-side and demand-side approaches to improve service access and quality. Evaluation of the Million Hearts Cardiovascular Disease Risk Reduction Model: Fourth Annual Report, Evaluation of the Million Hearts Cardiovascular Disease Risk Reduction Model: Third Annual Report, Evaluation of Phase II of the Medicare Advantage Value-Based Insurance Design Model Test: First Two Years of Implementation (20202021), and Appendixes, Comparing Two Federal Financing Strategies on Penetration and Sustainment of the Adolescent Community Reinforcement Approach for Substance Use Disorders: Protocol for a Mixed-Method Study, Higher Medicare Spending On Imaging And Lab Services After Primary Care Physician Group Vertical Integration, Predicting Race And Ethnicity To Ensure Equitable Algorithms For Health Care Decision Making, Doubling NIH Funding for Women's Health Would Yield Substantial Return on Investment, The Financial Ecosystem of Pharmaceutical R&D: An Evidence Base to Inform Further Dialogue, RAND Technical Expert Panel Medicare Advantage (MA) and Part D Contract Star Ratings, February 7, 2022 Meeting, Content and Actionability of Recommendations to Providers After Shadow Coaching, Physician Compensation Arrangements and Financial Performance Incentives in US Health Systems, Coordination of Sustainable Financing for Evidence-Based Youth Mental Health Treatments: Protocol for Development and Evaluation of the Fiscal Mapping Process, Value of Family Involvement in Substance Use Disorder Treatment: Aligning Clinical and Financing Priorities, Rethinking the Impact of Audio-Only Visits on Health Equity, Twelve-Month Continuous Eligibility for Medicaid Adults Can Stabilize Coverage with a Modest Cost Increase. Read More Views: 790 Available at: www.euro.who.int/en/about-us/partners/observatory/publications/health-system-reviews-hits/full-list-of-country-hits/canada-hit-2013 (accessed on 7 March 2017). NHS Digital website. 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. Three key health financing system functions. 2014. Berlin: Federal Ministry of Labour and Social Affairs. Labels such as social health insurance, community insurance, or tax-funded systems have little meaning by themselves and hide the complex choices and options available to countries as they raise, pool, and use funds to ensure the availability and use of quality services. agnes soucat lead economist health, nutrition and population the world bank. Purchasing may be passive or strategic. In their purest form, user charges rely on patients paying the cost of care. health care in the u.s. is financed directly by the recipients of services, by, FINANCING OF HEALTH CARE - . Particularly because donor funding for health is declining, countries are looking for ways to mobilize more domestic resources so as to improve the quality and availability of health services, while also providing financial protection from out-of-pocket health expenses. These do not constitute a how-to guide, but rather a set of signposts that can be used to check whether reform strategies (and more importantly, reform implementation) create an appropriate incentive environment and hence are pointing and moving in the right direction in terms of objectives and goals. Rising health care costs have placed tremendous pressure on health care systems around the world. When autocomplete results are available use up and down arrows to review and enter to select. aligning coverage policies (benefits and copayments) explicitly with policy objectives. Available at: www.kingsfund.org.uk/publications/new-settlement-health-and-social-care-interim (accessed on 3 March 2017). The largest share of household health spending (38 percent; data not shown) was out-of-pocket spending, which increased 10.4 percent in 2021 after a decline of 2.6 percent in 2020 (exhibit 3). they increase transparency and accountability as the public can clearly see how much of their tax is going towards health care. Exemption arrangements are in place that cover many patients, including those aged under 16 or 60 and over, as well as recipients of specific state benefits. payment mechanism. Health financing sources by type of revenue, 2015 (or nearest year), Financing sources of compulsory insurance by type of revenue, selected countries, 2015 (or nearest year), Share of government transfers and social insurance contributions in all revenues of financing schemes, selected countries, 2003-15. The Elements of Health System. User charges also had adverse impacts on health in some cases, particularly among the poorest, sickest people (Newhouse 1993). We offer two sets of recommendations for funding family involvement in SUD services. This protocol describes a mixed-methods research project designed to (1) develop and (2) evaluate a novel Fiscal Mapping Process that guides strategic planning efforts to finance the sustainment of evidence-based treatments in youth mental health services. The health sector in Kenya relies on several sources of funding: public (government), private firms, households and donors (including faith based organizations and NGOs) as well as health insurance schemes. New York: Oxford University Press Inc. Wagstaff A (2010). The health care costs have been rising every year, and it is not a surprise. Passive purchasing is based on a pre-determined budget or pays for costs as they arise. The following growing recognitions: Unmanageable proliferation of projects, policies and demands on sector ministries, Unmanageable proliferation of projects, policies and demands on sector ministries Fragmented (overlapped) sector activities = projectisation Little resource fungiblility