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Evolving through crisis
How Argentina’s healthcare system can increase
resiliency and sustainability in a post-pandemic
world
A report by The Economist Intelligence Unit
Commissioned by
EVOLVING THROUGH CRISIS
HOW ARGENTINA’S HEALTHCARE SYSTEM CAN INCREASE RESILIENCY AND SUSTAINABILITY IN
A POST-PANDEMIC WORLD
Contents
Introduction2
A fractured healthcare system 4
A virtual solution to inequality 4
Federal support and structure 5
Collective purchasing at work: Remediar 6
Transformative innovation 6
Valuable partnerships 6
Seeking data in a digital world 7
Fighting for quality care 8
Delivering on the promise of care 9
References10
The EIU conducted all research independently and bears sole responsibility for this article. The insights presented
are those put forth by the EIU, and do not necessarily reflect the views of the sponsor or contributing experts.
1 © The Economist Intelligence Unit Limited 2021
EVOLVING THROUGH CRISIS
HOW ARGENTINA’S HEALTHCARE SYSTEM CAN INCREASE RESILIENCY AND SUSTAINABILITY IN
A POST-PANDEMIC WORLD
Introduction
A fter more than a year of the pandemic, the weaknesses of many healthcare systems have been
exposed. Argentina devotes 9.2% of its GDP to providing healthcare to its citizens. However, a
variety of systemic challenges keep patients from receiving the high-value care one would expect from
such a sizable financial investment. The covid-19 crisis has made clear that change is imperative to
create a more resilient and sustainable system that puts patients first.
Quality of care varies widely across provinces, and the three central forms of insurance in Argentina do
not always cover the same medications and procedures. Transformation at the federal level must align
these disparate systems into a cohesive whole and take the essential step of centralizing and digitizing
data across the health ecosystem.
Without a full picture of the system, it is hard to articulate the changes that would have the greatest
impact on patients. More clearly defined federal policies could ease pressure on the judicial system by
reducing the need to litigate insurance disputes. This change would benefit not only the patients who
are advocating for their own care but also the government that bears the financial burden of a judiciary
stretched beyond its capacity. The global health crisis caused by the pandemic has pushed Argentina’s
healthcare system to the brink, creating an opportunity and a desire for sweeping reforms. It is now
up to the government, the payors, the clinicians and the patients to unite in pursuit of resilience and
sustainability and change Argentina’s system for the better.
Argentina devotes 9.2%
of its GDP to providing
healthcare to its citizens
2 © The Economist Intelligence Unit Limited 2021EVOLVING THROUGH CRISIS
HOW ARGENTINA’S HEALTHCARE SYSTEM CAN INCREASE RESILIENCY AND SUSTAINABILITY IN
A POST-PANDEMIC WORLD
F or insights into Argentina’s healthcare landscape and the road to long-term resilience, The
Economist Intelligence Unit (EIU) convened and interviewed experts in this field. We wish to
thank them for their time and contributions:
l Silvia Fernández Barrio - founder and president of the Civil Association for Psoriasis Patients
of Argentina (AEPSO) and member of the board of the International Federation of Psoriasis
Associations (IFPA)
l Gustavo Citera - head of the rheumatology section of the Institute of Psychophysical
Rehabilitation
l Juan Pablo Denamiel - deputy manager of strategic management for the Superintendent of
Health Services of Argentina
l Natalia Jorgensen - director of the Health Technology Assessment Center (CETSA)
l Esteban Lifschitz - chief scientific officer at HIRIS Care
l Carlos Gonzalez Malla - associate professor of internal medicine at the University of
Buenos Aires
We also conducted in-depth interviews with two other experts:
l María Alejandra Iglesias - patient representative at CONETEC and president of SOSTÉN Civil
Association
l Mauricio Monsalvo - secretary of administrative management for the Ministry of Health of
Argentina
This article was based on a roundtable moderated by Marcio Zanetti.
Amanda Stucke managed the research, and Carolina Zweig led analytical and logistical support.
Biz Pedersen authored this article.
