1995;32:25777. There are two forms of institutional setup found for this pooling arrangement. Complementary insurance for health services covers benefits that are excluded from the public systems package, thereby giving access to a wider range of benefits. Different frameworks for assessing of health . The highest VHI expenditure share (47%) was in South Africa, yet this spending covered only about 16% of the population [52]. Terms and Conditions, Risk pooling is the spreading of the financial risk associated with the need to use and pay for health services, rather than to be fully borne by the individual who falls ill [11].The objectives of this paper are to raise the profile of pooling as a health financing policy instrument and to provide a simple classification of country pooling arrangements through which we discuss the challenges typically associated with how fragmentation manifests in each setting. a. the QIO program provides patients with information about the quality of care at US hospitals b. the QIO program focuses on helping medicare and medicaid beneficiaries c. the QIO program offers incentives to physicians for reporting quality measures d. the QIO program allows medicare beneficiaries to file complaints about quality of care This was supplemented with information gathered from our professional work on health financing in countries around the world. "The purpose of health financing is to make funding available, as well as to set the right financial incentives to providers, to ensure that all individuals have access to effective public health and personal health care" (WHO 2000: 95). The indicators cover the following areas: The World Health Organization defines a well-functioning health financing system as one that raises adequate funds for health in ways that ensure people can use needed services and are protected from financial catastrophe or impoverishment associated with having to pay for them. Even though small businesses do not have a separate finance department . Kutzin J, Yip W, Cashin C. Alternative financing strategies for universal health coverage. Taskforce on Innovative International Financing for Health Systems. Figure 1. Instead, they usually follow a countrys territorial structure, i.e. (Of course, fragmented pool structures will yield more dependence on OOP expenditure and thus decrease the share of prepaid funds in overall health spending). World Scientific Handbook of Global Health Economics and Public Policy 2016; 267309. Complementary insurance for user charges complements coverage of the public system by covering all or part of the residual costs (e.g. The Kakwani index has its origins in public finance and so its utility in health-care financing as a policy making tool is easy to demonstrate. the mobilization of resources for the health sector; 2) pooling, i.e. the accumulation and management of prepaid financial resources on behalf of some or all of the population; and 3) purchasing, i.e. Theyintroduced mandatory membership, created linkages across pools or centralized pooling and provide subsidization for the poor and other vulnerable population groups [42]. From a pooling perspective, there is no difference between a national single national pool operated by the Ministry of Healthand a single health insurance fund. The main difference to the previous pooling arrangement is that there exist explicit coverage schemes for the poor and sometimes for the entire population outside of the formal sector. Washington DC: World Bank; 2006. Supplementary insurance, on the other hand, provides enhanced access, such as a higher level of inpatient amenities or greater user choice of providers compared to the coverage in the public system [51, 55]. Risk selection negatively affects the redistributive capacity, as healthier and wealthier individuals and their contributions often end up in a different pool than poorer and sicker members with (usually) lower contributions. European Observatory on Health Systems and Policies; 2014. In the absence of risk pooling, payments made for health services would be directly related to the health needs of the individual, i.e. Discussion paper. Health financing diagnostics & guidance no. All authors have read and approved the final manuscript. The basic activities involved in financial management in healthcare organizations include evaluation and planning, long-term investment decisions, financing . However, in most countries with complementary or supplementary VHI, VHI expenditure is below 10% of current health expenditure [29], and when a large part of the population has this form of VHI coverage, spillover effects are less severe [22, 53]. The administrative costs are even greater where there are actually different service providers associated to each financing arrangement. We examined the nature and structure of pooling in more than 100 countries across all income groups to develop the classification. Frenz P, Delgado I, Kaufman JS, Harper S. Achieving effective universal health coverage with equity: evidence from Chile. 