Getting the organization and financing of public healthcare onto Argentina’s public policy agenda has long been a challenge. The main reasons for this are likely the complexity of the country’s healthcare system and the multiplicity and diversity of sectors involved in this, which range from provincial governments to the legislative branch and trade unions, and from medical and professional organizations to international organizations, churches, and pharmaceutical laboratories, the different agendas of which seem difficult to reconcile. Questions such as how to guarantee a sensitive right like preserving and caring for human life while understanding that there are budgetary limitations to this inevitably spark complex discussions that can be hard to keep on track.
To make matters more complicated, the public policy debate did not make healthcare a priority objective until the outbreak of the Covid-19 pandemic in the early months of 2020. This may be partly due to the relative success of different approaches to financial protection for healthcare, which means that out-of-pocket healthcare expenses (which represent about 10% of total healthcare spending) are perceived as being relatively low in comparison to other countries. Another possible explanation is that the policy debate may have previously revolved around the disparities (be they real or perceived) between public hospitals and private clinics, or difficulties in accessing particular treatments that generated public responses outside the health sector.
The lack of debate may also be due to the limited “voice” of the sectors that are most jeopardized by the current state of the system (low-income population, indigenous peoples, sexual minorities, etc.), and their limited influence on the definition of policy priorities and work agendas for the healthcare sector.
However, three arguments reveal the growing need for a debate on health policies in Argentina in the near future. The first of these is the increase in system operating costs as a result of new technology and drugs that are already being used or are in the process of being adopted- Another is the increased demand for care from a population with more complex demographic and epidemiological profiles. This has been happening in Argentina and in several middle- and upper-middle-income countries in the region, leading to a correlated increase in the judicialization of healthcare.
The second argument is the fact that the last ten years have brought an institutional commitment to guaranteeing coverage for population groups that did not have formal access to this in the past, which requires opening up the debate on how to generate/allocate resources to ensure that this commitment can actually be met.
The third argument, which was brutally exposed by the pandemic, is the challenge of governing a healthcare system that is fragmented between three sectors (public, private, and social security-based), each of which is largely autonomous. The decentralization of the public system at the provincial and municipal levels and the multiplicity of social security funds of different sizes and with different capacities for responding to healthcare issues mean that there is a massive need for coordination. The lack of such coordination implies huge costs in terms of efficiency in the use of resources and undermines the basic principles of equity in access to healthcare.
Although there is a clear correlation between investment in healthcare, the health of the population, and reducing the spread of disease, the factors that hinder the implementation of an effective, equitable, quality care model exceed the health system’s sphere of influence. Income levels and their distribution, formal employment, education gaps, access to clean water and decent housing, and other determinants all affect health outcomes as much as or more than the system itself.
The onslaught of COVID-19 meant that the emergency response took precedent over planning and consensus-building processes for healthcare reform, clearly revealing the need for debate around the response capacity of the Argentinian healthcare system. The current situation could be framed as an opportunity for us to rethink the current model of care and engage in critical analysis of the existing mechanisms of financial protection that the population is offered in the event of illness.