Uneven and fragmented. This is how the Economic Commission for Latin America and the Caribbean (ECLAC) and other entities define the Argentine health system. The reason for this statement is associated with tripartite model, which involves the public, private and social security spheres in their way of functioning. Embedded in this model, there are still others four subsectors: public hospitals, union clinics (associated with social security), prepaid health plans, and the PAMI (Comprehensive Health Care Program).
Regarding the numbers, total health expenditures represented 9.2% of the Argentine GDP in 2023. Of these, 5.3% was associated with public spending and 3.9% with private costs. Individually, it is estimated that each person costs around 1,243 dollars to the South American country.
With regard to human resources, data from 2020 indicated that the country had approximately 4 doctors and 6 nurses for every 1000 inhabitants.
In addition, it is estimated that at least 36% of the population use public health institutions, while 60% they go to social security clinics. There is still 13% of the people who receive assistance from prepaid drug companies and 10% that use more than one subsystem to obtain medical care.
In the Argentine health model, the PAMI also appears as one of the great highlights, as it is a public health insurance for the elderly, managed by the INSSJP (National Institute of Social Services for Retired and Pensioners). It serves retirees, pensioners, and war veterans. Health coverage is extensive and involves everything from appointments, tests, hospitalizations, and medications, to prevention activities and programs. It is estimated that around 3.5 million people use PAMI in Argentina.
Even so, in practice, the fragmentation of the health system means that the low-income population has fewer options to access health and deals with lower quality services. In addition, the divisions also influence the lack of integration between the different subsystems. In other words, as in Brazil, it is difficult to provide comprehensive monitoring to patients and to have access to their complete health history.
However, before we analyze the details of this system, how about understanding how it all began?
The history of the Argentinian health system
The roots of the Argentine health system go back to the late 19th and early 20th centuries, when the first social security policies and mutual societies emerged. However, it was specifically from the 1940s onward that the State took a more active role, expanding public services and creating the National Social Security Institute (INPS).
Already in the 1970s, fragmentation intensified with the proliferation of Social Works (OS), entities funded by contributions from workers and employers, responsible for providing health services. In parallel, the public system mainly served the indigent and unemployed population.
When the 1990s finally arrived, more intense transformations took place. During that period, decentralizing public service reforms were implemented. These measures strengthened the private sector.
In 1996, National Social Works Act (LNOS) was sanctioned on December 23. The decree determined that the three subsystems should be governed by the same rules, thus making them a single system. This measure also aimed to ensure that access to health was universal and of quality for all Argentines.
The LNOS also allowed the Argentine population to have Freedom to change health insurance at least once a year, without restrictions. The purpose of this decision was to stimulate competitiveness between institutions, so that the quality of the service was improved.
Another characteristic determined by law was the List of basic services — including consultations, hospitalizations, tests, and medications — which should be offered to all OS beneficiaries.
In addition, there was the creation of SuperSalud (Superintendence of Health Services), an autonomous body whose responsibility was to regulate and oversee health plans, ensuring that consumers had their rights fulfilled and protected.
Overall, the LNOS was created to expand access to health and reduce service quality disparities. However, inequalities prevailed.
Tripartite system: what does this mean?
Since the changes established in the 20th century, Argentina's health system has three subsystems in its structure:
- Público — It is financed by taxes and is aimed at the low-income population without social security coverage. It covers hospitals and public clinics distributed across the country, but faces problems of poor infrastructure, lack of resources and long waiting lines.
The public sector is universal and free, and all citizens and residents can use it regardless of their socioeconomic situation.
Public health services are funded by the federal, provincial, and municipal governments. The facilities are varied: in rural areas it is more common to have small health centers, while large general hospitals are seen more frequently in cities. Because it provides free consultations, exams, and treatments, the portion of the population that uses public services the most are low-income families.
Although functional, the public sector faces significant challenges, such as poor infrastructure, long waiting lines, and lack of resources and personnel in many regions. Despite this, it is an essential network to ensure that the population has access to basic and emergency care.
- Social Security — It is managed by Social Works (OS), which serve formal workers and their families. The quality of the services varies depending on the OS. Some offer comprehensive coverage, but others have gaps.
The financing of the social security sector occurs through contributions from employers and employees. In addition, this subsystem offers specific health plans, some administered by unions and others directly by the state.
On the other hand, service coverage varies depending on the plan and the specific social project. Even so, in general, the offer presents an intermediate level of service between the public and the private.
- Privy: It is accessible through paid health plans and is aimed at the population of high income. It offers greater agility and quality of service, but it excludes a large part of the population.
The private sector is comprised of a wide network of hospitals, clinics, and doctors' offices that operate based on direct payments or through private insurance.
This segment is generally accessed by those who have the financial capacity to afford the costs or have private health plans. The quality of services in the private sector is generally high, with shorter waiting times and more modern facilities.