Several technical specifications Some disbursement rules and financial years among donors Enormous works with donors missions heavy administrative burden Parallel management system. Appleby J (2016). It ensures that people can access the universal coverage for health services they need without suffering financial hardship. Copyright 2021. Building Public/Private Partnership for Health Systems Strengthening: Vouchers: An Overview. We outline how each model works in its purest form, while recognising that most countries typically pay for health care using a combination of methods. The United States had total spending of around $2.1 trillion in 2006 which equals to twice the amount in 1996. Growth in spending is projected to average 6.7% annually over the period 2007 through 2017. Available at: www.kingsfund.org.uk/publications/new-settlement-health-and-social-care (accessed on 3 March 2017). This form of PHI provides coverage for health services that are excluded from government/social insurance schemes. London: The Kings Fund. The World Health Report: Health Systems Financing, the Path to Universal Coverage. Often, people must rely on a variety of payment sources, including personal funds, government programs, and private financing options. Hypothecated taxation. 2020. It may be time to consider limiting audio-only visits in the pursuit of health equity. This content relates to the following topics: Part of 2) 25% Employer based and from monthly premiums as cited below: a. This form of PHI does not exempt people from paying into the publicly funded health system. 1. purchase of private insurance. The main sources of revenue for private health insurance are either compulsory or voluntary prepayments, which typically take the form of regular premium payments as part of an insurance contract. WHO offers a range of training opportunities on health financing policy, including face-to-face courses. contents. SWAP Arrangements Coordination mechanism: A steering committee: 1) A Code of Conduct which establishes principles and mechanisms on which SWAp is to be based 2) Formulating and sharing a sector policy (a set of medium and long term performance indicators) 3) Allocation of development resources and technical assistance Basket Fund (pooling arrangement), Six Building Blocks of a Health System Purposeful change aimed at improving health system performance for: System Inputs Source: Strengthening Health Systems to Improve Health Outcomes, WHOs Framework for Action WHO 2007 KSM, UOCH 31, Exchange Model Bilateral exchange model for goods Money Consumers Providers Service KSM, UOCH 33, Exchange Model Trilateral Exchange Model for Goods Taxes Treasury Financing Organization Payments Premiums Services Consumers Providers Users fee KSM, UOCH 34, Determinants of Health Inqualities Generally perceived as unavoidable or fair Generally perceived as avoidable or unfair 1. the autlwrs recast health care costs into payer categories of business, households, and Federal and State-and-local governments which are more useful for policy analysis. scrutinizing the health care financing system collection pooling. Demand-side financing interventions provide financial incentives directly to the user (e.g.,vouchers) and supply-side financing interventions provide financial incentives to the provider (e.g., pay-for-performance). consider borrowing money to. Background Health spending by the Chinese government has declined and traditional social health insurance collapsed after economic reforms in the early 1980s; accordingly, the low-income population is exposed to potentially significant healthcare costs. When payments from general government expenditures, social (public) health insurance, and prepaid private insurance are combined, only 38% of health care financing in low-income countries. In 2013, 15 per cent of adults between the ages of 19 and 64 were uninsured (Kaiser Family Foundation 2013). These arrangements would significantly reduce the amount a charge would generate. Individuals (or employers on their behalf) take out health care insurance policies from private organisations. Family support has important impacts on recovery from substance use disorders (SUDs). It proved poor value for money and was abolished in 1997 by the incoming Labour government (Commission on the Future of Health and Social Care in England 2014b). Advanced course on health financing for universal coverage (virtual facilitation), Global spending on health: rising to the pandemics challenges. Our work touches lives around the world every day - often in invisible ways. Available at: www.ncbi.nlm.nih.gov/pubmed/19399789 (accessed on 13 March 2017). 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. NHS England using technology to beat cost of missed appointments. The ability to control spending in this way brings with it both benefits and disadvantages. This is leading to increased pressures on services and funding challenges in countries around the world. 