Inequity and Fragmentation in Health Services of Gran Buenos Aires

Universidad Nacional de General Sarmiento - Instituto del Conurbano

June 07, 2010 |

Inequity and Fragmentation in Health Services of Gran Buenos Aires

A study developed by the area of Social Politics of the UNGS analyzes the sanitary policies of the Metropolitan Region of Buenos Aires characterized, as the researchers explain, by inequity. The system “is a complex trap permanently out of tune by the changes of the political, economic and social changes”, they remark.

With the aim of analyzing sanitary policies at the local level and their consequences in the performance of health services, teacher researchers of the Conurban Institute (ICO) of the National University of General Sarmiento (UNGS) develop the project “Local Health Systems at the local level in Gran Buenos Aires: looking at the management from the attention of the population’s health”.

“Fragmentation and inequity can synthesize the diagnosis of the public subsector in the Metropolitan Region of Buenos Aires at the beginning of 2000”, explains Magdalena Chiara, teacher researcher of the ICO and responsible for the research. With more than a hundred hospitalization centers under the orbit of three jurisdictions and around 700 primary attention centers the health system of the region offers services to a population of 18 millions of inhabitants who have alternative covering programs available. “It is a complex issue which is permanently challenged by the changes of the political, economic and social context”, adds Chiara.

Among some of the critical points to the management of the sanitary policy in this region -characterized by inequity- appears the hospital-center model, where just the disease becomes the reason of the meeting between the user and the professional; it is also identified the Health Primary Attention (APS) strategy which although it is restored in the discursive role it finds difficulties to develop in all its directions. Some examples are the lack of early training attraction activities, the low resistance of territorial work, the little initiative of the community and the lack of professional profiles.

A data which expresses structural inequity is the gap of post-neonatal mortality which expands from 2 to 10 per thousand, with values lower than 3 in the municipalities of Vicente López, San Fernando and San Isidro, from 3 to 6 in the districts of the first cordon and in others like Moreno, Malvinas Argentinas, Tigre, Berazategui, between 6 and 9 in districts such as José C. Paz, San Miguel, Quilmes and Lomas de Zamora, and of 9 percent in Ezeiza. Other indicator that shows the differential demand about the public subsector is the percentage of population without medical insurances which presents the lowest values in the furthest districts from the Autonomous City of Buenos Aires, with a maximum of 60 percent and more in Merlo, Florencio Varela, Moreno and José C. Paz.

A key aspect in the research refers to the different reactions of the local sanitary politics in front of the opportunities opened by financing mechanisms. There are put into play two logics in tension: that centered in the answers of the territory (which seeks to internalize in the local sphere the resolution of the different complexity levels) and other which in investigation is called technocratic which makes a gamble on the intergovernmental articulation from some spaces which in many cases lack the capacity to guarantee in a timely way the transit of the patients in the system.

As background of these two logics there is a weave of financial incentives such as those derived from provincial co-participation which make a little contribution to the articulation of the system as a group. “The distribution of resources favors districts with higher offer and high complexity facing first level services generating incentives that operate in the inverse sense to the rest of the public policies”, expresses Chiara.

“Human resources also emerge as a management problem, among others their working conditions, professional career, distribution in the territory, the (un) incentives towards first level, the competence among the municipalities by critical specialties, the problems in formation”, contributes Javier Moro, researcher and teacher of the ICO and member of the team.

Sanitary politics is developed in the tension between fragmentation and integration with different local reactions facing the financing mechanisms with diverse articulation efforts and institutionalization difficulties; all that in a context of great indefinitions about the general model which harmonizes the contributions of each jurisdiction.

The research

The methodological approach of the research uses information from diverse sources: hemerographic revision, analysis of the normative and expenses in health in the conurbano. Qualitative techniques are used to make deep interviews to key actors and quantitative techniques in the use of existent data bases (EPH and census) to its geographical referencing linked to the offer of services and financing; in the same way there are self elaboration polls developed belonging to health teams and homes.

Given the interest of the research in the management local level and the particular dynamics generated in the territory there were selected three municipalities to be analyzed in depth during the period 2001-2007. Considering different aspects which show heterogeneity there were taken cases such as Malvinas Argentinas, San Fernando and Tigre.

It is an Oriented Scientific- Technological Research Project (PICTO) with financing from the FONCYT. The team is integrated by Magdalena Chiara, Javier Moro, Carlos Jiménez and Ana Ariovich (ICO/UNGS); María Mercedes Di Virgilio (IIGG-UBA) and María Alejandra Wagner (FTS-UNLP).

Brenda Liener
Comunicación y Prensa UNGS

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