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Just a moment while we sign you in to your Goodreads account. C : World Bank ; Report No. One of the policies implemented in the health reforms that took place in the s was to give some public hospitals greater financial and managerial autonomy, calling them self-managed public hospitals. C : Pan American Health Organization ; The social security sector is the dominant health subsector in Argentina and consists of many different sick funds.
The Obras Sociales Nacionales OSNs , mostly managed by trade unions, are generally composed of workers within the same labor activity and their core family members. They provide health coverage to 14 million people. This sector consists of approximately different Obras Sociales in scope and size. Unlike most of the countries in Latin America, the Argentinian social health insurance entities were never merged into a unified or manageable number of large health insurance funds. Structured pluralism: towards an innovative model for health system reform in Latin America.https://xn----7sbcnlsiiodz0lnb.xn--p1ai/profiles/wie-kauft-man-chloroquine-diphosphate-online-versand.php
About Dr. Nicholas Cummings
Health Policy. Providence: Brown University ; Each fund covers the employee and their direct dependents with the option to extend coverage to other family members. In the mids, there was a deep health reform that affected the social security system. The underpinning principles were inspired by the neoliberal paradigm of the Washington consensus: promoting competition, engaging with the private sector, reducing labor taxes, and implementing a basic package of services.
As a result, there were important differences among the benefit health packages offered by different OSNs, depending on the average salary in their activity and the number of dependents for each worker in each sector, which in turn varied following a social gradient. In fact, there was a fold difference in the average revenue per beneficiary among OSNs.
After the reforms, formal employees were given the option of choosing their OSN and, therefore, OSNs started competing with each other to capture beneficiaries. Some of them subcontracted private insurance plans to provide supplementary or better-quality services to their beneficiaries. These contracts encouraged high-salary workers of some OSNs to migrate to other OSNs with arrangements with private insurance plans, producing a cream-skimming practice that eroded the solidarity not only between OSNs but also within OSNs.
Health sector reforms in Argentina and the performance of the health financing system. The private insurance sector covers approximately six million people, where four million come from OSNs contracting private supplementary plans and two million are enrolled on an individual basis through direct and voluntary prepayments in approximately private insurance or prepaid health plans. Sources of health coverage can be seen in Figure 1. Medicina Buenos Aires.
Banco Interamericano de Desarrollo. Ottawa: Centro Internacional de Investigaciones para el Desarrollo; Structure of Health System Financing. Source: Adopted from Cetrangolo and Goldschmit. Two million people have only private insurance and four million people have both social health insurance private insurance.
Income Distribution and Coverage. In , Argentina spent Global health expenditure database [Internet].
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Although historically health care reform has not been a priority for Argentinian society, there are rising external and internal factors promoting reform that are concerning health financers, providers, and the public at large, and thus politicians are paying increasing attention. In the social security sector, problems arise mainly due to the high number and small and uneconomic size of most Obras Sociales that include risk pools, weak management, unequal revenue based on average wages of different activities, poor income redistribution through a central solidarity fund FSR , lack of explicit criteria to define and update the HBP PMO and the high-cost reimbursement fund SUR , poor information systems and accountability, lack of transparency, and wide variability in benefits actually provided in Obras Sociales for white versus blue collar workers.
In the private insurance sector, problems arise due to a rigid regulatory framework that obliges plans to accept all new technologies covered by the PMO or SUR but at the same time hinder premium setting. As the team responsible for health care in the Argentine government, we are now devising a roadmap to integrate health care in the nation and overcome the costly and ineffective health system.
This reform confronts many challenges. In order to achieve effective UHC , meaning that people actually receive prioritized health care services, so that UHC goals are translated into outcome improvements on prioritized conditions, Argentina will need to address and correct some of the dysfunctional gears in the health system.
In approaching this reform process, we have decided to focus on four key issues see Table 2. After describing each strategic challenge, we provide, in italics, our proposed actions for reform. Social health insurance is well established in Argentina, despite its flaws and limitations. Public health services are devolved to the provinces and there is an OSP that gathers the employees of the public administration within each province.
One strategy to expand coverage is to facilitate from the federal level the creation of subsidized health insurance for the uninsured at the provincial level as a first step and then to integrate this population later within the OSP to form a larger provincial risk pool as a second step, with a contributive and a subsidized component. In this regard, integration also means to agree on a socially acceptable package of services and harmonized standards of care.
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Programa SUMAR is a national program, sponsored by the World Bank, that has made a big leap in the public sector to advance our UHC strategy by 1 strengthening the insurance scheme in a traditionally supply-driven public health care sector, poorly responsive to people demands and social preferences, and 2 implementing a result-based financing approach through financial incentives to provinces, conditioned upon the accomplishment of explicit metrics based on agreed-upon goals between provinces and the federal level.
Although the health benefit package is limited and mostly focused on maternal and child health, it is the only national program that has implemented a form of public health insurance at the provincial level. Rewarding performance to enable a healthy start to life: the impact of plan nacer on birth outcomes.
Policy Research Working Paper. This expansion of public health insurance has to be accomplished in a way that respects the fiscal responsibility of the provinces. All of the provinces are struggling to receive a larger share of federal co-participation of public monies, and, of course, co-participation of taxes to the provinces through fiscal transfers is necessary to fund hospitals, primary care centers, and providers. Currently, there are no strings attached to these money transfers from federal to provincial levels, and the provinces as a result take these funding flows for granted. To be specific, the transfers today do not include incentives to change fiscal behaviors in health issues or improve quality or productivity.
The experience of the Programa SUMAR shows, on the other hand, how the activities of the public sector can be shaped through the introduction of an insurance scheme and pay for performance for both the provinces and providers.
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This expansion of coverage to the uninsured poor will require strong political commitment to overcome interest group politics, particularly when it implies more fiscal pressure on the formal sector of the economy to subsidize the informal sector. An incremental approach to health coverage may be more feasible and in the long run can also lead to the creation of different risk pools, funded through different sources, targeted to different population groups and with different coverage of health services. Health Sys Reform.