Understanding Healthcare Systems: Levels of Care and Argentina’s Model
Levels of Care
Medical care is intended to diagnose, treat, and rehabilitate patients.
Primary Health Care (PHC)
The Argentine Health System (APS) offers a comprehensive approach to health through the integration of curative medicine, prevention, and health promotion through a health team.
PHC brings together three different perspectives with the goal of Health for All:
- As a strategy: It streamlines health services by levels of complexity, prioritizing basic benefits.
- As the level of assistance: Equivalent to primary care.
- As a program of activities: Actions taken to solve health equity problems.
According to the needs of each area, PHC is inserted inside the Health Center. Needs are met through a basic package, called Health Programs, such as the maternal and child health program.
Places Where It Is Done
Primary health care takes place in health units, health centers, outpatient clinics, and so on.
Resource Types
PHC requires simple and inexpensive resources, from basic first aid to low-complexity laboratory tests. Human resources are generally composed of clinicians, pediatricians, gynecologists, and so on.
Population Covered
PHC serves the community, both healthy and sick individuals.
Secondary Health Care
Considers aspects of hospital infrastructure.
Laboratory analysis contributes to the diagnosis and monitoring of patient outcomes.
Sites Involved
Attention is performed in hospitals and polyclinics.
Resource Types
Resources are of medium and high cost, including human resources for each medical specialty.
Population Covered
Serves sick individuals.
Tertiary Health Care
Care is provided in tertiary establishments with modern technology for rehabilitation, treatment, and health recovery.
Sites Involved
Takes place in hospitals or rehabilitation institutes with high technology.
Resource Types
Requires complex, high-cost resources.
Population Covered
Individuals with disabilities who require complex therapies.
Doctor-Patient Relationship
It is the interaction between a professional with knowledge and a person with a problem.
The ideal doctor-patient relationship has features like:
- Respect: Accept the patient as a person who may be different.
- Empathy: See things from the patient’s point of view, achieved by listening with understanding.
- Honesty: Loyalty and integrity with the patient. Before transmitting the truth, one must be sure to know the truth.
- Tolerance: The physician’s ability to tolerate emotional disturbances.
Optimal communication with patients is essential and involves a technique that includes:
- Encounter: Between sender and receiver in a given time and space.
- Anamnesis: Information provided by verbal or nonverbal language.
- Physical examination: Done through physical communication.
- Analysis of the meeting: Analysis of information obtained in previous stages.
- Plan to follow: A planned meeting between members to continue to care for the state of health, disease, and care.
- Final Thoughts: Assess if good communication was achieved during the medical assessment.
Medical Records
In the doctor-patient relationship, a written document arises. The clinical history consists of several stages built in the first encounter and subsequent encounters between doctor and patient. Its stages are:
- Reason for Consultation: The patient’s reason for the consultation.
- Anamnesis: Data or private information about the patient obtained by the doctor.
- Physical Exam
- Study Methodology: Additional studies are proposed, accepted, and implemented, and their results are recorded.
- Diagnosis: The patient should be informed of the diagnosis.
- Treatment
- Evolution: Alternatives to the patient’s progress drafted by both the physician and by interconsultants.
The history has legal significance, and the patient is the owner.
Hospital Organization
Hospitals are the principal health institutions. There are different levels of complexity in hospitals.
The WHO established three types of hospitals:
- Regional: Have more than 1,000 beds and are located strategically in the region.
- District: Have up to 500 beds and are of intermediate complexity.
- Rural: Have from 20 to 100 beds and cover dispersed and remote regions.
Hospital Management and Administration
Responsible for planning the activities in the hospital. Management and direction are responsible for reviewing and monitoring the areas that comprise the various activities of the hospital:
- Administration: Responsible for obtaining, managing, and distributing the institution’s resources, such as personnel, money, records, and materials.
- Clinical Administrative Division: In charge of control, program, and implementing changes proposed by management.
- Medical Division: Manages ancillary services or medical subspecialties such as nuclear medicine, surgery, radiology, etc. Also responsible for quality control in medical subspecialties, outpatient internal medicine, etc.