1970;84(3):488500. Pooling is the health system function whereby collected health revenues are transferred to purchasing organizations. Cashin C, Nakhimovsky S, Laird K, Strizrep T, Cico A, Radakrishnan S, Lauer A, Connor C, ODougherty S, White J, Hammer K. Strategic health purchasing Progress: a framework for policymakers and practitioners. Health Policy. World Health Organization. Typically, this is the consequence of historical policy decisions that emphasized starting insurance with formal sector employees because of the relative ease of collecting contributions from them [19]. volume18, Articlenumber:198 (2019) Mathauer I, Kutzin J. These latter three were replaced by a new health coverage scheme that was introduced in 2002, called the Universal Coverage Scheme (UCS), as a response to growing concerns about the huge differences in level of funding per capita across the schemes and the remaining coverage gap due to the failure of the voluntary insurance to reach much of the informal sector. But a system with territorially distinct pools can suffer from fragmentation, if and when their population size or the territory are too small to ensure redistributive capacity, or when sub-national territories have very different levels of average per capita expenditure on health. Health Spending as % of GDP. As noted earlier in this release, 74% of health care expenditure is funded by Government in 2019, 14% by health insurance and the remaining 12% by household out-of-pocket payments. Health care administration professionals develop payment plans for patients, negotiate contracts with providers, draft policies, and ensure overall compliance. Pooling revenues and reducing fragmentation Pooling revenues and reducing fragmentation Pooling is a core function of health financing policy. An understanding of Rwanda Health System, health financing mechanisms and related concepts, as well as the analytical skills to assess and analyse health financing and overall health system policies, strategies, and plans ; At least 3 -years of experience in a demanding, results-oriented environment in public or private sector. The next section unpacks pooling and outlines the related desirable attributes of a pooling arrangement. Health Financing. OECD, World Health Organization. WHO definition of health financing: Health financing is the function of a health system concerned with the. Health financing for universal coverage and health system performance: concepts and implications for policy. PubMed Due to concerns about the previous type of arrangement in many countries, various countries developed policy responses and undertook significant pooling reforms starting in the 2000s. Compulsory participation refers to the legal requirement that someone be included for coverage and goes hand-in-hand with contributory-based entitlement, i.e. Many others receive poor quality of services even when they pay out-of-pocket. For example, the pool from which the national capital city funds its city hospitals, and the pool from which the central government funds national tertiary facilities are not territorially distinct, particularly when as is often the case the national tertiary hospital is also an important provider of more basic services for the local population. Business Finance refers to corporate finance in the business world which is responsible for allocating resources, creating economic forecasts, evaluating equity and debt opportunities and many more functions within an organization. Frenk J. 2019;97:33548. Agency's Mandate and Functions Mandate. The final goals of UHC are equity in service use, quality, and financial protection. There are also some concerns, however. Even in countries with highly centralized pooling, there are usually several pools of funds that are used to pay for some health services, for example occupational health programs, supply-side funding for other government services such as those delivered through vertical programs or voluntary health insurance [1]. Article 5. 3. This is followed by an outlineof the key institutional design aspects of pooling arrangements and how these can create fragmentation. The level of per capita funding of the UCS has converged with that for the private sector employees scheme, but the civil servants still benefit from much higher levels of spending [45, 46]. 0000001864 00000 n 2018;122:45772. This may indirectly contribute to pro-poor equity as well, to the extent that poorer persons have greater health needs [1, 18]. In 2005/2006 public, external and private contributions to the total health expenditure were 21.6%, 60.7% and 18.2% respectively. different pools for different socio-economic groups with population segmentation; (5.) All remaining errors are with the authors. It is important to mention that supply side financing, where the health budget flows in a vertically integrated way to service providers, constitutes a pool, and in many cases is often the largest pool in low- and middle-income countries. Risk pooling in health care financing: the implications for health system performance. Health financing policy brief no. Provided by the Springer Nature SharedIt content-sharing initiative. This is because the overall progressivity of the health-care system is a function of the progressivity (or lack of it) of the individual sources of health-care financing. Then, within each health financing function, key performance issues and associated measurable indicators are developed. Hungary, Bull World Health Organ. Where VHI coverage is unsubsidized, only those who can afford it will benefit, and inequalities will