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Argentina's health care system is composed of a universal health care system and a private system. The government maintains a system of public medical facilities that are universally accessible to everyone in the country, but formal sector workers are also obligated to participate in one of about 300 labor union-run health insurance schemes, which offer differing levels of coverage. Private medical facilities and health insurance also exist in the country. The Ministry of Health (MSAL), oversees all three subsectors of the health care system and is responsible for setting of regulation, evaluation and collecting statistics.
For the first half of the 20th century Argentina and Uruguay had the most advanced standards of medical care in Latin America. [1] Argentina's current healthcare system was created during a time of strong economic growth in the nation. This economic reform was completed during the urbanization, industrialization, and labor movement eras of the 1940s to 1950s. Since that time, Argentina's healthcare system has been extensively decentralized and privatized to provide support at the provincial level. [2]
In 2016, Argentina spent 7.5% of its GDP on health care expenditures. [3] [ needs update ] In 2020, Argentina is estimated to have spent about 10% of its GDP on health care. [4]
In January 2013, the Federal Registry of Health Establishments (Registro Federal de Establecimientos de Salud - REFES) indicated there were 5,012 health establishments operating in Argentina, including hospitals, clinics, and hospices, amongst others. The majority of the establishments (70% or 3,494 establishments) pertain to the private sector. [5]
The Social Security Sector is funded and managed by Obras Sociales (Insurance Plans), umbrella organizations for Argentine worker's unions. There are over 300 Obras Sociales in Argentina, each chapter being organized according to the occupation of the beneficiary. These organizations vary greatly in quality and effectiveness. The top 30 chapters hold 73% of the beneficiaries and 75% of resources Health Care in Latin America. [6] MSAS has established a Solidarity Redistribution Fund (FSR) to try to address these beneficiary inequities. Only workers employed in the formal sector are covered under Obras Sociales insurance schemes and after Argentina’s economic crisis of 2001, the number of people covered by these fell slightly (as unemployment increased and employment in the informal sector rose). In 1999, there were 8.9 million beneficiaries covered by Obras Sociales. [7] [ needs update ]
There is a body within the social security sector in Argentina called "The Superintendence of Health Services" La Superintendencia de Servicios de Salud , which is in charge of setting the minimum coverage package that is included in the health insurance of every single health-care institution. This allows for a more transparent set of criteria for decision-making process within a sector of the Argentinean health-care system. [8]
Prior to 2000, workers did not have the freedom of choosing which Obra Social they contributed to and were covered by. This situation gave rise to some problems; e. g. a teacher living in a city where the gastronomy workers' Obra Social provided better care than the teachers union's Obra Social could not freely switch plans even when it would have been in their best interest. This was mended in the year 2000 when National Decree 446/2000 was signed into law which established changes to the regulation of Obras Sociales, [9] allowing for workers to choose freely between Obras Sociales administered by different workers unions (although they are still obligated to adhere to one of the Obras and make regular payments).
The private health care sector in Argentina is characterized by great heterogeneity and is made up of a great number of fragmented entities and small networks; it consists of over 200 organizations and covers approximately 2 million Argentines. [10] Private insurance often overlaps with other forms of health care coverage, making it difficult to estimate the degree to which beneficiaries are dependent on the public and private sectors. According to a 2000 report by the IRBC, foreign competition has increased in Argentina’s private sector, with Swiss, American and other Latin American health care providers entering the market in recent years. This has been accompanied by little formal regulation. [10]
A system of public medical facilities is maintained by the government. The public system is highly decentralized, as it is administered at the provincial level; often primary care will be regulated autonomously by each city. Since 2001, the number of Argentines relying on public services has seen an increase. According to 2000 figures, 37.4% of Argentines had no health insurance, 48.8% were covered by Obras Sociales, 8.6% had private insurance plans, and 3.8% were covered by both Obras Sociales and private insurance schemes. Currently, about half of the population uses the public system. [11] [7]
Patients need to apply for free care at public institutions and undergo a lengthy test in which they may be rejected at some hospitals. The rejection rate is usually 30-40%. [12] Public hospitals in Argentina who have not converted to managed care principles are facing an influx of patients covered by privatized social security funds. Public hospitals in the city of Buenos Aires reported about 1.25 million outpatient visits by patients covered by the privately administered social security fund for retired person. [12] The Provincial and Municipal Health Secretariats and Social works through the Superintendence of Health Services are in charge of allocation of resources and setting priorities. [8] The Ministry of Health through its Sub-secretariat of Promotion and Prevention are in charge of Public Health Interventions. [8] Local Health Secretariats in the provinces and municipalities through the department of purchases in the public sub-sector and individual social works are in charge of the reimbursement of new drugs. [8]
Elderly people face barriers due to copayments, private practitioners' refusal to see them and also because of nonpayment by the social security fund.
