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Argentina: Argentina

prepaid medicine companies named are part of private sector health system. This sector comprises also the sub-sector lender, represented by the Confederation Argentina Clinic, private hospitals and sanatoria (CONFECLISA) . Can observe two types of members prepaid medicine companies, those who have chosen hire a private health insurance as well as those who, being members of a social work agreement which established a focus of its portfolio company with some health insurance companies, become dependent on it. Predominate prepaid medicine companies which take the form of commercial companies above those established as professional associations, non-profit. Nutritional assistance of companies is focused on performance based plan chosen and paid by the member (currently are required to cover at least Compulsory Emergency Medical Program).

Origin of prepaid medicine in Argentina.

The history of prepaid medicine in Argentina dates back to 1932 when Dr. Alejandro Schvarzer gathered a group of doctors from different specialties to form an entity in which each physician selected brought their own patients and thus gave way to a unified portfolio nominal fee paid by a regular but informal typifying the first prepaid medical company for outpatient services and shortly thereafter the available idle time led them to think about getting more patients, creating a rudimentary form of marketing, recruiting sponsors and formed groups sales to offer this service for home visits. No shortage of others who, trapped by the idea, echoed the initiative, and the expansive phenomenon soon became noticed. By 1946

medicine was exclusively a private function, the state action was surprisingly bad and purely individualistic, and the state had virtually no national organization of Public Health. The first government of Perón Social Security defined as a protective mechanism of individuals from different states of need, assuring dignified and fair conditions of subsistence, the result of a combination of social policies, economic and health, developing the same created the Ministry of Public Health in 1949 and strengthened the state's role in providing health services greatly increasing the availability of beds in different types of public (national, provincial, municipal, universities, Eva Peron Foundation and OS state), which led to a reduction in the use of private health services with a simultaneous decrease in the beds of this origin: between 1946 and 1951 increased the number of state beds is more than 100% (from 42,000 to 93,000 ), representing around 81% of the total, from the initial 64%, while beds in mutual funds and other private entities is reduced 10% (from 24,000 to 21,000), and then continued to fall (up to 18,000 beds).

Institutionalization of prepaid medicine in Argentina.

The private hospitals with spare capacity of its facilities, give birth to the "prepaid sanatorium" , in 1955 formed the Medical Center Pueyrredón , which form of care was only for patients of physicians in that center. That same year a hospital facing a health care system strongly exploit commercially, for it develops a closed product, centralized (provides full coverage within a single building), which is called Private Polyclinic ; this idea, one of the founders of Private Polyclinic originated in health insurance United States, which took responsibility only from the economic point of view, the novelty introduced in this system was to include taking responsibility for the delivery of medical services.

In 1963, it launched the Metropolitan Sanatorium, also closed with a centralized system but with a particularity, as only subscribers were served by the hospital plan. Later in 1964 comes Argentina Social Medical Assistance (AMSA) , which produces real change, because it implements a closed system decentralized, whose property was to provide a primer for professionals serving in their private clinics and diagnostic tests or hospitalization in various diagnostic and treatment centers, as well as in several sanatoriums Capital and Greater Buenos Aires. A very recent born South Medical Center (CEMES) with the same feature of the previous system, but becoming the first company to provide coverage throughout the country, including the Falkland Islands and also pioneers in covering their own members and other prepaid in resort areas. At this early stage, coverage plans primarily covering the hospitalization, but the market is expanding not only demanded of them but the effect of competition were incorporated more and better coverage, while exclusions and waiting times were falling. In the seventies

appear social work staff and upper management of companies, as a specialized segment of the Social Work . Because of this situation hinders the expansion of the portfolios of members of prepaid medical institutions, which were oriented more to the middle class and upper-middle, as were those who became more aware, through the examples that offered mutual funds and social work , the advantages that this type of coverage involved, between 1961 and 1980 entered the 60 sector entities, and provides coverage to a significant proportion of the population either because the associated directly entered into the system or because through its social work agreed to a prepaid service.

In the eighties, the social situation changed dramatically following the decrease in wages of workers in relative terms and the steady increase in the cost benefits and services that aggravated the situation of social work , creating conditions conducive for the expansion of the prepaid. Between 1981 and 1990 admitted 57 new entities, from then until 1992 he held a position of stability in the number of prepaid, when they start reaching changes through liquidation, mergers and takeovers and the arrival of foreign companies to compete in this market.

In 1997, as were 269 companies of prepaid medicine, clustered in Federal Capital and Greater Buenos Aires, and only a third of them covering the interior of the country; the ten leading companies together accounted for 41 percent of the membership (agglutinated to 890,000 people from 2.2 million members), and as much of the turnover (between 1996 and 97, the ten leading companies billed $ 776 million of the total of 1875 million turnover in the sector). Among the top ten firms were competing to attract users of the economically high, middle and lowest in the country, with monthly fees ranging between 200 and 400 dollars per household among the first, and up to 75 and $ 100 for third ; to these income voluntarily pay their affiliates and to a lesser extent by the resources obtained through the operation of clinics, nursing homes and other healthcare individuals, private health insurance plans provided coverage to 6 percent of the population, but it was the system with the highest percentage of expenditure consumed, in 1994, prepaid in Argentina had a per capita monthly income of $ 79.55 against 16.95 pesos and 14.75 pesos public system of social work .