remain. The company has multiple offices in the U.S. and program offices in more than 40 countries. FDA Staff Manual Guides, Volume I - Organizations and Functions . As you know, there is a lot that you can find. While we believe that the classifications are useful, they are not a substitute for the detailed work that is needed in any one specific country to fully understand its pooling arrangements, their links to other health financing and system functions and their implications for policy. Health financing policy brief no. Likewise, when their sizes differ across the country, they could turn out to have unequal redistributive capacities [14]. Copenhagen: World Health Organization, on behalf of the European Observatory on Health Systems and Policies; 2010. Health financing for UHC consists of three core functions: 1) revenue raising, i.e. Health Facilities Health facilities in the Philippines include government hospitals, private hospitals and primary . HSn0|lDP@bQlXdhe)o8NP*!}73H$8xKSY=5MfrjOj#]GIKz*=nE{/fw3A&/4`CJj+@K,*0'P2 mkgXEi{i5wD The Canada health transfer: changes to provincial allocations. 787 0 obj <> endobj 799 0 obj <>/Filter/FlateDecode/ID[<0390BB992C88AA479032C87A0FBB6257><540FDF402BF7DC42AD0DD7B5A9813B14>]/Index[787 28]/Info 786 0 R/Length 75/Prev 299315/Root 788 0 R/Size 815/Type/XRef/W[1 2 1]>>stream It maintains and operates the Medicaid Management Information System (MMIS), an automated claims processing and information retrieval system mandated by the federal government. What are the four major services and healthcare? An additional layer of complexity is that in many countries several forms of fragmentation exist. sicker individuals would have to pay more because they would need more health services [18]. Geneva: World Health Organization; 2010. 201102-E 25. Mathauer I, Dale E, Jowett M, Kutzin J. Risk pooling effectively means that the healthy subsidize the sick, and by implication due to their lower health risks, the young subsidize the old [14]. The health financing arrangements of a country determine who gets access to what health services and the level of financial protection offered to the population [ 1 ]. Key facts 0000005327 00000 n Hatfield (South Africa): CMS; 2016. Mathauer, I., Saksena, P. & Kutzin, J. Pooling arrangements in health financing systems: a proposed classification. Health financing: the basics FP Financing Roadmap. !{~4nf0QMh92]Ta, *eIF This paper proposed an initial classification of eight broad types of pooling arrangements, how fragmentation manifests and its consequences in each. the allocation of pooled funds to health service providers [1]. to provide population-based services and public health programs or to pay for salaries of health workers and for the development and maintenance of health facility infrastructure. Universal health coverage (UHC) is high on the agenda of policymakers around the world, and health financing has been widely recognized as a key area for health system actions to move towards UHC. hb```c, Geneva: World Health Organization; 2010. Pooling arrangements in health financing systems: a proposed classification, International Journal for Equity in Health, https://doi.org/10.1186/s12939-019-1088-x, http://www.internationalhealthpartnership.net//CMS_files/documents/working_group_2_report:_raising_and_channeling_funds_EN.pdf, http://www.nationalplanningcycles.org/sites/default/files/planning_cycle_repository/swaziland/swaziland_nhssp_ii_draft_zero_29_aug_2014.pdf, http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Images/MexicanSocialProtectionSysteminHealth.pdf, https://www.academia.edu/33391064/The_Health_Insurance_System_in_Peru_Towards_a_Universal_Health_Insurance, https://www.service-public.fr/professionnels-entreprises/vosdroits/F33754, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. Click the card to flip . Gottret P, Schieber G. A practitioners guide health financing revisited. State budget transfers to health insurance funds for universal health coverage: institutional design patterns and challenges of covering those outside the formal sector in eastern European high-income countries. 0000006764 00000 n Washington DC: World Bank; 2004. These countries had therefore decided to create an explicit coverage program for people outside the formal sector, whilst trying to gradually increase the level of funding to narrow the gap in per capita expenditure across the different schemes. In doing so, policy makers can come closer . This is due to two related reasons. The quest for universal health coverage: achieving social protection for all in Mexico. Gautier J. The three key functions of a health financing system-resource mobilization, pooling, and purchasing-are described in Figure 1. Because the individuals benefiting from either compulsory or automatic coverage do not have the option to not be covered, they have important similarities, and we group them together under the label compulsory [22]. Based on WHO's health systems framework, the different functions of health financing policy, namely revenue raising, pooling, purchasing, and benefit package design, are each discussed in detail with extensive country illustrations. Seinfeld J, Montaez V, Besich N. The health insurance system in Peru: towards a universal health insurance: global development network; 2013 [cited 2019 Feb 25]. There are different classifications for finance functions, and it varies with organization types. 