Health Care Organization and Delivery in Argentina: A Case of Fragmentation, Inefficiency and Inequality
| Author | Gabriel E. Novick |
| Date | 01 March 2017 |
| Published date | 01 March 2017 |
| DOI | http://doi.org/10.1111/1758-5899.12267 |
Health Care Organization and Delivery in
Argentina: A Case of Fragmentation,
Inefficiency and Inequality
Gabriel E. Novick
Abstract
Fragmentation is a common trait of most Latin-American systems. In Argentina the lack of integration among sub systems has
a deep impact on health care access and financial sustainability, leading to exclusion, inefficiency, inequality, lack of trans-
parency in administration and one of the highest burdens of household catastrophic out-of-pocket spending in Latin America.
The national budget, although within the average of the region, is insufficient to cover the health care needs of the uninsured
and to fully address the imbalances in social determinants of health. In this article, we first present the organizational and
financial structure of the health care system. We then analyse the system dynamics and local health care history, and we
explore a few possible lines of action and reforms for the next decade. This analysis may provide lessons for other countries
in the region with analogous contexts and facing similar challenges.
Background
According to the Pan American Health Organization (PAHO),
the Argentinean health care system is heavily fragmented.
Furthermore, a report from The Lancet Oncology Commis-
sion states that the ‘multiple independent systems lack verti-
cal and horizontal integration, resulting in inadequate
coverage for many’(Goss, 2013, p. 396). Fragmentation,
however, is a common trait of most Latin-American systems,
including Argentina, which are all also experiencing epi-
demiological transitions, ageing populations, and increasing
burdens of non-communicable diseases. In this region, gov-
ernment health care spending is subject to biased allocation
of resources and segmented financial structures. This results
in basic or minimum care, especially for the poor or unem-
ployed. Although the Argentinean system intends to provide
universal coverage, the segmentation and fragmentation, as
well as the lack of integration among sub-systems, lead to
inefficiencies and inequities.
This article presents the basic structure of the Argen-
tinean health care system, its impact on health care access
and financial sustainability and the role of social determi-
nants of health in the country. It also reflects on local health
care history to explore a few possible lines of action and
reforms for the next decade.
Overview of the Argentinean health system
About 36 per cent of the population in Argentina does
not have any formal coverage and receives health care in
the public system (Figure 1). About 16 per cent of the
population have private coverage, 5 per cent by means of
a monthly premium and out-of-pocket expenses and 11
per cent via a worker0s union (Obra Social). The worker’s
unions represent the largest part of the social health insur-
ance sector which includes 63 per cent of the total popu-
lation.
These unions consists of more than 300 national unions
(Obras Sociales Nacionales), each of which is associated with
a specific trade or industry and encompass 36 per cent of
the population. The segment of social health insurance also
includes 24 provincial unions (Obras Sociales Provinciales)–
one for each province –which cover around 5 million public
sector employees and their dependents (16 per cent of the
population) (Figure 1). Many of the provincial unions also
contribute to and are covered by a national union. Social
health insurance is funded by a compulsory payroll contri-
bution from employees (3 per cent) and employers (6 per
cent). Unions can contract private companies to provide
total or partial coverage for their affiliates; each year the
affiliates can choose the union that best fits their service
expectations and preferences. Finally, this segment includes
the retirees (11 per cent of the total population) covered by
a state-run pensioners’health fund (Programa de Atenci
on
M
edica Integral –PAMI), which is financed by a portion of
the payroll tax and its own revenues.
Figure 1 also depicts the percentage of the population
with some form of duplicate formal health care coverage
(15 per cent), including union affiliates, as well as those that
receive medical care from private companies, networks and
providers.
It is important to note that the social security system does
not represent a government agency, but a pool of indepen-
dent worker0s organizations that at one point in time
acquired the role of health care administrators and provi-
ders. Since their creation, alternate government agendas
have been giving these organizations different levels of
political and financial support.
Global Policy (2017) 8:Suppl.2 doi: 10.1111/1758-5899.12267 ©2017 University of Durham and John Wiley & Sons, Ltd.
Global Policy Volume 8 . Supplement 2 . March 2017 93
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