In 1991, the government of Carlos Menem signed a document with the IMF, within the framework of pro-competitive reforms in Latin American health systems, which encouraged the integration of prepaid medicine companies (EMPs) to health insurers. Social Security (SeS) medical care services which, in the case of Argentina, are called social works (OSs).
The term used was “deregulation of social works.”
The Pan American Health Organization (PAHO-WHO), the World Bank (WB) and the Inter-American Development Bank (IDB) participated in these efforts and supported actions aimed at implementing the reforms.
The document was ratified by the government of Fernando De la Rúa and had influence on many of the measures that were adopted until the first decade of the 21st century.
It should be noted that the starting point - the agreement with the IMF - equated two types of entities of a different nature: the SOs are entities financed by legally compulsory percentage taxes on the salary, as part of the SeS regime;
Already in 1970 it had been ratified that they were administered by the union of the corresponding branch of production.
EMPs are private health insurance, voluntary in nature, with state regulations.
Due to the fact that they are private contracts, they would not necessarily have to cover all health risks, but rather the coverage segments agreed upon between the insurer and the insured.
In order to equalize the legal differences, some fundamental steps were previously taken: a) the collection of the SOs was unified through the ANSeS;
b) OS's freedom of choice was established;
c) both types of institutions were committed to covering the same basic benefits package, the Mandatory Medical Program (PMO);
d) the Superintendency of Health Services (SSS) was created, under whose jurisdiction the SOs were placed, and e) when a new regulation was issued, the EMPs were also placed under the jurisdiction of the SSS.
To advance this virtual nationalization of private insurance, the same Law obliged companies to have authorization from the SSS and the Ministry of Commerce to update the price of the policies.
The behavior of unionism in the face of these measures is significant.
Initially they were strongly opposed to the EMPs competing with the SOs, not for conceptual arguments, such as the principles of solidarity and equity of the SeS, but to protect the captivity of their beneficiaries and the collection exclusivity of each branch of production.
For more than a decade they put up possible obstacles to prevent their members from choosing to change coverage.
Meanwhile, through various maneuvers – not always legitimate – they enabled a type of outsourcing by which the OS of origin maintained a commission for the ownership of the collection, but transferred the administration of the services to an EMP – and also the risks—of medical care.
These procedures were applied especially with affiliates with greater purchasing power, in order to prevent them from migrating to an EMP.
But at the same time, the founding principles of solidarity and equity of the SeS were sacrificed, where different income levels would be entitled to the same benefits of access and quality of care.
During the same period, the model of self-managed public hospitals was promoted, confirmed in 2000 by De la Rúa.
A WB loan was arranged to train hospitals in billing and collection procedures.
In practice, hospital conversion has failed to modify the behavior of the population, who go to the public hospital as a last alternative.
An attempt was made to reduce pharmaceutical spending, forcing the prescription of medications by their generic name, with various conflicts and poor adherence.
To compensate for the precarious economic balance built over 3 decades, between the financing of medical care and the resources to sustain it, both OSs and EMPs dedicated large investments in the '90s to recycle, buy or build their own large establishments, equipped with modern technology.
Symbolically, it implies balancing the insurance finances, whose purpose is to limit spending, associating it with a providing company, which develops with greater productivity, equivalent to associating car insurance with the body shop.
To confront the DNU of the Government of Javier Milei, the CGT expressed its opposition, describing the reforms as anti-constitutional and authoritarian.
In reality, they are demanding the continuity of the collection of the SOs, instead of authorizing the EMPs to collect directly from the outsourced beneficiaries.
But both should reconsider the strategy of balancing each other, associating financing with benefits, because they have opposite purposes.