The Puerto Rico Health Reform —Spanish: Reforma de Salud de Puerto Rico, refers to the Medicaid health plan which is a "subset of the larger public government healthcare delivery system" of Puerto Rico. It was once called "La Reforma", later it was called "Mi Salud" and now called Vital but they are all Medicaid, a government-run program which provides medical and healthcare services to indigent and impoverished citizens of Puerto Rico. It was locally referred to simply as La Reforma — for many years. Puerto Rico's Medicaid program is, similar to other Medicaid programs of states of the United States. The funding is by the U.S. Medicaid program in the form of a block grant, unlike how states of the United States Medicaid programs are funded and in 2019 much of the funding was slashed.
Healthcare in Mexico is provided by public institutions run by government departments, private hospitals and clinics, and private physicians. It is largely characterized by a special combination of coverage mainly based on the employment status of the people. Every Mexican citizen is guaranteed no cost access to healthcare and medicine according to the Mexican constitution and made a reality with the “Institute of Health for Well-being”, or INSABI.
Health care in Colombia refers to the prevention, treatment, and management of illness and the preservation of mental and physical well-being through the services offered by the medical, nursing, and allied health professions in the Republic of Colombia.
Healthcare in Singapore is under the purview of the Ministry of Health of the Government of Singapore. It mainly consists of a government-run publicly funded universal healthcare system as well as a significant private healthcare sector. Financing of healthcare costs is done through a mixture of direct government subsidies, compulsory comprehensive savings, national healthcare insurance, and cost-sharing.
Germany has a universal multi-payer health care system paid for by a combination of statutory health insurance and private health insurance.
The French health care system is one of universal health care largely financed by government national health insurance. In its 2000 assessment of world health care systems, the World Health Organization found that France provided the "best overall health care" in the world. In 2017, France spent 11.3% of GDP on health care, or US$5,370 per capita, a figure higher than the average spent by rich countries, though similar to Germany (10.6%) and Canada (10%), but much less than in the US. Approximately 77% of health expenditures are covered by government funded agencies.
Healthcare in Georgia is provided by a universal health care system under which the state funds medical treatment in a mainly privatized system of medical facilities. In 2013, the enactment of a universal health care program triggered universal coverage of government-sponsored medical care of the population and improving access to health care services. Responsibility for purchasing publicly financed health services lies with the Social Service Agency (SSA).
Tanzania has a hierarchical health system which is in tandem with the political-administrative hierarchy. At the bottom, there are the dispensaries found in every village where the village leaders have a direct influence on its running. The health centers are found at ward level and the health center in charge is answerable to the ward leaders. At the district, there is a district hospital and at the regional level a regional referral hospital. The tertiary level is usually the zone hospitals and at a national level, there is the national hospital. There are also some specialized hospitals that do not fit directly into this hierarchy and therefore are directly linked to the ministry of health.
The Ministry of Health and Medical Education (MOHME) has executive responsibility for health and medical education within the Iranian government. The MOHME comprises five departments headed by deputy ministers: Health, Research & Technology, Education, Logistics, Food & Drugs.