The challenges and dilemmas of health in Argentina
Several systemic and structural challenges impact the quality of health of the Argentine population. However, in addition to fragmentation, the main problems are linked to funding difficulties, poor infrastructure, and limited human resources.
With regard to the funding, experts consider current methods to be unstable. Argentina is dependent on the collection of taxes and contributions, which limits investments in infrastructure, equipment, technology, and human resources.
As for the issue of human resources, the biggest problem lies in the scarcity of health professionals, especially in remote areas. The labor shortage is aggravated by low compensation and poor working conditions in many public units, which make it difficult to retain qualified professionals.
- According to the 2023 World Statistics ranking, the average salary of a doctor in Argentina is lower than in Bangladesh. While in the South American country the income of these professionals is around 5,280 dollars a year, doctors from South Asia usually earn more than 7,000 dollars. Still for comparison purposes, the data indicate that in Brazil doctors earn about 10 times more than in Argentina.
Another point is the infrastructure precarious. In addition to the old physical structure of many units, there is also a lack of equipment and medicines. This reality is often even worse in rural areas and in communities of people with low incomes.
The private system in Argentina
In the context of healthcare in Argentina, the prepaid system refers to private health plans, also known as prepaid medicine.
In this modality, the plans can be individual or business. Coverage varies according to the contracted plan, which also influences the monthly fee, grace period, and shares.
Prepaid plans offer access to a wide network of health care providers and to quality services, often with shorter waiting times than the public system.
According to data from SuperSalud, in 2023 approximately 13 million people in Argentina (about 30% of the population) had a prepaid health plan. Of these, around 6 million were used for individual plans, while the remaining 7 million were beneficiaries of business plans.
Still in the private sector, it is estimated that the country has more than 4 thousand clinics and hospitals as service providers.
The impact of the pandemic
As in the rest of the world, the Covid-19 pandemic also put the Argentine health system to the test. The country, already with a fragmented and uneven system, faced enormous challenges in dealing with the exponential increase in cases and the demand for ICU beds and respirators.
The peak of cases in mid-2021 led to the saturation of health services, with overcrowding in hospitals and intensive care units, especially in areas such as Greater Buenos Aires. The shortage of beds and respirators resulted in long waiting lines and cases of patients not receiving adequate care.
In addition, work overload and the risk of contagion jeopardized the physical and mental health of health professionals, leading to an increase in employees dismissed due to illness and emotional exhaustion. Still on this issue, the lack of personal protective equipment (PPE) also put these professionals at risk, aggravating the situation.
Vulnerable populations - such as low-income communities, ethnic minorities, and people with chronic diseases - suffered the most from the domino effect of the pandemic, who felt even more the lack of access to quality health services.
Despite the challenges, the Argentine health system has demonstrated a certain capacity for resilience, implementing measures to contain the spread of the disease and minimize its impacts, such as:
- Restrictive Measures — Lockdowns and curfews, to reduce the circulation of the virus and alleviate pressure on the health system. These measures, while unpopular in some sectors, were essential to contain the spread of the disease and prevent an even greater collapse of the system.
- Expansion of Hospital Capacity — The Argentine government invested in the construction of new ICU beds and the purchase of respirators, increasing hospital capacity to meet increased demand. The expansion, while insufficient to meet all demand, helped save lives and prevent an even greater collapse of the system.
- Vaccination Campaigns — Mass vaccination campaign against Covid-19, which has already vaccinated a large part of the population. Vaccination has been essential to reduce the number of serious cases and deaths from the disease, alleviating pressure on the health system and allowing for the gradual resumption of activities.
Reflection of the economic crisis
Argentina is facing a severe economic crisis, characterized by high inflation, devaluation of the local currency (peso), and growing public debt. In 2023, annual inflation surpassed 100%, one of the highest rates in the world. Meanwhile, poverty reached around 40% of the population.
One of the most direct impacts of the crisis occurred with the cuts in the public health budget. According to the Argentine Ministry of Health, there was a significant reduction in investments in infrastructure and the acquisition of medical supplies. Several public hospitals reported difficulties keeping stocks of essential drugs, such as antibiotics and insulin.
Another symptom of the crisis was the increase in the cost of imported drugs and medical equipment, due to the devaluation of the peso. According to the Argentine Chamber of Medicines, around 30% of basic medicines face regular shortages in pharmacies and hospitals.
Possible solutions?
In recent years, the Argentine government has implemented some initiatives to improve access and quality of health services. One of the main examples is SUMAR Program (Unified System for Monitoring and Evaluation of Outcomes, an initiative of the Argentine government to expand access to quality health for people who do not have formal medical coverage.
Created in 2012, as an expansion of the old Plan to be born, SUMAR focuses on primary health care And on disease prevention, focusing on maternal and child, female and adult health. The program is aimed primarily at young people aged 0 to 64 who do not have formal medical coverage, in addition to pregnant women and postpartum women with the same condition.
Despite being one of the successful programs, SUMAR is still insufficient and also suffers from a shortage of human resources, poor infrastructure, and unstable funding.
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