3 © The Economist Intelligence Unit Limited 2021EVOLVING THROUGH CRISIS
HOW ARGENTINA’S HEALTHCARE SYSTEM CAN INCREASE RESILIENCY AND SUSTAINABILITY IN
A POST-PANDEMIC WORLD
A fractured healthcare system
T he quality of care patients receive varies widely depending on which province they live in and the
type of insurance they have (public, obras sociales or prepagas). As of 2010, 46% of the population
was insured through the obras sociales program directly, 11% was insured by private companies
through obras sociales, 5% had private insurance and 2% had public insurance through a specific social
benefit program, while the remaining 36% was covered by public health insurance.1 In addition to the
variety of coverage across the country, provinces have enormous autonomy in how they choose to
operate, further fragmenting and segmenting the healthcare system. As a result, two citizens in two
neighboring provinces may receive radically different care for the same condition.2
Healthcare Patients with financial means are more likely to receive high-quality care because they can take legal
inequities in action to force their insurance provider to approve a recommended course of treatment. Alternatively,
Argentina have well-off patients may opt to receive treatment in a province that is known to offer excellent care for
been exacerbated their disease. As Maria Alejandra Iglesias, a patient advocate and member of CONETEC, explained,
by the challenges “Those who are covered by an obra social or prepaga, surely have support in other areas of their lives
in providing too. Either they or their family members have a job that provides insurance, or their socioeconomic
care during the situation enables them to get coverage. In general, those that only have access to the public system are
pandemic. in a more vulnerable or precarious financial situation which can in turn increase the health conditions
that require care. These many obstacles add to the fragmentation of the health system and hinder
opportune, timely and adequate care.¨
To address these inequalities, stakeholders must pursue a variety of solutions, such as expanding
virtual healthcare, increasing federal support of collective purchasing power, embracing innovation and
founding new public–private partnerships.
A virtual solution to inequality
Healthcare inequities in Argentina have been exacerbated by the challenges in providing care during
the pandemic. Carlos Gonzalez Malla, supervisor of health technology assessment at the National
Health Technology Assessment Commission of the Ministry of Health and a member of CONETEC,
spoke of covid-19 mortality rates for patients who enter intensive care in public hospitals versus
private hospitals. The tragic reality, he acknowledged, is that patients in public hospitals may have a
significantly lower rate of survival.
At the same time, however, the pandemic’s challenges have forced certain adaptations that have
increased the quality of care. For example, Ms. Iglesias described patient advocacy groups’ success
4 © The Economist Intelligence Unit Limited 2021EVOLVING THROUGH CRISIS
HOW ARGENTINA’S HEALTHCARE SYSTEM CAN INCREASE RESILIENCY AND SUSTAINABILITY IN
A POST-PANDEMIC WORLD
in reaching out to patients: “[Going virtual] was an opportunity to reach all these people.” With this
new form of communication, she hopes that advocates will be able to reach more patients and
professionals and use this new connectivity to create a higher standard of care.
Federal support and structure
To resolve the fragmentation of the healthcare system, the federal government can help coordinate the
provinces and provide a common standard of care to unify a disparate system.1 By increasing federal
support and oversight, Argentina will also be able to leverage its financial investment to optimize
healthcare value. For example, government agencies could increase Argentina’s purchasing power
when negotiating prices for essential medicines. As an example of the power of collective purchasing
to reduce cost, Juan Pablo Denamiel, deputy manager of strategic management of the Superintendent
of Health Services of Argentina, and Natalia Jorgensen, director of the Health Technology Assessment
Center, successfully negotiated the purchase of hemophilia medications. Controlling costs at this high
level benefits patients through savings and improved quality of care. There are, however, obstacles to
implementing this process effectively as Mr. Denamiel points out, “Today the system is very complex
regarding the execution and financing of collective purchasing, so it requires significant energy to make
it work. The most difficult part is the political aspect because of the different interests at play. It can also
be challenging to integrate different groups with different purchasing and selling capacity, in addition
to variations in the medical needs of the population.”