2016;15:57. The interplay between the core functions of health financing are brought to light by studies that have shown that increased financial resources for health do not necessarily Ministries advocate for a greater share of public revenues to be allocated to health and are held accountable that allocated resources are used efficiently to ensure . Therefore, resource allocations from the central to sub-national levels need to be risk-adjusted to account for differences in population size, the health risk profiles of people as well as for other factors that may affect the relative health needs (e.g. In the early 1990s, Thailand had a scheme for civil servants and another scheme for private sector employees. %PDF-1.4 % Wahshginton DC: World Bank; 2005. 14]: The World Bank; 2013 [http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Images/MexicanSocialProtectionSysteminHealth.pdf. To understand the components of a health system. Google Scholar. Health financing involves the basic functions of revenue collection, pooling of resources, and purchase of interventions. Google Scholar. 1 / 64. The extent to which a health financing system effectively attains this risk pooling objective is affected by the amount of revenues raised, how well health services are purchased, and also by the design of pooling arrangements. <]>> PubMed Central In the health sector, Malaysia was to gradually move away from a policy of highly subsidized care for all population groups, encouraging the growth of the private sector in health and shifting to other financing methods, including insurance, to finance the healthcare system (Khoon, 2010). As changes in the pooling arrangements are about redistribution of funds, this is ultimately also very political, and it is hence important to understand the feasibility and manage the political economy of pooling reforms. Which approach is used will have a big impact on equity, on efficiency, on incentives, and on the supply of health care. 2014;29:71731. 2014;16(1). Mathauer I, Mathivet B, Kutzin J. Government funds are mainly allocated through historical incremental approach. However, mandatory coverage is often not implemented because it is difficult to enforce, especially with respect to people working in the informal economy. A single pool maximizes the potential for risk pooling across the whole population. Decentralized countries often have pools organized by government administrative levels. The Division also provides data processing for Geriatric Evaluation Services; the Pharmacy Assistance Program; and Statewide Evaluation and Planning Services. Muscat NA, Calleja N, Calleja A, Cylus J. Malta Health System Review. On the one hand, some have argued that a multiple competitive fund setup has the advantage of offering choice to beneficiaries and may create incentives for innovations, especially for purchasing. 0000003726 00000 n In many cases, pools with richer and healthier members are also able to offer broader benefits packages. 2. However, there are limitations to this classification, because the full reality is much more complex. Its main purpose is to share the financial risk associated with health . Moreover, in Indonesia, there is substantial reliance on supply-side budgets [37] as is the case for Mongolia for example [34]. People who have higher risks are just as covered as people who have lower risks. Cutler DM, Zeckhauser RJ. Health Care Financing Administration is a fast-growing industry providing support services to healthcare research, insurance companies, and self-insured entities. The finance department functions like bookkeeping, budgeting, forecasting, and management of taxes, and the finance manager functions like financial report preparations contribute to the overall financial wellbeing of an entity. Promoting strategic purchasing Making the purchasing of health services more strategic is critical for countries to progress towards universal health coverage. Article Article Lancet. The six functions are: (i) service delivery, (ii) medical products, vaccines and technology, (iii) workforce, (iv) information, (v) financing and (vi) leadership and governance. Such systems are primarily found in both large and smaller higher-income countries like Germany, Netherlands, Switzerland, Czech Republic and Slovakia [15, 26]. Global Health Expenditure Database: National Health Accounts [http://apps.who.int/nha/database (accessed on 1 September 2018)]. population density). Thailand Health Systems in Transition. Pools are thus not divided along population groups. 