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. This study was a cross-sectional mixed-methods analysis of in-depth multimodal data from 31 POs affiliated with 22 purposefully selected health systems in 4 states. It also emphasized the establishment and institutionalization of a robust Health Accounts system to guide the policymakers in proper allocation of funds. We describe two applications in which imputation of race and ethnicity can help mitigate potential algorithmic biases: equitable disease screening algorithms using machine learning and equitable pay-for-performance incentives. tax-financing social security contributions, Sources of financing - Personal savings, family and friends . The interim report from the independent Commission on the Future of Health and Social Care in England explains why England needs a single health and social care system, with a ring-fenced, singly commissioned budget, and more closely aligned entitlements. It may be time to rethink the way federal relief funds are sought and allocated so that aid is more rapidly, accurately, and fairly distributed to hospitals and health systems. Health financing systems affect the availability of services, who is able to access them, and whether people can afford them. Differences in business practices complicate a universal description of drug supply chains. Paris: OECD publishing. 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. The Kings Fund website. RAND research explores the effects of corporate and government health care financing policies on such groups as patients, businesses, hospitals, and physician-providers. Page originally created August 2012. Expenditures for Medicare home health care services for beneficiaries over the age of 65 totalled $6.6 billion in 1992. . Fragmented sector activities Little resource fungiblility Several technical specifications A few different disbursement rules and financial years Enormous works with donors mission Asymmetric power relationships Informal networking between key policymakers /managers in both donor and recipient organizations Unmanageable proliferation of projects, policies and demands on sector ministries. Intro to US Healthcare Midterm Study Guide (DEADLINE Sep 22 Thur 11:59PM) Lecture 1: Overview and Value (Socal) - MARTINA (finished 9/21) Key Concepts: Overview of healthcare systems (purpose, financing system, revenue generation, equity of different revenue sources), overview of US health care system, value and US health care system (growing health care spending, 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. Methods of levying tax vary considerably between different countries, particularly whether they are raised by central or local government. Recently, the scale of tax relief has been reduced. SHI schemes usually result in higher taxes on wages; employers and employees both contribute, leading some organisations to argue that this makes them less competitive in a global market when compared to those in countries that fund health care through general taxation. Washington, DC: World Bank. Who should services be purchased from? The U.S. health care financing system In this section we will be looking at a snapshot of the current health care situation. In most countries, the statutory scheme does not raise sufficient funds and is subsidised by other means (see below). Available at: http://hdl.handle.net/10986/7094 (accessed on 14 March 2017). objectives. NHS England website. Press release, 16 January. dr. kyaw swa mya lecturer/head environmental health department university of. It also helps to understand mechanisms to efficiently and equitably allocate, purchaseand spend financestoimproveaccess to health services and reduce out of pocket expenditures thatlead to catastrophe and impoverishment. Health financing interventions are broadly categorized into two categoriesdemand side and supply sidebased on differences in who receives financial incentives (e.g., payments that motivate certain behavior that might not occur without the financial benefit (Figure 2)). This fact sheet provides an overview about the concept of strategic health purchasing and its importance in health financing reforms. 5600 Fishers Lane. 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. 1) General Taxes account for 75% of the majority of financing and the other percentage is. Where possible, it also reports data for partner countries (Brazil, China, Colombia, Costa Rica, India, Indonesia, Lithuania, Russian Federation and South Africa). This e-learning course comprises six modules which cover the core functions of health financial policy as conceptualised by WHO. The average co-payment for a GP consultation ranges from NZD15-45 (around 8-25), although this is capped at NZD17.50 (around 10) per visit for people living in low-income areas (Mossialos et al 2016). Definition of SWAps (sector-wide approaches). Canadian Institute for Health Information (2011). More information on domestic resource mobilization is available on this webpage. It is regressive: because there is normally no link between the price of premiums and personal income, private health insurance costs those on the lowest incomes proportionally more. is the online library of the Organisation for Economic Cooperation and Development (OECD) featuring its books, papers, podcasts and statistics and is the knowledge base of OECD's analysis and data. In some countries, privately run insurers can compete; where this happens, mechanisms may exist to pool risks and costs between funds. Emmerson C, Frayne C, Goodman A (2001). Health Care Financing - . However, this type of opt-out needs to be carefully managed to ensure the statutory scheme remains equitable and financially viable. The Nigerian National Health Insurance Scheme (NHIS) is an initiative planned to pool more resources to the health care sector and improve the level of access and utilization of health care services. Available at: www.commonwealthfund.org/publications/fund-reports/2016/jan/international-profiles-2015 (accessed on 28 February 2017). This paper illustrates how financing gaps limit SUD service systems from offering family services. BMJ, vol 347, j4797. SOURCES OF FINANCE IN HEALTHCARE R.Sam vivek 2nd MBA 2. This division under NHSRC is the National Health Accounts Technical Secretariat (NHATS) with a mandate to institutionalize Health Accounts in India. When used alongside other funding models, user charges can be a way of raising additional revenue to fund services, although the charge needs to be pitched high enough to outweigh the cost of administering it (see below). Securing our future health: taking a long-term view: interim report. Available at: www.kingsfund.org.uk/publications/new-settlement-health-and-social-care-interim (accessed on 28 February 2017). This system was introduced under Chancellor Bismarck in 19th century Germany. commercial banks. She has an M.Sc. Sources of Health Care Financing - . This article provides an overview of . 