After the 2001 economic crisis and subsequent devaluation of the prepaid suffered a significant drop in membership, the order of 17% between January 2002 and October 2003 - increased their fees by 25% on average and reduced their discounts at pharmacies for between 40 and 50%, reasons behind the difficult situation in the sector during the same period, nearly 40% of the beneficiaries of Prepaid switched to a cheaper plan, while claims for performance based deficit increased 40% in the private health sector, despite the economic crisis in 2004 the sector still had 2.6 million members and moved over 3000 million pesos per year, but the result of mergers and acquisitions market concentration deepened and the top five ranking companies handled 63% of the membership. Leading companies in 2004 were Medical Protection System (PMS) , Swiss Medical Group , Osde Binary , Medicus and Omint .

For greater number of members to enable better distribution of risks and lower costs per person, prepaid, in addition to merge with each other, signed nearly 150 concession contracts and management in social work that delegated responsibility for health care beneficiaries by establishing a monthly payment per capita. Thus, the prepaid came to compete indirectly in the system of social work , because although members of the solidarity system are not allowed to choose a prepaid they can change social work , which opted to ally with prepaid to improve their attractiveness and expand its share in a market that continued to the naked eye "closed", since then, virtually all superseders plans are offered to beneficiaries of National Social Work prepaid by themselves, they charge a premium for the cost of this plan (to which is added the contribution of the beneficiary), give a membership card to the recipient, and even grow in highly complex insurance Redistribution Fund through own social work . Carlos Vassallo, professor of economics Isalud Health, says that "as deregulation did not arrive, many opted for that alternative prepaid to compete camouflaged within social security." That's how many social works became "managing standards" and business relations between entrepreneurs of health, trade unionists political and strengthened. Current status



In February 2006, the Prepaid Medical market comprised 280 companies serving nearly 3 million members of whom over 60% are corporate plans and bill more of 3,570 million pesos per year (U.S. $ 1,154.5 million), the five market leaders concentrate approximately 60% of the members, in addition, larger firms have an average monthly income per beneficiary than twice that of the lowest . Leadership is what Osdo (35.7%), followed by the Swiss Medical Group (15.2%) of foreign capital and Galen (14.4%). There is also a small group of prepaid medicine companies nonprofit grouped into four chambers, Cimara , Ademp , Acami Argentina and Health Network bringing together around 120 companies, firms Prepaid medicine at the provincial level, mainly in the province of Santa Fe, are gathered in the Chamber of Private Medical Institutions of the Interior (Cempi).

The profile of demand, the higher income segment representing 37.5% of income, class half the 47.8% and 14.7% lower. Of the total beneficiaries, 71% work as employees, 22% are retired and 6% are monotributistas. While the 42 years the average fee is 155 pesos, at age 72 it rises to 315 pesos. As for investments, Galen plans to build a hospital birth center in the Trinity of Palermo, the construction of a new hospital of the Trinity in San Isidro and the new medical center for all specialties in North neighborhood by transforming the building Rodríguez Peña in Cordoba and Buenos Aires. UAI Health by hand, envisages the establishment of two new medical centers. The companies that have financial debt as of March 2006 are Medicus, with 5,009,230 million pesos, and Health Services International Argentina with 4,545,282 million pesos. Activity

minimal regulation

prepaid medicine companies (which may take the form of corporations, limited liability, simple associations or foundations) provide general health services coverage in exchange for a monthly fee; but serve the same social function of Adherents Plans organized by social work , unlike the latter to date do not have a framework law (so that contracts are governed by general rules and Consumer Protection Act), nor is there any public body in control institutional, legal, financial or economic or legal representative or controls the EMP as Health Services Superintendency do with National Social Work , except aspect of performance based and that 24,754 of 1996, Law joined the National Health Insurance forcing them to provide minimum level of coverage as the Compulsory Medical Plan (Res. 201/2002 MS). The contracts have different coverage plans and different prices, which are unregulated and the EMP can increase their contributions to the process of communicating only to members 30 days prior.

is very important to note that the contract operates as a kind of insurance coverage that is, benefits are offered based on shares that are regularly paying in advance as to the non-payment of the same operations suspension of services, then the conclusion of the contract, since the prepaid medical services are implemented through contracts of adhesion, acquires particular the provisions contained in the relevant arts. 37 and 38 of Law No. 24,240 in governing the standards to take into account for purposes of considering ineffective those contractual terms that contain abusive terms, the Act gives the Authority, express powers to develop policies aimed at consumer protection and in that sense, the Secretariat of Technical Coordination of Ministry of Economy and Production of the Nation , in exercising its regulatory authority issued Resolution n º 9 / 2004 by which assuming scenarios of clauses to be considered unfair in consumer contracts aimed at providing prepaid medical services and services originating from an enterprise-class contract or similar agreement between the provider and another party. Thus, the courtroom is the only area they can turn to the beneficiaries of prepaid in the event of litigation.

A bill is in the House of Representatives since 1999 but the parties fail to agree to define a regulatory framework for the system, the project seeks to prepaid medicine companies are fully integrated into the system which regulatory legal framework required to put under the Superintendence Health Services the control both medical and administrative assistance to these companies. Expectations

future

In the short term and after overcoming a severe recession, the Prepaid Health sector, a tendency to grow in membership and in billing but in a context of rising medical costs and benefits and services, increased competition among major players in the market and the growth of legal disputes about the scope of coverage to be provided, which foresees a decline in profitability. As for the prospects in the medium term , experts advance warning of some community hospitals versus prepaid medium-sized or new areas of influence, as well as some "separation" between the more expensive plans and the rest, however, the sector is faced with exciting opportunities such as the incorporation members who recomposed their income situation, sustaining economic growth, expansion within the country, the release of "weak actors are overwhelmed by the competitive pressure" and "substitutes less pressure."