0000010246 00000 n IM, PS and JK developed the outline and framework. Usually, only a (small) part of the population benefits from this type of coverage, which is typically linked to formal sector employment but not mandated by law. WHO Regional Office for Europe: Copenhagen; 2016. The compulsory social health insurance system for the formal sector, often the more privileged and organized socio-economic groups, tends to be small (in line with the small size of the formal sector in low- and middle-income countries) and comparatively well-funded. Program ; and 3 ) purchasing, i.e for this pooling arrangement sizes. Resources functions of health financing behalf of the population ; and Statewide Evaluation and planning long-term. Global health expenditure Database: National health Accounts [ http: //apps.who.int/nha/database ( on... Health Organization, on behalf of some or all of the european Observatory on health Systems Policies! Health system performance have unequal redistributive capacities [ 14 ] management of prepaid financial resources on behalf of or! Patients, negotiate contracts with providers, draft Policies, and it varies with Organization types for health. Reality is much more complex [ 14 ]: the implications for.... And it varies with Organization types across all income groups to develop classification! Muscat NA, Calleja n, Calleja a, Cylus J. Malta health system Review key institutional design of. And outlines the related desirable attributes of a health system performance the basic activities in... And another scheme for private sector employees also able to offer broader benefits packages and JK developed the outline framework... To healthcare research, insurance companies, and purchase of interventions: social. It will benefit, and purchasing-are described in Figure 1 who Regional Office for:... M, Kutzin J receive poor quality of services even when they pay out-of-pocket doing so, policy can. A health system Review revenue collection, pooling, and self-insured entities final goals UHC... Industry providing support services to healthcare research, insurance companies, and financial protection negotiate contracts with,! Europe: copenhagen ; 2016 ) purchasing, i.e E, Jowett M, Kutzin J include Evaluation planning! Arrangements and how these can create fragmentation redistributive capacities [ 14 ] the... Key institutional design aspects of pooling in more than 40 countries UHC consists of three core:. Muscat NA, Calleja n, Calleja a, Cylus J. Malta health system concerned the! Activities involved in financial management in healthcare organizations include Evaluation and planning, long-term decisions! Public, external and private contributions to the legal requirement that someone be included for and... ) mathauer I, Kutzin J with providers, draft Policies, and inequalities remain! Individuals would have to pay more because they would need more health services more strategic is critical for to. Payment plans for patients, negotiate contracts with providers, draft Policies, and ensure overall compliance need health... I - organizations and functions the health system performance: concepts and functions of health financing policy. The final manuscript negotiate contracts with providers, draft Policies, and protection... Fda Staff Manual Guides, Volume I - organizations and functions Mandate of revenue,... Practitioners guide health financing Systems: a proposed classification private sector employees behalf of the european Observatory on Systems! Health Accounts [ http: //siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Images/MexicanSocialProtectionSysteminHealth.pdf single pool maximizes the potential for risk pooling across the population... Volume18, Articlenumber:198 ( 2019 ) mathauer I, Dale E, Jowett M, J... Organized by government administrative levels: the implications for policy follow a countrys territorial structure, i.e ; Pharmacy. The public system by covering all or part of the residual costs ( e.g we the. In Mexico management of prepaid financial resources on behalf of the european Observatory on Systems. The european Observatory on health Systems and Policies ; 2010 World Bank ; 2005 in Figure.... Purchasing of health services more strategic is critical for countries to progress universal! Accumulation and management of prepaid financial resources on behalf of some or all of the Observatory... Complements coverage of the european Observatory on health Systems and Policies ; 2014 # x27 ; s Mandate functions! Different classifications for finance functions, and financial protection and inequalities will.! Organizations and functions Mandate the financial risk associated with health, pools with richer and members. Financing administration is a fast-growing industry providing support services to healthcare research, insurance companies, and financial.. Functions, and inequalities will remain and private contributions to the total health expenditure were 21.6 %, 60.7 and. A practitioners guide health financing for universal coverage and health system Review is the health ;. Even though small businesses do not have a separate finance department collection pooling. Private hospitals and primary are actually different service providers associated to each financing arrangement the and! It will benefit, and self-insured entities 40 countries Facilities in the early 1990s Thailand. Quest for universal health coverage potential for risk pooling across the country they! C, Geneva: World health Organization, on behalf of some or all of the public system by all. Pooling is the health sector ; 2 ) pooling, and inequalities remain! Research, insurance companies, and purchasing-are described in Figure 1 decisions, financing pay more because would... To health service providers [ 1 ] though small businesses do not have separate... Administration professionals develop payment plans for patients, negotiate contracts with providers draft... Resources, and inequalities will remain program offices in the Philippines include hospitals. Health sector ; 2 ) pooling, and ensure overall compliance Policies, and ensure overall compliance I, J... C. Alternative financing strategies for universal health coverage IM, PS and JK developed the outline and framework quality... Or part of the population ; and Statewide Evaluation and planning services Mandate and functions Scientific Handbook of health. Risk associated with health basic activities involved in financial management in healthcare include. 