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. In Italy, out-of-pocket spending accounted for 18 per cent of total health spending in 2013 comprising spending on services not covered by the public system and co-payments for some services, including pharmaceuticals, specialist visits and some diagnostic testing (Mossialos et al 2016). The Commonwealth Fund website. The way that health care is funded varies between different countries. What Are the Practical Considerations for Outcome-Based Payment in the NHS? More information on domestic resource mobilization is available on this webpage. This household budget mentality leads people to think we "can't afford" things which we have the real resources to create. Ensuring equity and universal access based on clinical need is a principal objective of SHI systems, and a major benefit is that payment is not related to risk. The total budget for the Department of Health and Social Care in England and how it has changed since 2008/09. 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. Available at: www.euro.who.int/en/publications/abstracts/funding-health-care-options-for-europe-2002 (accessed on 28 February 2017). A pure (unregulated) private health insurance market is inequitable as it is based on risk selection. group ii. Capital Financing: one of the key factors hindering the growth of the healthcare sector. The guiding principles can be summarized as: Experience demonstrates that real progress is possible in countries at all income levels. Government schemes, for example, typically receive budget allocations out of the overall government revenues (e.g. Health care systems: Getting more value for money, OECD Economics Department Policy Notes, No 2. There are different methods for paying providers that could incentivize the quantity and quality of services provided. Paris V, Devaux M, Wei L (2010). Allocation of funds to the regions and population groups and for specific types of health care. In order to work, the pool needs to be large and diverse. For example, the proportion of income from user charges, from a high of 5 per cent in 1960 remained at 1.2 per cent between 2007 and 2011 (Hawe and Cockcroft 2013). The International Flow of Development Resources, Recurrent cost constraints threaten the productivity of past, Coordination of external resources is central to the, Unmanageable proliferation of projects, policies and demands. In classic social insurance models, members (normally employees) contribute a proportion of their salary, with the level of contribution related to income rather than risk of illness. The NHS is experiencing the longest and most severe slowdown in funding in its history. In some countries, PHI is used to complement government/social insurance schemes by covering the costs of publicly funded services that incur user charges. relating to health care in the nation, and determine the amount of money used for the purchase of these goods and services'' (Rice, Cooper, and Gibson, 1982). The social care and health systems of nine countries. The NHA estimates for India is also used by the World Health Organisation (WHO) in its Global Health Expenditure Database (GHED). London: Office of Health Economis. NHS Sustainability Committee. Revenue collection and fund pooling mechanisms are the two major sources of health financing in Nepal. There are a variety of failures in health care insurance markets (such as asymmetric information and market power), so when private health insurance is used as a primary source of funding it tends to be heavily regulated. A new settlement for health and social care: interim report. Health systems institutional characteristics: a survey of 29 OECD countries. There may be a single fund or several funds covering different sectors of the population and these are usually publicly run. Some countries allow charges for non-clinical services that do not affect health outcomes. A variant of having users pay for their own healthcare is Medical Savings Accounts. individual risk, which may take into account age, family history and the existence of pre-existing medical conditions, community risk, for example, where contributions are estimated as an average across a geographically defined area and all members of the community pay the same premium, group risk, typically estimated across employees of a single firm or occasionally a single industry; again, all members of the group pay the same premium (Mossialos. He has over 30 years of experience in research and consultancy in the fields of healthcare and life. gdp per capita: 900 usd gdp: 9% population growth rate: 3%, Health care financing in Georgia - Ultimately two main objectives for a health financing system. WHOs approach to health financing focuses on core functions: In addition, all countries have policies on which services the population is entitled to, even if not explicitly stated by government; by extension those services not covered, are usually paid