Chapter 2

CEIS Health Report 2006
Generally speaking, OSN, OSP and PAMI do not have a large amount of their own professionals,
so they are obliged to hire private ones. Based on the documents 18 of the latter,
this led to the fact that an increase in the cost of services administered after the devaluation
was not reported in the prices and this causes the deficit to fall upon the professionals
rather than on the financers (OSN and PAMI).
This deficit affects workers through non-payment of tax obligations, non-renewal of medical
teams, non-accomplishment of building improvements and indebtedness with suppliers.
In the case of Private Medical Companies, there does not exist a compensating mechanism,
although the value of dues paid by beneficiaries are more than enough for the economic
coverage of PMOE.
And, finally, in the case of the Public Sector, since there does not exist a basket of defined
services it is therefore complicated to make an analysis through the deficits. An
exercise would be comparing the cost of PMOE funding vs the total health expenditure 19
for each province (adding up the expenditures for three levels of government and assigning
it to the citizens lacking insurance coverage).
The result of this exercise is that 67% of the population lacking coverage lives in provinces
that do not have enough financial means to cover the PMOE, since there are differences
going from $ 1 per capita per month up to $ 10.
2.6.7 Final remarks
We have presented the main inequalities relating to coverage and funding in the health
sector. It is obvious how per capita income and coverage fluctuate in the subsections
(public, private and welfare) and between the same. As an example there is the six-fold
difference in the per capita expenditure between the province that spends the most and
the one that spends the least; or the difference in insurance coverage by province that
goes from 30% to 70% of the population. The system’s fragmentation may be the explanation
to these discrepancies.
It is very difficult to reach some conclusions regarding deficit and how to affront it due to
this fragmentation. The comparison between estimated necessary expenditure for each
subsection and the expenses effectively sustained may be used as a methodology for
solving this kind of problem (through the definition of guaranteed services basket costs).
In accordance with this methodology both OSN and PAMI demonstrate deficits, especially
in the second case. For that which regards the public sector, there are greater difficulties
in estimating this deficit although the example presented demonstrates that the
majority of citizens with coverage for the public sector is not guaranteed an entire basket
of services from a financial point-of-view. In the case of OSP, it has not be possible to
establish an estimate of these deficits. Whereas for EMPP, income should be sufficient to
offer PMO to its members.
18 See “I costi dell’attenzione medica in Argentina”. Serie studi n. 3. ADECRA, 2005.
19 The Expenditure Equity study in “Salute” of the Ministry of Health demonstrates the limitations of this methodology.
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