Meanwhile, the execution, that is, the benefits, are carried out through the national, provincial and municipal public hospitals, plus the primary care centers of the same department. This subsystem spends around 2.7% of Argentina’s GDP. Which is equivalent to 16,575 million dollars annually that are allocated to public hospitals and primary care centers.
The second, and singular legsince its characteristics are exclusive to Argentina. It is the so-called subsystem of theThis is financed by salary contributions and employer contributions. This contributory characteristic is not what distinguishes it, since there are multiple antecedents and varied examples of contributory systems in the world.
What is exclusive to Argentina is the intermediation, technically the management and administration of these funds. It is in charge of Union Social Works, Provincial Social Works, PAMI and the different Solidarity Funds and programs such as FSR, SUR, among others. The union social works that administer the largest proportion of funds in this subsystem.
The execution of the benefits of this subsystem is through the contracting of health providers, that is, medical professionals, offices, sanatoriums and private clinics, in specific cases by public hospitals. This subsystem spends 3.9% of GDP, the equivalent of 23,941 million dollars annually that should be allocated to pay the contracted benefits to providers in a timely manner.
The third legis constituted by the private subsystem. It is nourished or financed by out-of-pocket spending on citizens’ health. In one part, the intermediaries, who manage and administer part of that expense, are the Prepaid Medicine Companies The rest corresponds to the out-of-pocket expenses in particular terms made by citizens without coverage both in benefits and in medications. And the executors are offices, sanatoriums and private clinics. The expense of this subsystem amounts to 2.8% of GDP, which is equivalent to 17,189 million dollars annually, as in the previous case, they should be allocated to pay or honor contracts with professional providers, offices, sanatoriums and clinics in a timely manner. shape.
Who is in charge of the Argentine health system?
Now, having described the territory of the health system and some of its particularities, we turn to its effects or results. The public subsystem concentrates the activity of the national, provincial and municipal hospitals, plus the primary care centers corresponding to each jurisdiction. It serves approximately 27% of the population; generally low-income people resort to the providers of these subsystems.
Although this provision should guarantee equal access for all citizens, since it is enshrined as a universal right, according to article 42, as well as article 75, paragraph 22, through the incorporation of international human rights treaties.
The public subsystem takes care of only 27% of the populationit is the State that spends the least to serve the population, since it spends less than the social security subsystem and less than the private subsystem.
In turn, the National State only spends less than 20% of the total expenditure of the public subsystem, the provinces 62.61% and the municipalities 17.39%.
The National State is responsible for almost the same proportion of spending as the municipalities, with the greatest burden of public state financing falling on the provinces.
What are the consequences of this health situation?
As a consequence of this -with few exceptions- Public hospitals have been in a dire state for decades.depending on the vocation and invaluable effort of the doctors and non-doctors who make these establishments operate every day with the resources they can and do not have.
Another consequence is the lack of adequate coordination between actors, the use of resources and equity of rights and access to services between jurisdictions that negatively affect said central objective. The decentralized financing model crystallizes the inequalities associated with subnational socioeconomic levels: The provinces that invest the most in health per person have spending 3.5 times higher than those that do the least.
The paradox is that, during decades of declamation of a present State, the absence is confirmed in the data that the State at its three levels is the one that spends the least of the three subsystems, spends the taxes of the entire population and does not cover the needs not even 30% of it. And it should be emphasized that it spends the taxes of all taxpayers for this purpose.
Let us keep in mind that in the world there is – except in the USA – a scheme or a tendency for states to guarantee what is called Basic Universal Coverage. In Argentina, no mechanism guarantees this concept, which is enshrined in the National Constitution, but is conspicuous by its absence in practice.
The provinces, in turn, complain of inequities in the non-compliance with the Federal Income Sharing Law and the adjustment factor is the systematic reduction of the amounts to be invested in health.
What role do social works play?
If we focus on the Social Security subsystem, a unique system in the world that delegates a huge portion of funds under the tutelage of union organizations with weak financial and health controls and multimillion-dollar figures of non-existent management; the general picture begins to get much darker.
Added to this, the management of the Union Social Works They are tied to the leadership of the unions that have access to these funds and indefinite reelection. A combination of union achievements obtained during the first government of Perón and then during the dictatorial government of General Onganía, shield any possibility of modifying said board until today and even less achieving transparency in the administration of those funds that, added to the discretionary transfers by Different concepts of Social Works imply figures that are unimaginable to measure.
More than 300 social works of which during 2024 more than 100 were closed for not meeting the minimum requirements to be able to function and 24 provincial social works run by the provincial governments plus the PAMI, which represents 1% of GDP in annual terms.
The National Social Works (OSN) They are non-governmental institutions that manage resources from salary contributions deducted from workers’ salaries and employer contributions, representing 35-40% of the population. The resources are collected by the AFIP and administered by the ANSES, which distributes them among the 300 NSOs based on the contributions of each member. Prior to this, a deduction is applied that feeds a Solidarity Redistribution Fund (FSR) – the instance of solidarity between NSOs. The NSOs must comply with a guarantee of rights expressed in the Mandatory Medical Program (PMO) and defined by the Superintendency of Health Services (SSS).
What happens in private and prepaid medicine?
In it private subsystem where the citizen’s out-of-pocket expenses and the amounts allocated to coverage by private medical companies occur, the situation does not minimize the asymmetries inherent to the system. What do we mean by this, people pay more and more and in return they have less and less coverage, and what doctors receive is becoming less and less.s. 45% of the patient’s so-called out-of-pocket spending is allocated to medications. The cost of medicines is a global problem and destabilizes all systems, even the most advanced in the world.
The prepaid medicine It emerged as an idea of complementary or supplementary coverage to the coverage provided by the state or the social security system. Today, prepaid medicine coverage constitutes the only real possibility of accessing basic benefits that should be guaranteed by the public system or social security.
The concentration in five large companies called financing companies, represent 75% of the market, this implies that health providers (clinics, sanatoriums, offices, etc.), are in some way subject to accepting the conditions imposed by this dominant group. No less since 65% of the population resorts to the private benefit system and has some type of coverage that pays late, delayed in values and without considering any context. To the point that a large portion of health providers do not even cover the costs of paying taxes, accumulating million-dollar figures in pension debt, for example.
This system, which is not coordinated, overlaps in many collection aspects and does not guarantee the necessary coverage. This is the result of years without public policies in the health sector that promote integration, coordination and therefore greater efficiency and effectiveness. The sector is in these conditions because in its three dimensions they end up prioritizing the collection aspect and not verifying the effectiveness of the destination and application of those funds. Patients have serious difficulties in accessing the necessary benefits, doctors are the adjustment factor and intermediaries dominate the scene.
Is a health system necessary?
Argentina has been characterized over the years by the professional, scientific and performance quality of health professionals and this is not only permanently degraded, but soon some central institutions will not exist to guarantee access to health. and therefore the quality of life of the people.
It is vital to begin once and for all an in-depth debate with specific health indicators and positions that will allow us to chart a path to reform the system.
A system that must be focused on the patient and must prioritize the doctor’s actions and at the same time be sustainable in economic terms. Everything done so far is going in the opposite direction. Maybe we have time to reverse it!
Ophthalmologist. Master in Health Service Administration. Secretary General of the Argentine Chamber of Ophthalmological Medicine (CAMEOF).
Source: Ambito

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