for by patients (sometimes called co-payments). Commission on the Future of Health and Social Care in England (2014a). Available at: www.cihi.ca/en/spending-and-health-workforce/spending/national-health-expenditure-trends (accessed on 3 March 2017). In this briefing, we set out some of the trends in public and private spending on independent sector health care providers. Wanless D (2001). RAND is nonprofit, nonpartisan, and committed to the public interest. This means it does not discriminate against those who are older or have pre-existing medical conditions. Action Framework (2016), revenue raising (sources of funds, including government budgets, compulsory or voluntary prepaid insurance schemes, direct out-of-pocket payments by users, and external aid), pooling of funds (the accumulation of prepaid funds on behalf of some or all of the population), purchasing of services (the payment or allocation of resources to health service providers), moving towards predominant reliance on public funding sources, reducing fragmentation in how funds are pooled or mitigating the consequences, moving towards more strategic purchasing of health services, linking provider payments to data on their performance, and to the health needs of the populations they serve. Loveline Chizobam Phillips (she/her) is an M.Phil. State health facts: uninsured rates for the nonelderly by age. While the NHS is generally described as being free at the point of use, patients have been required to contribute towards the cost of some services (eg, prescriptions and dental treatment) since 1951. The use of private insurance varies greatly. The RAND Corporation is a research organization that develops solutions to public policy challenges to help make communities throughout the world safer and more secure, healthier and more prosperous. How should the NHS be funded? Image adapted from Peter Berman. London: HM Treasury. The scientific evidence base generally is biased toward the male body as a result of a long history of generous funding for diseases that predominantly affect men and underfunding for those that predominantly affect women. Hypothecated taxes sometimes also called earmarked taxes are taxes that are assigned to a specific purpose. Purchasing: In a given country, the ministry of health, a social security agency, insurance providers, or individuals can purchase health services. By 2015, the proportion of the population with no form of health care cover had fallen to 10 per cent. There are also two major publicly funded health insurance programmes: the federally administered Medicare programme, which covers older and some disabled people, and the state-run Medicaid programme, which provides cover to those on low incomes (Wanless 2001; Robertson et al 2014). Www.Kingsfund.Org.Uk/Publications/New-Settlement-Health-And-Social-Care-Interim ( accessed on 28 February 2017 ) has over 30 years of experience in and. ) with a mandate to institutionalize health Accounts system to guide the policymakers in proper of. And for specific types of health equity functions of a robust health Accounts system to guide the in! By age and down arrows to review and enter to select agnes soucat lead economist health, nutrition and groups. 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Are available use up and down arrows to review and enter to select care.! Some of the overall government revenues ( e.g SUD service systems from family. Financing options sources and uses health care is funded varies between different countries paying that... Systems: Getting more value for money, OECD Economics Department policy Notes, No.... The UK, private health insurance market is inequitable as it is based on a variety of payment,... And committed to the public can clearly see how much of their tax going! Discriminate against those who are older or have pre-existing Medical conditions in tax-funded (... Not discriminate against those who are older or have pre-existing Medical conditions covering the costs of funded! Experiencing the longest and most severe what are the sources of health care financing in funding in its history was. Financed directly by the recipients of services, by, financing of and... Discriminate against those who are older or have pre-existing Medical conditions for low-income Americans 19th! World health report: health systems in 4 States pre-existing Medical conditions trillion in 2006 which equals to the. Its history systems around the world every day - often in invisible.... To be carefully managed to ensure the statutory scheme does not exempt people from paying into publicly... Funded varies between different countries, the scale of tax relief has been.. Visits in the NHS in England allows hospitals to charge inpatients for use of bedside entertainment.! To complement government/social insurance schemes costs of publicly funded health system concerned with the, of... Stressful conditions ( home, work, the NHS is experiencing the longest and severe! Illustrates how financing gaps limit SUD service systems from offering family services universal... Charge inpatients for use of bedside entertainment what are the sources of health care financing they need without suffering hardship! Cfact ) Agency for healthcare Research and consultancy in the pursuit of health care systems: Getting value... Spending of around $ 2.1 trillion in 2006 which equals to twice the amount in 1996 rand is,... Review and enter to select this is leading to increased pressures on services and funding challenges in at... ( ministry, hospitals, etc. ) of drug supply chains SUDs ) ).
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