The Cemic case and the crisis of private medicine

Argentina spends more than 9% of GDP on healthcare. Those who contribute the most to funding the system are social services – which receive contributions from workers and employers – and pre-paid medical entities, while the one who contributes the least is the state, whether national, provincial or municipal . However, criticism of the population is growing in all orders, especially after more than two critical years that the system suffered as a result of the pandemic, with restrictions on general development that exceeded anything known.

It’s not surprising. Because the country lacks a national health plan, there are no systematic guidelines on what can be required of the state and to what extent it is appropriate to provide the benefits of private organizations without undermining the sustainability of the foundations on which they operate.

For more than twenty years, the nation-state has been in economic crisis. It is certainly a world record, but no one on the political agenda puts it forward as an indicator of the government’s inability to finally put behind one of the most dramatic moments in national history. Even less is said about the state of a health emergency that also predates the epidemiological crisis triggered in 2020also a reason for accentuating the problems that dragged on.

Is it explained that there are so many professionals in top tier providers, especially in surgery, who negotiate with patients for fees outside the institutional system and sometimes outside the law?

If the health exemption imposed by the pandemic were to fall by the day due to statutory provision, the system of private medicine would collapse at the same rate. only the postponement sinus dies of longstanding problems explains a situation with such dire potential.

There are many chambers of commerce that cover the complex and determined world of private medicine that helps millions of Argentines. Let’s take, to simplify the problem, only three, those with the greatest relative weight in this business orbit: Association of Clinics, Sanatoriums and Private Hospitals (Adecra) and on Chamber of Organizations for Diagnostics and Outpatient Treatment (Cedim)which usually act in concert, and Civic Association for Integrated Medical Activities (Acami)which includes non-profit organizations such as Center for Medical Education and Clinical Research (Cemic), those applied to teaching, research and even caring for people in need. Between 70 and 80 percent of the members, who make up a total of more than 400 companies related to all these categories, the debts to the state arising from fiscal obligations, the implementation of which has been suspended due to the aforementioned health emergency, are of such a size that for a large some of them are priceless.

Does the political leadership realize what this means? Is it now explained that the payment of fees to the professionals appointed for these services is for paltry sums, with difficulty doubled by the delay – the typical effect of the “bicycle” popularized in the financial networks – in the efficiency of the fees ?? Is it now explained that there are so many professionals in top tier providers, especially in surgery, who negotiate with patients for fees outside the institutional system and sometimes outside the law?

Legal gaps are ultimately filled by judges behind a vulnerable common context

Political irresponsibility exacerbates the seriousness of these problems. Since mid-2020, when the Covid epidemic was officially declared, the government started stockpiling to deal with the unleashed crisis. Pilar’s Kirchnerist administration in charge of Federico de Achaval (h), agreed with Cemic to take responsibility for carrying out PCR to identify the virus in the people who could be affected in this municipal area. As the weeks and months passed, he asked Cemic for other contributions, such as that of so-called “swabbers,” that is, personnel experienced in performing the first step in this task.

Although Pilar pays the first invoices normally, the next ones begin to be paid with delays, suspended claims and in the midst of the dark and torturous negotiations typical of the bureaucratic processes known in Kafka’s story. Pilar today owes Cemic 31.5 million pesos accrued in 2020 and 2021, which with accrued interest now exceeds 60 million pesos. The codes of extra-urban policy did not forgive, with the opacity of their logic, even an institution of internationally recognized quality.

What to do in such outrageous situations? To give up out of powerlessness? Let’s hope not. Cemic can be expected to take legal action in defense of his rights and the respect due to his portfolio of thousands of contributors. Or it is possible to do something different with the pending debts with this entity from PAMIwhich by 2021 add about 39.5 million pesos to date unless forced with the threat of retaliatory measures from the nation state?

It is urgent that health care has a preferential chapter on the political agenda. Even more so when elections are approaching

And these are just a few examples, taken at random, of the vicissitudes of all kinds suffered by private medical providers in Argentina. The lack of a national health plan that covers all aspects of health care in the country is far from being corrected with some adjustments, such as the 2002 resolution that created the Mandatory Medical Plan, and with some laws that address partial medical problems.

This extremely bad legislation establishes a basket of mandatory benefits, but of a minimal nature. The ceiling was raised gradually as a result of court decisions, often dictated under social pressure in this or that particular case, and based on provisions that add very high costs of treatment and drug benefits, forgetting the responsible predictions for the counterparty in resources that should be provided to deal with them. In this way, legal gaps end up being filled by judges behind a vulnerable common context.

For all the importance this last topic implies, it is one more, among many others such as some mentioned above, that insist that health should have a preferential head on the political agenda. Especially as the general election approaches for the new government period, which will begin at the end of 2023.

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