A private health chamber presented proposals to rethink the health system in Argentina. It is an annual economic report for 2022, entitled “The construction of a true Argentine health system”which analyzed the “disorganization” suffered in Argentina within the national “labor and economic crisis” and proposes a series of “public policy guidelines”.
The work was prepared by Adecra+Cedimthe national chamber that brings together more than 420 private health institutions including clinics, sanatoriums, private hospitals, laboratories, and outpatient diagnostic and treatment centers, and pointed out that in Argentina, private salaried employment has stagnated at six million people since 2012. and, since then, the GDP has not grown, while the population continues to increase.
In addition, he indicated that with a more orderly public health sector, private providers could work in coordination in public-private articulation schemes.
“Argentina is submerged in a severe structural labor crisis“, they stated at the beginning of the study, headed by Jorge Colina, economic adviser to the chamber.
Employment in critical situation
According to a report prepared by the Idesa Institute, which measures the evolution from 2012 to 2022 of the labor situation of people over 20 years of age in Argentina, “of 12 million registered workers, only half are salaried in the private sectorwhich is the one that contributes the most to the financing of social security”.
“Employment in a dependency relationship in the public sector and the monotributo grew, but they do not constitute a genuine funding source“, the report stated, noting that what also went up it is the indicator of adults over 65 years of age, “product of the aging process”, and that of informal employment. “If he PBI does not grow, but the population does, there are more and more mouths to feed with the same amount of bread,” summarized Jorge Colina.
Medical residencies in clinics and pediatrics are not covered, but those in other specialties are filled
In this scenario, the “financial inconsistency”, “bad regulations” and the “overlapping of national interventions in provincial and municipal functions” are some of the biggest “disruptions” in the health system.
“The population with contribution derivation will be maintained, but it is not projected to grow significantly. The health sector should not wait for more resources to come from the private salary side, and the national and prepaid obras sociales will continue to stagnate,” they considered in the study.
The resources of the provincial social works
Regarding the resources of the provincial social works, estimated that “they are not going to grow considerably either”. “There will be more and more people to attend to with limited provincial public resources, which will not grow in line with the increasing demand of the population without medical coverage or with underfunded coverage that is treated at the public hospital,” they warned.
Lastly, they explained how the “diversification, complexity and modernization of medicine” come into play. “Medical residencies in clinics and pediatrics are not covered, but those in specialties fill up; cesarean sections are imposed instead of natural births to make resources work more; and low medical fees and hospital fees make volume a vital resource for survive, but the financiers push these fees down”, they exemplified.
As part of the outputs to command the system, from Adecra+Cedim They opined that “the proposals to build a National Health System and/or to nationalize the health system are not achievable” and stated that “a comprehensive modernization of Argentine labor legislation is essential.”
They also considered that, “on the basis of a more orderly public health sector, the private providers could work in coordination in public-private articulation schemes with the provincial and municipal public sectors”.
It should be noted that this last point in particular will be dealt with in one of the panels of the V Health Congressthe event that Adecra+Cedim will organize on August 23 and 24 at the Sheraton Hotel in Pilar, where more than 30 leaders of business management in the sector, Argentine politics and other national and international analysts in the area will debate.
Medical practice today is fundamentally based on specialties
Health promotion and prevention and medical care: the “disruption” of financing and the toppings
“According to the National Constitution, the Promotion and prevention of health they are the exclusive responsibility of the provinces and municipalities, but the Ministry of Health and other national portfolios develop promotion programs, which are limited and without explicit criteria, which causes confusion of roles, lack of coordination and dilution of responsibilities between the different levels of the State “, the report said.
The “destructuring” it also comes from “financial inconsistency” and “misallocation of resources.” “There are people with the Mandatory Medical Program (PMO) overfunded and others underfunded. Due to poor regulation there is a lot of double coverage,” explained Adecra+Cedim.
For example, “the provincial social works (OS) they cover 10% of adults with 1% of GDP, while national OSs cover 30% of adults with 1.5% of GDP. What the provinces allocate to public financing is not little, but it is managed centrally and without registers of people without coverage,” they later added.
On the other hand, the reality of AMONG is that it covers a sector of the population that grows more and more, but always with “the same financing rule”. “11% of the population is over 65 years of age, the modernization of medical practice has become widespread and in the last decade the irruption of biological medicines has put health systems around the world under financial stress,” they detailed.
The particular situation of medical providers
Another of the distortions of the system is given by the “difference in public policy agenda” of health centers based on the province in which they are located.
“Las private institutions of CABA their relationship with prepaid companies is almost a monopolistic agenda item, while in the rest of the provinces (except for the Conurbano, Córdoba, Santa Fé, Tucumán and Mendoza) private organizations focus centrally on provincial social work and PAMI” they explained.
Adecra+Cedim stated that a comprehensive modernization of labor legislation is essential
On the other hand, in private medicine there is a “distributive bid within medical providers due to technological change.” “The medical practice today it is fundamentally based on specialties, new technologies around the hospital bed and accelerated innovation in medicines”, to the detriment of the “culture of medical practice led by clinical and pediatric physicians”, they clarified.
“Private healthcare providers are stifled by low fees and tariffs, and the need to financially sustain a very expensive technological medical infrastructure. They respond efficiently to resource constraints, but are the last link in the healthcare production chain, the one that suffers the most from this lack of resources when taking care of the patient”, they pointed out.
“It is essential to propose a comprehensive modernization of Argentine labor legislation”
Adecra+Cedim proposed at the end of the report a series of “guidelines to organize the health system”on the basic condition of an economy with sustained growth.
For this, they opined that it is necessary to “comprehensively modernize” the labor legislation in our country and listed, among other measures: “Establish a non-taxable minimum on the wage bill for employer contributions of ANSES and PAMIenable SMEs to negotiate collective agreements at the company level to adapt working conditions to the productivity of the firm, and eliminate the multiplication of severance pay”.
Furthermore, “ordering the public sector within the argentine health system” is another of the great axes. In this sense, they highlighted the importance of creating two agencies: one for “results measurement” and another for “financing of biological medicines for the entire population and the spending on medicines for retirees “.
“He National Ministry of Health should become a national agency for measuring the health results achieved by the provinces and municipalities,” they suggested on the one hand.
On the other hand, they held that “PAMI would have to be provincialized, transferring the affiliates of each province to the provincial Ministries of Health, with financing equivalent to the totality of the per capita income of this social work, less the cost of medicines”. This expense, they added, “should be covered by a national agency that negotiates centrally with the drug industry”.
“With a public health sector more orderly, private providers would have to start thinking about working in coordination in public-private articulation schemes with the provincial and municipal public sectors,” they concluded.
