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Exodus in prepaid: due to the lack of specialists, 3 out of 10 affiliates are already served in the public sector


Delays of more than two months to get appointments for social work make people turn to care in hospitals.

The delays, of more than two months, to obtain a medical shift through social work or prepaid are no longer surprising.

The prepaid crisis is naturalized and contains several more crises: one is that of medical specialties.

But now the primer is more inaccessible and more "skinny."

And you have to be

doubly patient to be able to take advantage of the credential


Or do you have to look for alternatives?

A detail becomes data in the midst of this panorama.


verified that in the shift center via WhatsApp of two of the most important coverages in the country, the assistants (humans) already notify in advance, and almost identically, that the consultation will not be anything soon.

If you ask today for mental health, dermatology, ophthalmology, dentistry and even pediatrics, mainly, you get a message similar to this:

"we have a turn for May, shall we continue?"

Due to the lack of shifts with medical specialists in the prepaid, 3 out of 10 affiliates choose public hospitals.

Photo Juano Tesone


many affiliated people - who pay the fees with all their increases - the question is an invitation to look for specialists "from the outside".

And there are two alternative paths.

One is "new".

There are those who pay for a private consultation even though they are already paying month by month, and those who, more in the interior of the country but even in the City,

seek care in the public sector

even though they have affiliate credentials.

And a statistic puts context to this double use.

According to the Study on Health Access and Perception, carried out by the Colsecor Foundation, people now value public sector specialties more and

3 out of 10 use both health systems


In addition, less than 10% "minimized", continue with the same plan in which it was before. 

The percentages. 

34% have a social/prepaid work and use the public or private service indistinctly.

32% have a social or prepaid work and use the private health system.

It's almost a tie.

And 26% are treated for free in public hospitals, compared to 5% who pay privately for medical practices.

The exodus of doctors in the prepaid, a headache for affiliates looking for shifts with specialists.

The difference between which option is chosen the most is significant depending on the size of the cities. 

In cities with fewer than 10,000 inhabitants (35 towns from all over the country were randomly selected in the research), even though they have social security, 41% use the public or private service indistinctly.

In those with more than 100,000 inhabitants, on the other hand, the percentage reaches 29%.

He is also tall.

At the same time, in large cities, even with prepaid, 41% use the private health system more regularly, compared to 23% who use it that way in less populous cities.

Why does it happen especially in small or medium-sized cities?


The providers are mixed, which are usually the same. In addition, the public service does not collapse nor is it as massive as in larger cities or,

the private offer is very limited

, "

Mario Riorda, responsible for the service, explains to


. study and director of the Master's Degree in Political Communication at the Austral University.

"Also, they go to the public, but when there is no shift or there are more complexities or public coverage is not sufficient or fast, they must resort to the same professionals in the private sphere, be it with social work or coinsurance or individual payments," details.

Regarding the medical specialties, there is an overlapping of expenses and "transits" of those same patients.

From the private service to the public and from the public to the private.

For example, they are treated in the public service, there they are not guaranteed comprehensive coverage for their cases, they go to the private service, often with the same professionals.

And those same patients also usually have social work coverage, sometimes the provincial funds, and even so, they end up paying a premium (sometimes in black).

The impact on spending is triple

: they pay the contribution to the public system, they pay the contribution to the social or prepaid work and they pay an individual contribution.

In the aspects of

digital access

to services, medical specialties and equipment, the highest approval is for the private health service.

Within the public system, proximity to private homes and the availability of free medicines are more valued.

Slightly higher in the private sector, but there is almost no difference, in the sensation of humane and dignified attention and sensation of comprehensive coverage, with respect to the public system.

"skinny" primers

What is the specialty crisis?

The Argentine Health Union (UAS), which brings together the majority of private medicine organizations, recognizes the crisis of

specialists who leave the primer

and includes it in the "great crisis" of the entire prepaid medicine system: the insufficient financing that the system has.

The specialties have different tariffs and the amounts vary between the prepaid ones.

In all of them there is a delay in these tariffs with respect to inflation.

Many specialists decide to stay only in the primer that pays them the best per patient or go completely to the

private mode


Why does the indistinct use of public and private service also happen in big cities?

"It is very clear that it is for the specialties that people pay for private consultation or, among those who reduced their coverage plan to save money, end up looking for shifts in the public service. This second group, which lost purchasing power and needed to pay a fee prepaid or minor social work, you also see it in hospital guards,"

Jorge Gilardi, former president of the Association of Municipal Physicians of the City of Buenos Aires , told

Clarín .

In the two hospitals where these "double patients" are seen the most are Fernández and Piñeiro, where Gilardi works.

"But he happens all over Buenos Aires," he says.


"Today to get an appointment with an expensive prepaid you have to wait three months. Many specialists get off the card. This happens especially in the 'girls' specialties. But also in pediatrics. Unless you have a baby with a cough, which will go to give total priority, families are scheduled to be checked in two months from now," he says.

Also, marks the expert, there are "big delays in technology."

It refers to getting an appointment, punctually, for a CT scan or another highly complex study.

The problem is not perceived in chronic diseases because cancer or diabetic patients are scheduled for their controls four months before.

They "open the agendas" beforehand.

"The crisis is general. You can evaluate it from the lack of resident doctors throughout the country, when before they were registered in the residences of the city, province, of the Nation, in anyone who can enter, and today there are vacancies; even in the prepaid, that

doctors leave because their salaries are totally depressed

. How can there not be movements of patients seeking care as they can?", says Arnaldo Casiró, head of the Infectious Diseases Service at Hospital de Agudos Teodoro Álvarez.

"Specialists have to work long hours to make ends meet. The prepaid are left with fewer doctors and, at the same time, with fewer of the best," he closes.



was able to learn from sources in the sector, in the Province the vacancies for specialist quotas are also marked in public outpatient clinics. 

In paediatrics, coverage is only 28.8% of available positions


In neonatology it reaches 39.8% and in the rest of the clinical specialties the levels are much lower than 60%.

health first

Going back to the study, 78% of the population did not change the way they access health for economic reasons.

Among those who made changes, 7% said they had a social/prepaid work and went to a cheaper one, 6% who paid for private medical practices and now do some

in the public service

and 5% who had a social/prepaid work and began to use the public system.

In the “general” perception of the health service, what is private is valued slightly better than what is public.

66% versus 61% in approval.

The private sector is slightly higher, but there is almost no difference, also in the sensation of humane and dignified attention and the sensation of comprehensive coverage with respect to the public system.

Another relevant fact is that women are more affected by cost and inflation than men in matters of health.


look also

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Source: clarin

All life articles on 2023-03-26

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