As is the case with many countries today, Argentina is currently facing some familiar challenges in terms of healthcare. This blog article, by Ritza Suazo, provides insight in the longer term effect of recent reforms in healthcare.
Changing Demographics and Increased Chronic Diseases
As the population in Argentina continues to age, the number of chronic diseases and morbidities is growing and increasing the demand for services in the healthcare system. The most coveted services are in orthopedics, dentistry and cardiology.
Changing lifestyles are also contributing to the increased incidence of chronic illness (e.g. increased stress levels, changes in eating habits, less manual labor resulting in a more sedentary life style etc.).
These factors coupled with the delicate economic climate will pose an increasingly significant challenge in the years to come.
Lack of Integration: Outdated Protocols and Long Waiting Lists
The healthcare system in Argentina is quite fragmented, resulting in a variety of challenges:
Public hospitals have long waiting lists for treatment and surgery. Adding to this pressure are some of the private patients which choose to have expensive procedures in a public setting due to the expense or high premiums in the private sector.
Ineffective referring and overconsumption of primary care leading to higher (unnecessary) hospitalizations.
Inequalities in Accessibility and Quality of Care
In most of the urban areas, higher quality and less crowded services are available from private clinics, however these are unaffordable for the majority of citizens. Private hospitals tend to cater to the wealthier populations.
The fragmented healthcare system and a lack of a “set” national standards for quality of care, has resulted in significant differences in terms of clinical practices and resources from province to province. For example, a city like Buenos Aires has a wide array of high quality and modern healthcare facilities to choose from, while rural provinces like “Jujuy” remain underserved.
Those most affected are:
- Patients on waiting lists for surgery in the public sector
- Citizens living in poverty
- The elderly
- Indigenous populations
As is the case in many Latin American countries, there are inequalities in the healthcare system which result in some of the poorer and rural populations not getting even their basic healthcare needs met.
Healthcare expenses are rising rapidly and threatening the viability of public health insurance systems as well as inflating the out-of-pocket costs for patients.
There are various drivers for the rising healthcare costs:
- The ageing of the population, increasing the need for care (e.g. chronic diseases) and contributing less in terms of financial resources.
- The increasing awareness of quality standards for care delivery
- Limited tertiary care infrastructure and resources
- Inequalities in care provision and staff training between the public and the private sector Deterioration of Public Structures and Outdated Technologies and Treatments
Although many hospitals in Argentina are quite modern, offer high quality care and boast the latest technologies, this is not the case for the majority of the public institutions, especially those in rural and underserved areas. Many public hospitals are underfunded and struggle to offer basic levels of care. In many cases, renovated exteriors hide deteriorated internal infrastructures (i.e. peeling paint, creaking floors, etc.).
The areas that are most in need of advancement are: diagnostic equipment and minimally invasive procedure equipment.
In an attempt to address the above mentioned challenges, the government in Argentina has instituted the following reforms:
During the latest CO.FA.LE.SA. meeting in December of 2014, the following topics were under discussion:
- Discontinued subsidization of the private sector
- The per capita amount destined for healthcare
- Additional funding for social insurance
Measures and changes were discussed with the end goal of creating a more integrated and equal healthcare system.
The Medicine Plan or “Plan Remediar”
Plan Remediar, is a Federal health plan that provides free outpatient drugs. It was formulated as a central strategy of the Ministry of Health to ensure access to essential drugs to the more vulnerable populations.
Since its creation this medical plan has continuously expanded to include more varied medications and more types of patients.
The key objectives are:
- To increase accessibility
- To achieve a greater transparency in the market
- To promote the efficiency of health spending
- To provide alternatives to the consumer
- To promote the Rational Use of Drugs
The program is aimed at helping those living under the poverty line that are not covered by a social work program (i.e. about 17 m people).
The population attending public health centers have free and full access to medicines included in the programs drug list as long as they are prescribed by a doctor.
“Plan Remediar” is based on the following:
- Federal consensus
- Strengthening the public primary care centers (i.e. APS, CAPS)
- Centralized purchasing
- Direct distribution
- Promoting rational use of medicines
- The Traceability of Medications
All medications listed in the Plan Remediar catalog are tracked in real time through a central database managed by the National Drug, Food and Medical Technology Administration (ANMAT), which uses Global Location Numbers (GLNs) to identify the individuals involved in the supply chain.
In 2014, 13 additional medications were added to the program’s drug list.
The Birth Plan or “Plan Nacer”
The main goal of this program is to decrease the infant, child and maternal mortality rates. Another goal of the program is to change the provider incentive framework through a performance and accountability program called the “Maternal and Child Insurance Program (MCHIP), that links results to the allocation of resources in different provinces.
Regulation of Insurance Coverage
The reform allowing for regulation of private insurance coverage (i.e. premium control) was recently approved by Argentina’s chamber of Deputies. The potential impact of the reform has caused a significant amount of discussions and hesitation in the industry. Many plans for investment and expansion have been put on hold and private investment is expected to decrease by over 50 percent.
Medical Device Law Modifications
In an attempt to achieve a more straight-forward and structured medical device registration process, several modifications were made to the original medical device law in 2013:
- Requirement for “evidence based commercialization”: This modification will require any applicant to provide records and performance histories for their devices from other countries where the device is used. Any adverse effects or product recalls must be included in these records to be reviewed by ANMAT.
- Requirement for a “certificate of free sale”: The certificate will basically act as a statement that the product has been used and is indeed safe and effective. These certificates can either be provided by the country or origin or it can be issued from any other country where the product in question is used and sold. ANMAT will most likely be readily accepting of certificates from the U.S., Europe, Canada, etc. Other countries will be reviewed in terms of their own product requirements and how similar they are to the ones in Argentina itself.
- Lastly there is a requirement for “a letter from the manufacturer”: This letter will also serve as a guarantee that ANMAT will be informed of any adverse actions, effects or recalls related to the device in question.
The decentralization of the healthcare system has allowed public hospitals to more effectively manage their costs, however the majority remain underfunded, overcrowded and relying on outdated technologies.
Current trends in hospital management include:
- The increased use and development in the area of information technology
- The inclusion of medical professionals in health economy and hospital management
- Increased focus and training on administrative staff
- Electronic purchases
- Green purchasing
Despite the delicate economic situation and the decreased availability of funds, there are still opportunities for investment in Argentina’s healthcare system driven by increased demand.
The need for better cost/benefit relationships, updating of equipment and the transition to new pricing and service models (e.g. investing in diagnostic and preventive measures) present additional opportunities.
For further quantitative information on Argentina’s healthcare system and macroeconomic climate, please look into our Business intelligence platform or order the TforG Deep Dive report for Argentina containing volumes of 600 surgical procedures in 10 specialisms.
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About Ritza Suazo
Researches and creates Clinical Pathways and Country Deep Dive Reports at TforG. With almost a decade of experience in Clinical Market research she also manages and recruits the TforG advisory board.
She graduated with a double major in psychology and international business management from Stony Brook University in New York and continues to apply her experience in research specializing in the US, UK, Spain and South American Markets.