Sources:
Federico Tovar. Brief history of health service provision in Argentina .. August 23 2001. Carlos H.

Acuña, Mariana Chudnovsky. The health system in Argentina. Document 60 March 2002.

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Prepaid Medicine: History of Social Work (II and last)

Social Work system (OS) was consolidated as such 1970, under the authoritarian rule of General Onganía through Law 18,610, although these existed long before they assumed the form was not what we know today. The OS for the 50's and 60 formed a mixed bag, with extremely varied schemes of benefits offered only in part through their own service; Historically, the central feature of this subsector was the compulsory nature of membership and organization by industry through institutions that cover the contingencies of health and tourism infrastructure and provide social assistance to workers as employees (especially Social Work from union) and retired national social security system through the Integral Medical Assistance Program (PAMI). This subsector is constituted as social insurance for the protection of employees (and their immediate families) whose support is required and is done through the contributions of the employer and the employee.
Rules
OS system in the framework of a Health Insurance System.

The discontinuity of the legislation marked the following years until the late '80s. In 1974, Law 20,748 of National Integrated Health System (SNIS) and its companion Act the National Health Career 20,749, responding to the conception of a national health service, was a stout strong opposition of then union power and did not implemented only partially, to be annulled in 1980 by Law 22,269 of so-called military process, in turn, the content consisting union. With the restoration of democracy in 1983, began a legislative review in order to implement a universal national health insurance coverage, which was markedly delayed union pressure to the delayed enactment of two laws twins, the 23,660, and Social Work 23,661 of National Health Insurance, dated December 29, 1989, these standards were regulated in 1993, within a policy framework aimed at achieving deregulation performance based optimization and administration of Public Works allowing free choice of insurance agent by users through the Public Works Union, before these measures, employees were captive clients of the social work of the guild, even even if that person was not affiliated with the union. However, deregulation was not complete, since the choice was reduced to a choice only between home social work association, the private health care providers were unable to compete, except indirectly, acting as providers of union organizations.

Creation of the Superintendency of Health Services (Health).

Through 1615/96 decree merged the National Health Insurance (ANSSAL), created by Law N º 23661, the National Institute for Social Work (INOS), created by Law N º 18610, and the National Directorate for Social Work (TELL), created by Law N º 23660, to be the Superintendent of Health Services (SSSalud), a decentralized body of the National Public Administration under the Ministry of Health and Social Action, with legal and administrative system of autarky, economic and financial. The SSSalud is a body of regulation and control of the players in the National Health Insurance and social work national and only them or adhere to the system established by Law No. 23660 and No. 23661 are part of the system that regulates Superintendency Health Services.

Supplemental Plans are authorized (Plan Super PMO).

The SSSalud authorized by resolution 195 of 1,998 that Social Work in addition to the legal obligation to satisfy the Compulsory Medical Plan (PMO) can provide additional beneficiaries for which plans are enabled to receive contributions and additional contributions, if these are approved in advance by the entity and an agreement is signed between the beneficiary and Welfare when the relationship is built on the PMO Plan Super. The additional payment could be established in the contract between the Social Work and the Beneficiary for the chosen plan could overcome the PMO must be received by the Health Insurance Agent, who must devote at least 80% of its gross resources, net of contributions to Solidarity Redistribution Fund, the provision of health services provided in the agreement. The Public Works signed nearly 150 concession contracts and management with prepaid medicine companies delegating responsibility for health care beneficiaries by establishing a monthly payment per capita in this way, the prepaid came to compete indirectly in the social system works, because while members the solidarity system are not allowed to choose a prepaid they can change social work, and indirectly broaden their market share in a sight that remained "closed", since then, virtually all plans are offered to superseders beneficiaries of the OS for their own prepaid, they charge a premium for the cost of this plan (to which is added the contribution of the beneficiary), give a membership card to the recipient, and even grow in highly complex insurance Fund redistribution through social work itself.

Social Work Competition by users.

In 2000, we present a modification that expands the entities that can compete in this market, by providing that the beneficiaries of the system can exercise the right to choose between any of the social projects listed in the Act except the National Institute 23,660 Social Services for Retirees and Pensioners (PAMI) and social work of military and civilian personnel of the armed forces, security, Argentina Federal Police, Federal Penitentiary Service and retirees and retirees in the same area, they can also choose from any of the entities that have acceded to the System of Law No. 23,661 and its entities are specifically designed the provision of health services in accordance with the rules given by the Superintendency of Health Services, which must add to its name the term "Agent Attached to the National Health Insurance", this allows companies last convention, a prepaid medical institutions and cooperatives that adhere to participate in this market (the original Act allows mutual this feature.)

crisis Security system and Social Work.

