Marcela Valente
BUENOS AIRES, Feb 29 2012 (IPS) – In Latin America, Argentina spends the most on healthcare. It has a vast infrastructure, highly qualified health professionals and the necessary material resources. But other countries in the region are achieving better and faster health outcomes with fewer resources.
This is one of the main conclusions of the study Retos postergados y nuevos desafíos del sistema de salud argentino (Postponed and New Challenges to the Argentine Health System) by Federico Tobar, Sofía Olaviaga and Romina Solano of the independent Centre for the Implementation of Public Policies Promoting Equity and Growth (CIPPEC).
The authors also point to inequities in access to health care in the provinces, and the need for health policies adapted to the new epidemiological challenges in the country, where mortality due to non-infectious diseases is now greater than that caused by infectious diseases.
Argentina is losing its status as the regional leader in health care, Tobar, a sociologist and researcher, as well as a former chief of staff of the Argentine Health ministry and a consultant on health policies in 14 Latin American countries, told IPS.
Tobar emphasised that Argentina is the country with the highest numbers of beds, doctors and dentists per head and the most resources invested in health as a proportion of GDP.
It also has an extensive network of hospitals and primary health care centres that are very well distributed throughout the country, he said. Some of them do not work as well as they should, but the capacity is there.
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Tobar is very familiar with the network of health centres because he designed and coordinated Plan Remediar ( Remedy Plan ), launched 10 years ago to guarantee free distribution of some 50 medicines for ambulatory patients at every public health centre in the country.
He also highlighted the high quality of health professionals in all specialties, and said that, in contrast to the situation in the past, hospitals are now well supplied with necessities like medicines and disposable products.
During the economic crisis in 2001 and 2002 it was a commonplace to say that the public hospitals did not even have gauze, but now there is everything, everywhere, he said, including a variety of high-quality contraceptives for free distribution.
He said, however, there is a lack of proactive health policies, and the state should use its resources to reduce inequalities in the provinces, instead of increasing the gaps.
Unlike the situation in education, there is no federal health law to determine how state funds should be distributed to the provinces.
The budget is shared out arbitrarily, with some provinces benefiting more than others, regardless of their objective needs, Tobar said.
The researchers also indicated that the country should adapt to the new epidemiological challenges facing the population.
The study points out that the health system is structured efficiently to combat infectious diseases and injuries, but that more people in Argentina are now suffering from non-infectious diseases, mainly cardiovascular disease and cancer.
These challenges need to be better addressed, say the authors, who warn that the latest national surveys of risk factors, carried out by the Health Ministry in 2005 and 2009, found a deterioration in the behaviour patterns essential for physical wellbeing and illness prevention.
The surveys found that while smoking and exposure to tobacco smoke had fallen, so had the consumption of fruit and vegetables, while salt intake had increased, and a lower percentage of people engaged in physical activity.
In their cost-benefit analysis, CIPPEC states that Argentina spends 10 percent of its GDP on health, yet the progress made in life expectancy and infant and maternal mortality is slower than in other countries with similar incomes.
Every country in the region spends less per capita on health than Argentina, but Costa Rica, Cuba, Chile and Uruguay, for example, get better results in terms of infant mortality, maternal mortality and life expectancy at birth, said Tobar.
The study notes that Costa Rica and Uruguay, with lower health expenditure per head, have higher life expectancy rates than Argentina, where average life expectancy at birth is 75.4 years.
Furthermore, in Argentina there is a wide gap between provinces. For instance, in Chaco province in the northeast, life expectancy is 69.9 years.
As for child health, the neonatal mortality rate and the under-five mortality rate fell by 5.5 percent and 6.4 percent, respectively, over the last decade.
However, over 50 percent of mortality could be reduced through early diagnosis and timely treatment, and again, in comparison with other countries, indicators are poor and progress is slow.
Brazil, which historically trailed Argentina in health indicators, will overtake this country in a few years if the present rate of decline is maintained for infant mortality rates, says the study, which displays comparative results by country in tables and graphs.
Geographical inequalities are again evident in infant mortality. In the Argentine capital and the southern provinces of Neuquén and Tierra del Fuego, the under-five mortality rate is less than eight per 1,000 live births, while in Formosa, in the northeast, it is 25 per 1,000 live births.
For maternal mortality, the study found no improvement and enormous disparities between provinces. Tobar said 99 percent of births take place in hospitals or other health facilities; however, only 33 percent of pregnant women have had five prenatal check-ups, the minimum recommended, by the time they go into labour. The country s advances in maternal and child health are below its potential, in terms of its infrastructure, available human and financial resources, and level of economic development, the study says.
The authors state that there has been little or no progress towards reducing the inequalities that persist between different provinces in terms of access to health care and treatment outcomes, and recommend strengthening the regions that are lagging the most, in order to reduce the gaps.
For example, the province of Santa Cruz receives 7.2 times the public expenditure on health per capita than Misiones. The state does not compensate for, but exacerbates the differences, complained Tobar.
The study points out that the health system is highly fragmented, and this blurs lines of responsibility. Thirty percent of the population uses the public health care service, while nearly 64 percent has health insurance through contributions to a trade union, or by contracting a private service.
The per capita health expenditure for people who have insurance is, on average, double that of people using only the public health system.