The Health System in Argentina
Forms of coexistence of three subsystems:
- The public
- The Social Works
- Private
There is a lack of coordination between them, and each subsystem is different for the target population.
There are also levels of fragmentation within each of the subsystems:
- Public sector: Lack of coordination between different jurisdictions (national, provincial, and municipal).
- Obras Sociales and private organizations: Composed of heterogeneous groups.
Historical Development of Health Systems in Argentina
Argentina: Federal Organization
The Constitution of 1853 marked a historic change in Argentina, adopting a federal policy for the Republic, and health was not exempt. At the time, there was very little intervention in this area; health was in the hands of charitable organizations.
Tradition of Solidarity:
- Worker Mutuality: Nonprofit organizations that responded to the activities and needs of workers.
- Collectives Mutuality: Nonprofit organizations that gathered in solidarity for immigrants and responded to their needs.
It was only in the 1940s that the state interfered in public health issues, creating the Ministry of Health. It expanded the installed capacity of care and developed several programs to combat endemic and infectious diseases. From the rest was the creation of Social Work for employees.
Decentralization of National Effectors: A gradual transfer of national institutions to the provinces and municipalities, meaning that health care in the country moved to the provinces.
Extension of the Health System of Social Work: Extended the system of Social Work to all formal workers. The causes of decay are the weakening of unions and the loss of formal jobs.
In the 1970s, health coverage was extended to all employees on a mandatory basis. This broadened the number of families with social security coverage and gave economic and political power to the unions.
There was a huge disparity between each social work in terms of wages and the number of members, implying large differences in the type of coverage.
This drove the private subsystem, leaving social work as managers of services and benefits and paying private companies for the attention of their members.
State health services came to be reserved almost exclusively for the attention of the most deprived population without social security coverage.
The contribution of health resources by 50% comes from families.
Throughout the 1990s, there was a large inventory of deep regional disparities in economic development resources, generating a particular mode of operation and access to health services by the inhabitants of different regions of the country.
Health Ministries
The Ministry of Health is the highest national authority on health and social programs.
Provincial governments have full autonomy in public health policies. Municipalities are responsible for implementing programs and administering services within their jurisdiction.
Argentina currently has a Social Security system composed of the following six components:
- The pension system (retirement)
- Social work
- Unemployment insurance
- Workers’ compensation system
- PAMI, which provides medical coverage to the elderly
- The family allowance scheme
Subsystems of Health in Argentina
Public Subsystem
Provides health services free of charge through a network of public hospitals and health centers, allegedly to the entire population. The geographical distribution is very broad.
This subsector has the largest number of public beds available compared to the others.
Social Work Subsystem
Made up of institutions that meet the contingencies of health infrastructure and provide social assistance to pensioners and the national social welfare system through the Comprehensive Medical Care Program (PAMI).
Private Subsystem
Financed from voluntary contributions of its users, mainly middle and high income.
Planning or Present Programs in Health Policy
Compulsory Medical Program
Definition
A health program mandatory for all agents of the National Health Insurance and those who will access it in the future.
It builds upon the strategies of Primary Health Care, focusing on prevention efforts.
Primary Care Program
Basic Features
Provides basic medical care, made accessible to all individuals and families, emphasizing disease prevention, health promotion and education, and timely and efficient treatment of diseases.
PAMI: Comprehensive Care Program at the Institute of Social Services for Retirees and Pensioners
Established in 1971, the National Institute of Social Services for Retirees and Pensioners addressed the lack of health and social care for the elderly by their social work.
The Institute’s central action was the Comprehensive Health Care Program (PAMI), which initially served affiliates located in Buenos Aires.
Across the Country and More Members
PAMI launched a massive recruitment campaign and began designing its national structure, aiming to have an agency or branch in each province for retirees.
Currently, it is the largest social work.
PAMI provides more advanced services, some essential for retirees’ health, such as discounts on medications prescribed by doctors at the institute.
In the last 15 years, PAMI has become a model for its complexity and variety of services not offered by other social projects, addressing the problems of the elderly.