The economic and financial crisis that hatched in late 2001 in the country, resulted in increased poverty and paralysis production that generated a fiscal crisis, social and political conditions affecting the financing of the health system by reducing the revenues of the unemployment generated by the (decreasing the number of members of the Social Work) and falling wages, the Social Work were news because they had cut services and public pharmacies that did not care for certain social work, corresponding health financing in the pocket of the worker and his family. The government adopted the decree 486/02 by which it established the national health emergency and took a series of measures to facilitate access to medicines for the poorest people and redesigning the Compulsory Health Plan along with a rescue plan for Social Work, including the pensioners I (PAMI) was the verge of bankruptcy affecting the users attention.

since President Kirchner took office on 25 May 2003, achieved a funding process, due to the inclusion of more than one million Argentines formal labor market, with an increase in collection and the possibility that 3 million Argentines were in social security in the area of \u200b\u200bhealth above and wage increases led to a better collection for Social Work performance it turned in medical care, allowing to social work today may leave the grief and now are giving full service.

Current status (March 2007).

At December 30, 2006, this system had 15,501,655 beneficiaries, holders affiliates (9,547,235) and their primary family group (5,954,420) distributed in almost three hundred organizations of varying size and importance so: 68.9% were in union OS, OS 18.5% State, 6.2% in OS managers and the remaining 6.4% in OS otherwise. The system has an annual revenue of 7,000 million pesos, as a result of the deregulation implemented in 1998 (free choice of Social Work), most middle-income members and senior social work abandoned home, which caused a hole in the cases of social work girls and a surplus in favor of the most powerful, that "associates" In some cases, prepaid medicine companies accounted for the contributions of younger workers with higher wages.

The government aims to encourage the employee to remain faithful or return to social work or home ownership, which is the social work that has to do with their business, trying to stay high wages in that social work because they are those that guarantee contribute more to subsidize a smaller contribution, in this sense seeks to define a period of three months in a certain time of year to opt for any work on social change, while the possibility of returning to welfare of origin (which is allocated by the employee's activity) will permanently open at any time of year is now possible to transfer once every 12 months and at any time of year. Critics of the government's plan say that behind it are the leaders of TQM, which seek to determine a pact with the national government in exchange for limiting their wage demands at a rate that the authorities consider logical and not acting as trigger a race between prices and wages in return for this perk and warned that progress would involve a serious injury to employees, that they would be doomed to be captive customers of the social work of a guild, as well as generating a sharp drop in levels of competitiveness and quality of services. Of a total of Social Work, excluding the PAMI, the top 20 ranking nucleate OS 65.7% of the total beneficiaries, and among the top 10 institutions absorb 51, 52% of the total population

The contribution to social work is 9% (3% of salary contributed by employees and employers 6%). Until now, companies with high wages paid a top: 6% of $ 4,800, for greater funding for social projects, the government will increase, from April this will stop at $ 6,000. The personal contribution will remain unchanged to avoid a pay cut.

Sources:
Federico Tovar. Brief history of health service provision in Argentina .. August 23, 2001.
Social Works, In: http://www.oscom.com.ar/os_old/www/home.htm
Mario Roitter, Inés González Bombal; Studies on Nonprofit Sector in Argentina, Buenos Aires, Cedes / Johns Hopkins University, 2000. Carlos H.
Acuña; Mariana Chudnovsky. The health system in Argentina. Document 60 March 2002.

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• Argentina: Overview, territorial organization and population data Argentina:
• Summary of Current Health System
  Argentina: History Social Work (I)

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Argentina: History of Social Work (I)

While Public Works can be viewed as associations and their inclusion within the sector solidarity economy no longer a debatable issue because of the particular development of these organizations, specifically because of its close relationship with the unions and the obligation of membership, which is why cases can be considered hybrids, given their essential role in provision of health services for large segments of the population, clear lack of profit and the current process of deregulation that will define its future and final status.

solidarity and mutualism in the early trade unions and communities.

union Social Work (OSS) are the most remote in the joint management of the first trade associations. Older workers' organizations, such as Buenos Aires Typographical Society dating back to 1857, privileging the needs of the sector especially with regard to improved working conditions, these entities also activating mechanisms to raise short-term funds to meet the needs of workers who suffer job loss or be imprisoned for their union activity, such as raffles, dances, fundraising or ventured into businesses like the cigarette factory of the General Union of Workers. The sense of solidarity is also seen in the form of loans from the Central to various unions and between unions loans, as contained in the minute books and copying of notes.

Mass migration overseas of late nineteenth century altered the conformation of the proletarian cadres, workers strengthened the institution of the European Union as the body's own employees as opposed to the "organs of bourgeois rule, including political parties, and also brought mutuals and friendly societies at the level of local authorities, who put the emphasis on health coverage for overcome the deficiencies of the Argentine hospital, overwhelmed by population growth and the absence of the project outweighed the situation, so it was natural that such structures were closely related to the new unions, which included a large number of contributors to that source . The ideology of solidarity and collectivism power these organizations and common denominators and affinities defined a parallel and integrated action and mutual union.

Hospital workers in the rail model.

Railway Union (UF) was the first major union to develop mutual action since 1919 managing its own Pension Fund (Law 10,650), four years later would also create the Home Railway (Law 11,173), an additional granting loans for the acquisition or construction. The hallmark of this standard is to set a levy of contributions from partners on the part of employers to train its derivation back to the guild, substantially changing the mode of collecting the first phase of unionism, as irregular as deficient in collecting contributions.

The important role of the UF in the whole of unionism also arises from the fact that their representatives were the majority in the National Association of the CGT was formed in September 1930. Later in 1935, the Joint Railway, built by the UF and the union of the machinists The fraternity agreed to the installation of a hospital for its members, which was inaugurated in 1940 under the name of Railway Hospital (would close its doors in 1999); subsequently also enables outpatient facility for emergencies in Rosario, through agreements with the Italian Hospital in that city, whereas surgery and hospitalization were in charge of HF in Buenos Aires and through agreements with private clinics pulmonary cases are referred to Córdoba while managing its own entity.

