Hear
After the official presentation of its implementation in a district in the north of Buenos Aires, municipalities in at least three other provinces showed some degree of interest or analyzed the local viability of the health voucher system that was among the campaign promises of Javier Mileias this media learned.
With some 5,000 consultations covered in a private center for users of the public system, without social work or prepaid, the system has been operating since January in San Nicolás de los Arroyos. But, for the moment, in five municipalities in the province of Buenos Aires, Entre Ríos and Córdoba that have known or initiated contact to find out how it actually translates into practice, they talk about implementation. In fact, one asked not to even be mentioned when asked by this media.
The news that San Nicolás was the first municipality to begin implementing medical insurance so that, through an agreement with the mayor’s office for basic benefits outside the public system, the population without coverage could choose to receive care in a private center was given by the last Tuesday Ministry of Health of the Nation. In response to the consultation, at that time, it was indicated that it was a municipal initiative, which can be replicated in other parties and that “it will be encouraged by the Nation”, while “the next steps are evaluated.” It was not yet possible to obtain more details from the portfolio in charge of Mario Russo.
There are several differences in local realities that the municipalities pointed out to define their viability in the future: from the characteristics of the health system, between public and private, in each municipality to the size of the population.
In San Miguel, province of Buenos Aires, explained that it was among the topics of exchange between both municipalities, but that it is neither ruled out nor is it intended to be applied immediately. “They are different realities. In San Nicolás, there are many factors that combine to make it work and in San Miguel, perhaps not. In principle, its application is not being evaluated,” they expanded from that district in the northwest of Greater Buenos Aires.
Among the differences, they mentioned that they do not have a provincial hospital, the population is five times larger and there are neighboring municipalities also with high population density. “Yes,” they conceded, “the idea of San Miguel is to look for strategies that can generate synergy.” [de lo] private public; encourage the offer of private health to decompress the public system, which is badly hit.”
The day after the Nicoleño voucher system or municipal health insurance was disseminated, the mayor of Jesus Maria, Córdoba, requested contact with its counterpart from the north of Buenos Aires. “I am interested in delving deeper into what it is about to analyze if it is feasible to replicate it in Jesús María in the future,” he said. Federico Zarate in dialogue with THE NATION. “I found it very interesting,” she summarized.
A regional hospital operates in Jesús María, which is also attended by the population of Colonia Caroya and other towns in the northern province, in addition to four sanatoriums for a conglomerate of almost 100,000 inhabitants with coverage of Jesús María, Sinsacate and Colonia Caroya. Five geographically distributed dispensaries or community centers complete the possibilities of local care.
“70% of the population is cared for in the private sector, 25% is cared for in primary care centers and the rest in the regional hospital, in addition to offices of different specialties,” described Zárate. “But what we are seeing is an increase in the number of people who no longer have coverage in Jesús María,” he added. It was 30% in 2021 and now it is 37%, so that demand is beginning to flow into the public system. Although it has not yet been noticed, with these numbers, in months or years to come, it will have an impact on the public sector. “We must analyze options to prevent services from being saturated.”
Other municipalities with which there was contact are, as indicated, Puerto General San Martínin Santa Fe, and Gualeguaychuin Entre Ríos. THE NATION He contacted both municipalities, but they finally neither confirmed nor ruled it out until the closing of this note. Meanwhile, a municipality in the northern area of the Buenos Aires suburbs clarified that contact with the authorities of San Nicolás had existed, but “for general management issues,” not specifically health issues, and prior to the implementation of the vouchers. last January.
So far, according to the details provided by the authorities of San Nicolás, the change to “finance demand instead of supply” in health, as La Libertad Avanza promised during the electoral campaign, consists of the population without coverage and that until now it was only treated in the public sector, choose, if you want, to be treated in a private center that signed an agreement with the municipality to collect benefits. To do this, users access by DNI – which becomes the Municipal Medical Insurance affiliate number – a digital credential with a tokenlike social insurance or prepaid insurance, which is used in the clinic managed by a private group to access the service like other coverage.
At the moment, in San Nicolás there is only one private provider that participates in this system, GO Sanatorio San Nicolás. To define the values of each benefit, the Municipal Health Secretariat did not choose the list of tariffs used by the province of Buenos Aires, but rather the one applied by the Provincial Autárquico Institute of Social Work (Iapos) of neighboring Santa Fe.
In consultations with highly complex private centers, considered benchmarks in the country, about the viability of this system in the midst of the structural crisis that the Argentine health system continues to go through, there was agreement that there is still a lack of information about, for example, what it consists of. the agreement with the municipal or provincial State – depending on the level of implementation – and how, or through what mechanism, it is financed.
The main problem of the State as a financier of benefits indicated was the continuity of payments and contracts, in addition to who the public sector ends up transferring the risks to, including investment risks. The fragmentation of the health system in the country is another drawback mentioned. The size of the population or the needs to be addressed, according to the level of complexity, were other variables to consider before giving an opinion. “It can work, the issue is knowing how,” said a specialist in hospital administration who asked to preserve her name because she still does not have enough information about health vouchers.
THE NATION He tried to obtain more details with the national health portfolio, which had confirmed that it will encourage the adoption of the system in municipalities and provinces. It was not possible until the closing of this note.
“Municipalities can carry it out and finance the demand of patients who do not have resources or coverage,” he said. Eduardo Filgueira Lima, drafter of the health system reform that LLA had adopted for its electoral platform last year. “It would be a process, with institutions that join the list of providers that adhere to the system and municipalities that are administrators of the resource fund,” he continued. The details of implementation should be left to each jurisdiction.
There are several, as he responded, the risks of this process. “First of all, people should not be captive to a single provider or administrator of resources. You must be able to change from one or the other if required. That should be the first principle to follow. The only exception would be localities with a single provider, in small places –he indicated in dialogue with this medium–. The design that we had drawn up proposed that the population receive the voucher (a credit that may or may not be in an account, which the beneficiary takes to the administrator of his choice or functions as a promissory note), but that these resources be managed by different administrators, whether national, provincial or municipal social works, if they use the resources well, to cover the services of the providers that are incorporated into the system. The secret is that people have freedom.”
He also stated that this reform implies that the Government opens a negotiation with the provinces for co-participation to adjust resources. “If the Nation does not face it, change will never happen. National programs are a subsidy to supply, they develop an enormous bureaucracy. They are transfers to hospitals, municipalities or provinces so that they do something that they are required to do,” said Filgueira Lima. All that money, he proposed as LLA’s health reference during the campaign, “should be directed to finance demand” and conditional on indicators.
