Need and inequality in the use of health care services in a fragmented and decentralized health system: evidence for Argentina

Abstract

Background: The high fragmentation and decentralization in the provision of health care services that characterizes Argentina's health system, as well as the economic and social inequalities, challenge the achievement of the Universal Health Coverage (UHC). The objective of this study is to measure socioeconomic-related inequality and horizontal inequity in the use of health care services in Argentina as well as identify the factors that contribute to these disparities. Methods: The 2013 National Risk Factor Survey, developed by the Ministry of Health of Argentina, was used to measure socioeconomic-related inequality and inequity in the use of health care services through concentration curves, the Erreygers concentration index, and the index of horizontal inequity. Econometric micro-decomposition was applied to estimate the contribution of each determining factor to inequality in the use of health care services. Results: The Erreygers concentration index for the use of health care services was 0.1223, evidencing pro-rich inequalities. By adding variables of health care needs, the horizontal inequity index was 0.1296. Non-need factors such as education and health coverage with social security increase pro-rich inequality. Conclusions: The Argentine health system shows pro-rich inequality in the use of health care services. It is necessary to design strategies to improve articulation between the three coverage subsectors and national, provincial, and municipal governments to keep the commitment of "not leaving anyone behind." The results showed here could provide lessons for countries with similar contexts and challenges in public health.

Open Tibial Fracture Treatment in Argentina

“…In Argentina, a greater percentage of the population in the interior provinces has a lower socioeconomic status and lacks health-care insurance 18 , 19 . Additionally, interior-region medical centers have fewer specialists 17 ; these documented disparities include orthopaedic surgeons. The difficulty in procuring implants not only results in delayed care but also affects the type of surgery performed.…”

“…Exterior hospitals, as defined in this study, generally have more resources than interior hospitals [17][18][19] . Underscoring this discrepancy in resources, a recent study measured Argentinians' use of health-care services and determined that there is greater use of services by those with higher levels of per capita income 17 . Furthermore, more than one-third (36%) of patients in the interior group have no insurance and rely on government-related health-care insurance and personal resources 20 , which can delay the ability to acquire necessary implants for surgery.…”

“…Eight hospitals were designated as “interior,” and 5 hospitals were designated as “exterior.” The interior group represents trauma centers that are located outside of the Buenos Aires province. Due to Argentina’s economic and social inequalities and decentralized health system, the interior provinces have fewer trauma centers, fewer personnel, poorer infrastructure (underdeveloped information systems), and less access to resources, including fixation hardware, instruments, and supplies 16 , 17 . In contrast, the exterior group represents trauma centers in the Buenos Aires province, an urban region where the capital city is located.…”

Latin American Health Regimes in the Face of the Pandemic

“…Some of the Obras Sociales fare better than others, and these are superior, in general, to the public services. On the other hand, there are important regional differences: between the capital and the suburbs of Buenos Aires (the conurbado), as well as between the capital and the provinces (Palacios et al, 2020). Financial and infrastructure resources are highly concentrated in Buenos Aires, Cordoba, and Rosario.…”

Understanding inequities in health and health systems in Latin America and the Caribbean: a thematic series

“…Within these packages of reforms were those aimed at decentralizing and restructuring public healthcare provision during the 1990s [ 1 ]. As a result of these and other policies, Palacios, Espinola and Rojas Roque [ 2 ] found that the Argentine health system shows pro-rich inequality in the use of public services, and that this is fueled by the inequitable distribution of access to the social security institute and to the private healthcare sub-system. Bernales-Baksai [ 3 ] addresses the issue in Chile and Uruguay, countries with seemingly strong health system in the region, and shows how their policy architectures tackle segmentation.…”