The Argentine health system, in crisis for years, is now a quake.
The new Government of Javier Milei is seeking, based on new regulations, a certain
ordering of the
public, private and social security subsystems.
Although the formal path has already begun,
the specific direction
it will take is not very clear.
In the last few hours, a decree was published in the Official Gazette by which the Superintendence of Health Services (SSS)
withdraws from its role as intermediary
between public hospitals and social works regarding the
collection of benefits
.
These are the services that hospitals provide to social work members.
Until now, hospitals that served social work members could process the reimbursement of the cost of these benefits
through the SSS
.
The argument of the decree for this possibility to expire is that the organization that operates under the orbit of the Ministry of Health today acts in a "dysfunctional manner in the billing process, with the consequent
delay and accumulation
of procedures."
Decree 172 adds that “ the objectives
were not effectively met
” of a 2021 resolution, which approved the procedure for the recovery of the benefits provided by the Decentralized Management Public Hospitals (HPGD), aimed at facilitating the payment of such benefits.
And he talks about his own “
inefficiency and waste
of resources.”
Although in reality the system had obvious operational problems, in theory it was a
guarantee of collection
for the hospitals.
Rubén Torres, president of the Latin American Federation of Hospitals, explained that - until now - “if the hospitals that registered in the system were not able to collect the benefit from the social works within a
period of 90 days
, the superintendent was authorized to compulsorily transfer those funds.”
The regulations say that hospitals may establish their own agreements with social works.
Photo: Federico López Claro
SSS sources said that the system is made up of
1,063 hospitals throughout the country
, according to the registration platform updated until September 2023. “There may be some more that are not registered,” they clarified.
Agreements between social works and hospitals
Now, the decree enables social works to enter into
agreements with hospitals
, “aimed at establishing the mechanism to implement the payment of benefits, either through the corresponding jurisdictional authority or individually.”
And he adds that for the conclusion of the agreements, “the effectors of the public subsystem must be registered in the Federal Registry of Health Establishments (FEFES).
“Some large hospitals already have their own agreements with social works, basically because the
values of the official nomenclature
of benefits are
very outdated
.
For this reason, when we took office, and in a completely different inflationary context than the current one, we had to increase these values by 200 percent in one go,” recalls Adolfo Rubinstein, former Macri health minister.
The new decree, already published, says that the agreements “will be a
free agreement between the parties
and may establish, among other guidelines, the type of practices included, their codification, values, billing rules, payment methods and dispute resolution.” .
Rubinstein observes that this modification can “pose a problem especially for
smaller hospitals
in the provinces, which cannot establish agreements with different social works.
And the Government, which has to supervise the performance of national social works, ignores it.”
It will be necessary to see, in that case, the role that the provincial and municipal states
can play
.
The Garrahan Hospital is one of those that already has agreements for the care of social work affiliates.
Photo: Luciano Thieberger
Both municipal and provincial sources hinted to
Clarín
this Wednesday, after knowing the legislation, that the new way of direct linkage between social works and hospitals could mean
an advantage
in terms of negotiating prices more in line with market values.
"For us, the last payment period, which was last month, gave us an average of
32 months of delay
, and we must not lose sight of the fact that the charges are
interest-free
," they weighed from one of the provinces consulted.
One unknown, however, is whether this new scenario
will speed up or eventually
further hinder the access of social work affiliates to receive care in public hospitals, in cases where the latter do not find an effective way (whether private or under the umbrella of local States) to collect the benefits they provide.
The obligation to serve the entire population
In any case, Decree 172 warns that, beyond the fact that public hospitals are in the operational capacity to recover the cost of their services, “they have the
obligation
to provide medical benefits to
the entire population without distinction
and with the resources assigned to them.” ”.
The possibility of hospitals to
recover the benefits
they provide to social work affiliates is key so that, precisely, these health centers can provide
a service of the best possible quality
to those people who do not have social work or prepaid, who There are around
28 million Argentines
.
This decree was known at the same time that two others
were published
: the one that enables the possibility of transferring contributions directly to a prepaid plan without going through a social work;
and the one that forces prepaid companies to deposit 20 percent of the contributions they receive from affiliates to the Solidarity Redistribution Fund.
For Torres, who was also superintendent of Health Services between 2002 and 2006, the crux of the issue is “
what is the objective
of all this regulation.
The key would be to be able to recover the public health system, with a service of acceptable quality, so that people
do not have to pay
increasingly expensive fees in the private system.
The State has withdrawn from this problem years ago and the question is when it will be present again.”
P.S.