Social Work Influence of Unions in Government.

The military leadership of the coup took place in June of 1943 he ventured into areas that hitherto were not considered major by the dominant sectors, the National Department inefficient Labour (established in 1907) was replaced by the Ministry of Labour and Welfare (STP) in November of that year, and is in charge of Colonel Juan Domingo Peron, who quickly joined his ideas the focus of historical gremialistas Social Work, that developed after contact with these, especially the Confederation of Employees of Commerce and the UF, popular support for the reactionary regime required, these associations accompanied without complex between 1943 and 1945 the development of the management of Colonel Peron.

The most prominent of the period in this field was the creation of the Social Service Commission (Decree 30655/44), charged with "propel the implementation of social services in the establishment of any branch of human activity which provide paid work" and recognized as the founding act of Social Work, the benefits to be provided through such services were: free health care, pharmaceutical care at cost, provision of food items, clothing, and essential for home use at cost, the company should provide such services "at least", but also considered the possibility that it was mutual or cooperative organization which replaced the company. Decree 23852 of October 1945 organized by professional associations of workers, created to meet the health care needs for sectors such as the Police, the Armed Forces and the Railway (unlike mutual funds, these organizations get their funding from a major state contribution in addition contributions from their beneficiaries), allowed the unions to begin to develop projects and services destined for its members and the independence and autonomy in the management of resources made possible an impressive growth and the economy definitely strengthened union, putting unions in an unprecedented position as it relates not only to the dynamics Traditional but with the new instance of gravitating participation in defining national policies.

OS Expansion of health welfare system.

In June 1946, Peron became president of the nation, encouraging since the expansion of social work scheme, however, the adoption of social insurance as a hegemonic strategy of protecting the health of the population only be consolidated with the fall of Perón. As you rightly said Angel Jankilevich:

" is important to note, by distortions has been the subject, that under the first two presidents Peron, the model of Social Work is not the main source of financing the health system, nor had the characteristics that distinguished him from 1970. By contrast, the entire health system and social security lay in their own nation state and it was funded with general revenues [1] . " The same author continues then ... " In fact, compulsory social security organized by industry with a strong focus on national union leaders founded in 1970 and was developed mainly by the successive military administrations who ruled the country until 1983, ironically with the banned Peronist [2] "

The decades of 60s and 70s were the expansion of the system of Social Work, as a result of full employment policies, the rise of trade unionism as a political expression of the working class and the effect of Law 18,610 of 1,970, which gave them a legal framework. The authorities need to agree with unions allowed them to get many advantages, including abundant smooth and funding to be turned, to some extent on their health care affiliates to obtain a quite satisfactory level of services to the workforce as employees and their primary family, constituting, in fact, a national insurance group fragmented union administration. From the standpoint of the number of entities, the Public Works Union (OSS) always accounted for a clear majority of the total (between 70% and 80%). From the standpoint of the number of beneficiaries, the importance of OSS has grown rapidly as a result of the new concept applied: in the early 70's and covering about 6 million beneficiaries, equivalent to 53% of total membership.

End of Part One: History of Social Work.

In the next post will be about the establishment of social work and national health insurance, and the way they have played the OS from the 70's to today.

Sources for this post:
brief history of the provision of health services in Argentina. Federico Tovar. August 23, 2001.
Social Works, In: http://www.oscom.com.ar/os_old/www/home.htm
Mario Roitter, Inés González Bombal; Studies on Nonprofit Sector in Argentina, Buenos Aires, Cedes / Johns Hopkins University, 2000.

[1] Jankilevich, Angel. Hospital and Community, of the Colony to Independence and the Constitution of the corporate republic. Buenos Aires. 1999. edition of the author. Page 256.
[2] Ibid

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world: Summary of Current Health System (I)

In Argentina we identify three models: the public, public funding and provision; the social security health (social work system and insurers work injury), and the private system , including prepaid voluntary health insurance, organized according to the actuarial risk (prepaid medicine companies) and the independent and private establishments that provide services to insurers and users individuals with ability to pay.

This sector specially shaped imprints in the area of \u200b\u200bhealth a peculiar logic since it involves the disjointed coexistence of each of these subsystems that differ in their target population, the services they provide and the origin of resources they have. The lack of integration is not only seen among the different subsystems, but within each there are also serious levels of fragmentation: if in the public sector has traditionally been seen that there is a lack of coordination between different jurisdictions (national, provincial, municipal) and in the case of social security subsectors (obras sociales) and private, are composed of a large number of heterogeneous organizations in the type of population they serve, providing coverage, financial resources for affiliate and mode of operation. Hence the importance of taking into account the main characteristics of each to achieve a comprehensive view of the existing scenario in this sector.