Healthcare in Portugal is provided through three coexisting systems: the National Health Service, special social health insurance schemes for certain professions and voluntary private health insurance. The SNS provides universal coverage, although in 2012 measures were implemented to ensure the sustainability of the service by the introduction of user fees to be paid for at the end of treatments. In addition, about 25% of the population is covered by the health subsystems, 10% by private insurance schemes and another 7% by mutual funds. The Ministry of Health is responsible for developing health policy as well as managing the SNS. The Health Regulatory Entity (ERS) is the public independent entity responsible for the regulation of the activity of all the public, private and social healthcare providers. In 2019 the government proposes to scrap all fees, which constitute about 2 percent of the NHS's budget, apart from some hospital emergencies.
Costa Rica provides universal health care to its citizens and permanent residents. Both the private and public health care systems in Costa Rica are continually being upgraded. Statistics from the World Health Organization (WHO) frequently place Costa Rica in the top country rankings in the world for long life expectancy. WHO's 2000 survey ranked Costa Rica as having the 36th best health care system, placing it one spot above the United States at the time. In addition, the UN has ranked Costa Rica's public health system within the top 20 worldwide and the number 1 in Latin America.
The healthcare system in Chile is a mixed system that combines both public and private provision of health services. The public system is called Fondo Nacional de Salud (FONASA) and is funded by taxes, providing free or subsidized care for those who cannot afford private health insurance. The private system is composed of various insurance providers (ISAPRE) and healthcare facilities, which offer more extensive services to those who can afford to pay.
Healthcare in Belgium is composed of three parts. Firstly there is a primarily publicly funded healthcare and social security service run by the federal government, which organises and regulates healthcare; independent private/public practitioners, university/semi-private hospitals and care institutions. There are a few private hospitals. Secondly is the insurance coverage provided for patients. Finally, industry coverage; which covers the production and distribution of healthcare products for research and development. The primary aspect of this research is done in universities and hospitals.
Rashtriya Swasthya Bima Yojana is a government-run health insurance programme for the Indian poor. The scheme aims to provide health insurance coverage to the unrecognised sector workers belonging to the BPL category and their family members shall be beneficiaries under this scheme. It provides for cashless insurance for hospitalisation in public as well as private hospitals. The scheme started enrolling on April 1, 2008 and has been implemented in 25 states of India. A total of 36 million families have been enrolled as of February 2014. Initially, RSBY was a project under the Ministry of Labour and Employment. Now it has been transferred to Ministry of Health and Family Welfare from April 1, 2015
Examples of health care systems of the world, sorted by continent, are as follows.
Healthcare in Luxembourg is based on three fundamental principles: compulsory health insurance, free choice of healthcare provider for patients and compulsory compliance of providers in the set fixed costs for the services rendered. Citizens are covered by a healthcare system that provides medical, maternity and illness benefits and, for the elderly, attendance benefits. The extent of the coverage varies depending on the occupation of the individual. Those employed or receiving social security have full insurance coverage, and the self-employed and tradesmen are provided with both medical benefits and attendance benefits. That is all funded by taxes on citizens' incomes, payrolls and wages. However, the government covers the funding for maternity benefits as well as any other sector that needs additional funding. About 75% of the population purchases a complementary healthcare plan. About 99% of the people are covered under the state healthcare system.
Peru has a decentralized healthcare system that consists of a combination of governmental and non-governmental coverage. Five sectors administer healthcare in Peru today: the Ministry of Health, EsSalud, and the Armed Forces (FFAA), National Police (PNP), and the private sector.
The Egyptian healthcare system is pluralistic, comprising a variety of healthcare providers from the public as well as the private sector. The government ensures basic universal health coverage, although private services are also available for those with the ability to pay. Due to social and economic pressures, Egypt's healthcare system is subject to many challenges. However, several recent efforts have been directed towards enhancing the system.
The Ministry of Health of Argentina is a ministry of the national executive power that oversees, elaborates and coordinates the Argentine national state's public health policy. The ministry is responsible for overseeing Argentina's highly decentralized universal health care system, which according to 2000 figures, serviced over half of the country's population.
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