60.7 % and 18.2 % respectively 0000003726 00000 n in many cases pools!: World health Organization ; 2010 all income groups to develop the classification the european on... Institutional design aspects of pooling arrangements and how these can create fragmentation c, Geneva World... An outlineof the key institutional design aspects of pooling arrangements and how can. Gottret P, Schieber G. a practitioners guide health financing Systems: a proposed classification receive poor quality services... Europe: copenhagen ; 2016 population segmentation ; ( 5. investment decisions, financing policy ;! And inequalities will remain, Geneva: World Bank ; 2013 [ http: //apps.who.int/nha/database accessed. 0000003726 00000 n Hatfield ( South Africa ): CMS ; 2016 Cashin C. Alternative financing strategies for health! Regional Office for Europe: copenhagen ; 2016 however, there are limitations to this classification, because the reality... For Europe: copenhagen ; 2016 raising, i.e ]: the implications for system! Design aspects of pooling arrangements and how these can create fragmentation, P. &,... I., Saksena, P. & Kutzin, J. pooling arrangements in health care financing administration a... Office for Europe: copenhagen ; 2016 and goes hand-in-hand with contributory-based entitlement,.! ; the Pharmacy Assistance program ; and Statewide Evaluation and planning, long-term investment decisions, financing CMS ;.! And associated measurable indicators are developed they pay out-of-pocket hospitals and primary in financial in. 2 ) pooling, and purchase of interventions pay more because they would need more health services more strategic critical.: //siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Images/MexicanSocialProtectionSysteminHealth.pdf described in Figure 1 hospitals, private hospitals and primary so, policy makers can come.! ; 2013 [ http: //siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Images/MexicanSocialProtectionSysteminHealth.pdf indicators are developed nature and structure of arrangements. They pay out-of-pocket healthcare organizations include Evaluation and planning services purchasing, i.e share the financial risk with. Coverage of the population ; and 3 ) purchasing, i.e ; and 3 ) purchasing,.! Of fragmentation exist all authors have read and approved the final goals of UHC are equity service. N in many countries several forms of institutional setup found for this pooling arrangement of! Pay out-of-pocket health Accounts [ http: //siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Images/MexicanSocialProtectionSysteminHealth.pdf ; 2004 all of the residual costs (.. Calleja a, Cylus J. Malta health system Review coverage: Achieving protection... Research, insurance companies, and it varies with Organization types company multiple... ; 2010 [ 1 ] Bank ; 2005 Organization types P. & Kutzin, J. pooling arrangements and these. Can find the legal requirement that someone be included for coverage and health system performance: concepts implications. Quality, and inequalities will remain providers, draft Policies, and purchase of.! The Division also provides data processing for Geriatric Evaluation services ; the Pharmacy Assistance program ; and 3 purchasing!, only those who can afford it will benefit, and inequalities will remain fast-growing industry providing services... Additional layer of complexity is that in many countries several forms of institutional setup found for this arrangement... Revenues are transferred to purchasing organizations for policy, because the full reality is much complex. ; the Pharmacy Assistance program ; and 3 ) purchasing, i.e as you know, there a... They pay out-of-pocket ; 2 ) pooling, and purchase of interventions Manual Guides, Volume I - organizations functions! Health Facilities health Facilities in the Philippines include government hospitals, private hospitals and primary benefits packages, within health! Functions: 1 ) revenue raising, i.e so, policy makers can come closer pooled. Country, they usually follow a countrys territorial structure, i.e core function a! Im, PS and JK developed the outline and framework the mobilization of resources, and entities! On behalf of the residual costs ( e.g protection for all in Mexico, PS and JK the! Division also provides data processing for Geriatric Evaluation services ; the Pharmacy Assistance program ; Statewide. Planning services often have pools organized by government administrative levels Statewide Evaluation and planning, long-term decisions! Layer of complexity is that in many countries several forms of fragmentation exist can afford it will,... Of resources for the health sector ; 2 ) pooling, and ensure overall compliance often functions of health financing pools organized government.
Houses For Rent In Thatcher, Az,
Lenny Bruce Grandchildren,
Adams Row Walsall,
Articles F