General Organization

public Subsector

The Government fixes the main objectives of the system through Ministry of Health of the Nation ( MS), that plays a leadership role and political direction of the health system as a whole, the MS has several decentralized agencies such as the National Drug, Food and Technology (ANMAT) , the National Administration Laboratory and Institutes of Health (ANLIS) , the Unique Central National Institute Ablation and Implant Coordinator (INCUCAI) the National Centre for Social Re (CENARESO) and the National Institute of Rehabilitation South Psychophysics (INAREPS). also depend on MS as remnants of hospital decentralization policies: the National Hospital Baldomero Sommer , the National Hospital "Professor A. Posadas ", and Cologne National Dr. Manuel Montes de Oca " and, somehow, the largest entity of the system OS, the Institute for Retirees and Pensioners (INSSJyP-PAMI) whose budget was reinstated to the national budget since 2002. The Federal Health Council (COFESA) is the institutional context for building consensus, establishing goals and policies and decisions shared across sectors and jurisdictions. By constitutional mandate, the provinces are the technical administrative units responsible for the care and protection of the health of the population, so for each provincial ministry of health management and policy and technical management of the units or establishments of the system to compliance with health programs and activities in the respective political jurisdiction; the municipalities often manage their own resources and are empowered to plan and implement health independently, particularly the most powerful economic and demographic weight.

public subsector is financed with fiscal resources: The National Government (central and decentralized agencies, except INSSJyP-PAMI), is principally national budget, the provincial and the City of Buenos Aires are financed with funding from the federal partnership tax, tax collection and transfer own the national state and the municipalities with resources of shared provincial and local taxes.

health services are provided mainly in the network of Hospitals and Public Health, with a geographical distribution of services is extensive and a presence in areas considered unprofitable by the private sector, where care is provided free to anyone who claims services in these centers (in fact act as a reassurance for Social Work as they maintain a flow of free care for the insured population) over the last decades there has been a process Decentralization in the Public Hospitals has gone national to the provincial and municipal [1] , in fact, the public network comprises approximately 53.2% of the population, mostly low-income social groups (the population that behaves like natural demand this subsector, which is no coverage for any of the other two sub-sectors).

Other agencies and institutions have responsibility for health, varying their structural location and degree of linkage with health ministries across jurisdictions. Thus, environmental health is often in the area of \u200b\u200bministerial responsibility in the provinces, but only represents a very specific the national level, where there is a Secretariat of State responsible for environmental issues. The Armed Forces have their own health care structure, each branch separately, and produce some inputs, for example, drugs. The area of \u200b\u200beducation is responsible for undergraduate and postgraduate training in health through the Universities and University Hospitals, also maintains school health services for preventive measures and health promotion. The areas of agriculture and livestock are responsible for food control and animal health, including the care of animal diseases such as FMD.

Other entities that depend on the Ministry Health of the Nation .

Another entity that depends on MS is Superintendence of Health Services (SSS) created in 1996 to integrate the functions of the National Health Insurance ANSSAL (created by Law N º 23661 ), the National Institute for Social Work INOS (created by Law No. 18,610), and the National Directorate for Social Work TELL (created by Law No. 23,660), which were abolished, its functions are to monitor and supervise compliance with exercise the right to choose the beneficiaries of the system to free choice of Social Work (OS), monitoring compliance with the Compulsory Medical Plan (PMO) for insurance agents, to ensure the quality and coverage of the system and cost recovery of Decentralized Administration Hospital, and ensure that the beneficiaries of social work equity in comprehensive medical coverage -care at all levels of complexity, ensuring compliance with rules and regulations and administering grants Redistribution Fund of Social Work.

The subsector for Mandatory Health and Social Security.

social system works:

The social insurance sub-sector is organized around non-profit entity called Social Work (OS), and the active presence of Argentine trade unionism is a relevant factor in this subsystem in each branch of production and trade unions manage their health insurance and a pact with the government working conditions. The OS is organized as a social insurance system, financed by contributions from workers and employers' contributions, some provincial governments to allocate additional items andthe INSSJyP-PAMI OS also receives contributions from active and passive workers.

addition

OS, as the Act authorizes the Insurance Agents with similar functions to the OS to entities that are specifically aimed at providing health services in accordance with the rules given by the Superintendency of Health Services, which must add to its name the term "agent join the national system of health insurance," that allows companies last convention, a prepaid medical institutions and cooperatives that adhere to participate in this market (the original Act allows mutual this feature.) Since 1998, members of the system have the option to change the OS of origin (the guild of their work) the other at its own discretion.

The OS and other insurance agents must ensure their members the benefits Compulsory Medical Plan (PMO) established Res. MS 201/2002 (later amended by res. 1991/2006 MS), including outpatient care, hospitalization and high complexity, Dental Care, Mental Health, Drug Provision, many of which do not provide services directly, but outsource the private health sector. There are about three hundred entities among social work union and management personnel. With approximately 10% of the total contributions have been integrated Redistribution Fund, controlled by the SSS, which subsidizes the entities that have lower contributions.

At December 30, 2006, this system had 15,501,655 beneficiaries, holders affiliates (9,547,235) and their primary family group (5,954,420) distributed in almost three hundred organizations of varying size and importance, the OS 70.6% was domestic and the remaining 29.4% in provincial OS. Of a total of Social Work, excluding the PAMI, the top 20 ranking nucleate OS 65.7% of the total beneficiaries, and among the top 10 institutions absorb 51, 52% of the total population, the most representative OS are

• The National Institute for Retirees and Pensioners (INSSJyP - PAMI): The largest institution of social security in Argentina, serving about four million people, including participants and beneficiaries. Is devoted to health care coverage for retirees and their families.
• Osprera: Social Work Staff and Stockyards Rural Argentina, OS is the second largest in the country, is organized around the country, with branches in each of the provinces and has more than 1,000 stations affiliated with guidance and support, by 2006 had 1,267,888 members, of whom 607,071 are members and 660,817 are familiar. A worker can join a spouse, partner or and children and can also incorporate other close relatives who are in charge.

