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.
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
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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