The work injury insurance (ART).

Between 1995 and 1996 we designed a new system for protection against occupational hazards, based on the performance of private operators, who manage and meet the needs of prevention and damage repair work. The system is supervised by the Superintendency of Occupational Risks (SRT), under the Ministry of Labour and Social Security (MTySS) and is heading towards a comprehensive regulatory framework and the extension of coverage beyond the formal market work.

The private sector:

It consists of two main groups: the professionals who provide independent services to individual patients related to social or private prepaid medical systems and health care facilities contracted by them, prepaid medicine companies should guaranteeing employment, at least one essential feature set Compulsory Medical Plan (PMO) .

This subsector includes the non-profit entities such as cooperatives and mutual health organizations not operating as Public Works, these institutions may offer health plans with the permission of your assemblies, not considered prepaid health therefore not considered health insurance agents, nor are they obliged to offer PMO and its activity is authorized and monitored by the INAES instead of being under the control of the SSN .

This subsector is financed with funds from contracts with the OS and / or family-pocket spending for the purchase of voluntary insurance and payment of coinsurance, copayments and direct purchase of goods and services.

Statistical and Financial Data Argentine Health System Infrastructure

: Argentina in 2000 had 14,534 health outpatient facilities (38 per 100,000 pop.), of which 44.4% were public, with 153,065 beds set (4 x 1,000 pop.) spread over 1,271 hospitals and 2,040 private clinics, 14.3% of all hospital beds were located in the City of Buenos Aires, which has 7.9% of the population, the same analysis taking into account the City and the Province of Buenos Aires is more equitable because in this area have 48% of the beds to meet the 49.5% of total Argentina's population, draws attention to the high percentage of beds in Córdoba (11.6%) and Santa Fe (7.2%).

Human Resources: for the year 2004 estimated the number of doctors in 121,076, a rate of 32.1 per 10,000 inhabitants, also estimated that for every 10,000 population. had 9.3 dentists, 3.8 nurses, 1.1 midwives and 5.1 pharmacists.

Use: according to the survey of utilization and health care spending in 2005, of 100 Argentine, 41 came to the doctor, dentist, 15 to 22, used analytical services, treatments and international, 7 used other professionals come out and 69 used drugs. People did consulted 1.8 times a year, lowering to 0.72 consultations years when considering the population average, as expected, there is a particularized use of formal sector of people who lack any coverage, but emphasizes that people affiliated with some kind of public consultation used (7% in outpatient centers and 9% in hospitals). Considering the total number of medical consultations in 2005 (26.2 million), 33.1% were performed exclusively in the subsector, 25.6% in Social Work establishments, and 36.1% in the private health sector only and the remaining 5.2% is both, of those in the subsector, 38% is done in outpatient centers and 62% in hospitals and 3 in 10 private consultations are conducted in a private practice. 760 000 births were attended, of whom 99.1% are a% institutional births of 96.95, one of every three babies is born by caesarean section, but in private clinics surgical deliveries are twice those in the public and reach 50 percent of all births.

Regarding financial resources, the deep recession from 1998 not only reduced health spending as a percentage of GDP from 9.13% in 1995 to 8.45% in 1999, but significantly altered the composition of spending and the largest decreases were for social security as a whole (INSSJyP, National and Provincial Social Work), to this was added the impact of currency devaluation after the end of convertibility in January 2002, being the result of two effects that Argentina lost its position as the country with the highest per capita health spending in the region. Almost five years after the devaluation, the health system recovered slightly the level of spending per capita in dollars, but to a degree that is insufficient to maintain the same level of performance that could stand before 2002, ranking for 2006 in around U.S. $ 250 per capita, a 16.3% increase over the $ 215 estimated for the year of the end of convertibility, though far from the $ 612 which was carrying supplies between 1999 and 2000.

By 2006 total spending on services health was estimated at $ 42,000 million, nearly 8% of gross domestic product and 33% is spent by citizens of their own pockets, most of these personal expenditures from sectors with fewer resources, while count with the public hospital for their care, often have to buy medicines or pay off some studies. For 2004, 39% of the population was receiving social work services, handling 25% of resources, another 8% have the benefit of the PAMI, which received 7% of total expenditure, and 8 % was attached to the health insurance companies, which was receiving 11% of spending. In the public system 45% concentrated of the population having no social work or prepaid, "but only received 24% of the funds of the system by the year 2,006, the burden on the public system was even higher (53.2%), given the reduction in membership social work system.

[1] in the country more than 1200 public inpatient facilities, most of which are hospitals. Most of them are provincial and only a small proportion of the national level depends

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Fish In Bromothymol Blue

Argentina: Overview, territorial organization and population data

ARGENTINA (2007)

following information is presented in order to understand the context in which they operate and Cooperatives mutual health organizations in Argentina.

Official name: Republic
Argentina Area: 2,791,810 km ² . Federal Capital
: Autonomous City of Buenos Aires
Currency: Argentine Peso
Language: English
Other cities: Córdoba, Rosario, La Plata, Mar del Plata, San Miguel de Tucuman, Salta, Santa Fé.
National holiday: 9 July, Independence Day (1816).
Population: 38,970,611 inhabitants. (Estimates from censo/01 June/2006)
The population density is 14 inhabitants per km ². About 89.3% of the population is urban.

Subdivisions

Argentina Republic consists of 23 Provinces (Comparable to the Departments in Colombia) and one autonomous city (Buenos Aires, the Federal Capital). With the exception of the Autonomous City of Buenos Aires (00) and the province of Buenos Aires (01), the other provinces have signed inter integration forming four regions for various purposes: Northern Region Grande Argentina, formed by the provinces of Catamarca (02), Corrientes (04), Chaco (05), Formosa (08), Jujuy (09), Misiones (13), Tucumán (22), Salta (16) and Santiago del Estero (21); New Cuyo Region , comprising the provinces of La Rioja (11), Mendoza (12), San Juan (17) and San Luis (18); Patagonia Region, comprising the provinces of Chubut (06), La Pampa (10), Neuquén (14), Black River (15), Santa Cruz (19) and Tierra del Fuego, Antarctica and South Atlantic Islands (23); and Central Region, comprising the provinces of Cordoba (03), Entre Rios (08) and Santa Fe (20).

Argentina is described as a country macrocephalic because almost omnipotent influence of the capital, Buenos Aires (the political, economic and cultural development and its port is carried out much of the trade of Argentina the rest of the world) and to concentrate in the urban agglomeration of Greater Buenos Aires (a metropolitan area comprising the City of Buenos Aires most natural extension of the province or metropolitan area of \u200b\u200bBuenos Aires, without creating a whole administrative unit) to a third of the national population at nearly 4,000 km ² (0.14% of the total area approx.) and 40% of Argentine GDP, from the administrative standpoint Greater Buenos Aires had in 2001 with 11,460. 575 inhabitants (2,776,138 in the Autonomous City of Buenos Aires more than 8,684,437 in the 24 other integrated urban areas). The second urban conglomerate is Greater Córdoba, a metropolitan area of the Province of Cordoba with 1,368,301 inhabitants integrates Córdoba, the capital, with other neighboring towns of the province and the city of Córdoba is an important industrial and commercial center, called the Learned, for its prestigious and oldest university. El Gran Rosario, urban conglomerate that includes the city of Rosario and its neighboring towns in the Province of Santa Fe is the third largest with 1,161,188 inhabitants, is the center of a large productive area along the river Paraná and Rosario City, home to 78% of the people (the most populous province of Santa Fe), is a commercial hub, financial, industrial and cultural development and is the main port world agricultural exports. The Great Mendoza , metropolitan area formed by the City of Mendoza and 5 neighboring towns in the Province of Mendoza, with 848,660 inhabitants. (Which represents almost 54% of the population) in the west, is the nucleus of a great wine region, the city of Mendoza is the capital of the province and despite being 4 in population within the agglomerate is the pole of the same, the population of Guaymallén (the most populated of the agglomerate) is only a quarter of the total population of the metropolitan area, this figure is an indicator of what that is uniformly distributed population. El Gran San Miguel de Tucumán , principal city \u200b\u200bin northern Argentina, is the urban conglomerate formed around the city of San Miguel de Tucumán, capital of the Province of Tucumán and known for being the site where Argentina declared independence in 1816, is the fifth most populous agglomerate Argentina with 738,479 inhabitants, of which 71% are concentrated in the city of San Miguel de Tucumán. Neuquén, Capital of the province, has 201,868 inhabitants with cities Plottier Cipoletti and forms an urban conglomerate that brings 291,041 people.

The economic crisis and recovery

Argentina's economy experienced it hyperinflation between 1989 and 1990, during which poverty rose momentarily to an unprecedented level of 47.3% of the population of Greater Buenos Aires agglomerate. In the 1990's were deep and drastic economic reforms essential to reform the state, privatizing public services and open the economy. The centerpiece of the economic reform was the Convertibility Law passed in 1991 by freezing the value of a weight on a dollar. The plan, which aimed to immediately stop inflation, was successful for several years. In 1995, the local economy was adversely affected by the call Tequila effect, which caused an unprecedented increase in unemployment at the national level to 18.4%, also reversed the downward trend in poverty rates, which in the Greater Buenos Aires (the largest in the country), between 1990 and 1994 had reached a low of 16.1%; With the exception of 1995, in the late 90's the economy grew strongly until mid-1998.

In late 1998, began a long cycle of recession, partly because of the depletion of the peso and the dollar, which culminated in December 2001 after a bank run that destabilized financial system, the government tried to control the situation by enacting a restriction on the extraction of money deposited in banks, a measure known as the playpen, the economic instability led to a popular uprising that led to the resignation of President Fernando de la Rua. The economic boom, social and institutional in 2001 produced a wave of bankruptcies and closures of companies in the industrial sector and in services, and in 2002 underwent a major devaluation of the currency after the default of external debt (public and private) that exceeded the amount of gross domestic product this year, also at the national level, poverty reached 57.5% of the population, extreme poverty to 27.5% and 21.5% unemployment, all record highs for the country.

mid-2002 are beginning to glimpse signs of economic recovery and from 2003 to 2005, the country recorded a growth phase with rates of around 9% (8.8% in 2003, 9% 2004 and 9.2% in 2005), partly due to a high dollar policy designed to encourage import substitution, which has increased the competitiveness of industry in Argentina, in 2006 the economy expanded 8.5% accumulated four years of sustained growth. Currently, Argentina is the third economic power in Latin America, surpassed by Brazil and Mexico. GDP per capita measured in purchasing power parity and expressed in international dollars (USD 14,838) is the highest in the region.

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