5 © The Economist Intelligence Unit Limited 2021EVOLVING THROUGH CRISIS
HOW ARGENTINA’S HEALTHCARE SYSTEM CAN INCREASE RESILIENCY AND SUSTAINABILITY IN
A POST-PANDEMIC WORLD
Collective purchasing at work: Remediar
Remediar provides another example of success. This initiative was spearheaded in part by Mauricio
Monsalvo, secretary of administrative management for the Ministry of Health of Argentina.3 He
described Remediar’s mission to consolidate the federal supply system and use collective purchasing
power to reduce medication costs: “Textbooks suggest that price distortions come from the
intermediaries, from development to the point of sale (drugstore). This includes labs, the distributor,
etc. Remediar was an intelligent way of lowering the price of medications and entering the market in a
disruptive way, competing even with generics.”1
Transformative innovation
Only significant Fighting the cost inefficiencies of the Argentine healthcare system will require innovation in most
systemic changes aspects of the healthcare system. The private sector is essential to generate these desired advances, as
will bring medical technology and drug development is effectively spearheaded by private industry. Information
about the cost management is another area that would benefit from private sector driven innovation. Only by
savings needed embracing public-private partnerships to harness this innovation within the healthcare system will
to revitalize Argentinians reap the benefits of truly innovative thinking. As Esteban Lifschitz, chief scientific officer
Argentina’s at HIRIS Care, pointed out, “Biosimilars are an example, in fact, of the innovation brought by the
healthcare pharmaceutical market, which aims at less expensive alternatives, without sacrificing the patient’s
system.
health.” Only significant systemic changes will bring about the cost savings needed to revitalize
Argentina’s healthcare system. To realize these savings, stakeholders must be open to solutions that
can address the structural barriers currently restricting the healthcare system.
Valuable partnerships
In addition to the federal government playing a larger role, collaboration among various industries,
from private insurers to scientific research societies, and the formation of new public–private
partnerships, can increase the efficacy of the healthcare system while simultaneously reducing
expensive redundancies.4 While stakeholders are aware of the changes that need to be made, the
pandemic has brought a renewed sense of urgency to transform these systems. A unified approach
could fuel developments in many areas, including digital data collection and utilization.
6 © The Economist Intelligence Unit Limited 2021EVOLVING THROUGH CRISIS
HOW ARGENTINA’S HEALTHCARE SYSTEM CAN INCREASE RESILIENCY AND SUSTAINABILITY IN
A POST-PANDEMIC WORLD
Seeking data in a digital world
T here is a well-known lack of both patient data and system-wide data in Argentina.5 If collected
and integrated, better data could illuminate the weak points in the healthcare system. Acquiring
this data requires innovative healthcare management and significant improvement in the flow of
information among patients, healthcare providers and the Argentine government. While Argentina
has kept pace with current developments in medicine and medical technology, it lags other developed
nations in its management systems and digital data collection. Poor data management limits the
effective and equitable use of those medical resources.
“Let’s be serious Silvia Fernández Barrio, founder and president of the Civil Association for Psoriasis Patients of
about digitizing Argentina (AEPSO) and member of the board of the International Federation of Psoriasis Associations
things. Let’s be (IFPA), emphasized the necessity of a cohesive data system: “Let’s be serious about digitizing things.
serious about Let’s be serious about unifying, let’s be serious about interconnecting the whole country and
unifying, let’s be talking about useful data.” The collection and use of data in decision-making would be useful to all
serious about stakeholders, including clinicians, patients and payors. The healthcare providers and government of
interconnecting Argentina have significant work ahead to gather and digitize essential data across the country. Once
the whole country such data have been systematized, the benefits will be clear and lasting.
and talking about
useful data.”
As data become available, they can be used toward multiple ends. Mauricio Monsalvo described
Silvia Fernández Barrio,
founder and president
the Remediar program as one example of successful data use. Remediar collected data points from
of the Civil Association many sources in the medication distribution line. “Once we gathered enough quality data,” he said,
for Psoriasis Patients of
Argentina (AEPSO) and “we managed to create better consumption projections, which we used to rationally update the
member of the board of the
International Federation of
medications within our program rather than relying on assumptions of what medications were
Psoriasis Associations (IFPA) needed… we’d call it forecasting nowadays. In parallel, we also designed a large-scale training program
for professionals to improve the rational use of medication. It wouldn’t be as useful to predict the
rational demand if there’s a large volume of irrational or at least inadequate demand.”
This sort of collection and implementation of data is essential to make the healthcare system more
effective and resilient. If data were collected, organized and shared countrywide, patients could be
offered more preventive care, inequalities among different provincial systems could be identified and
rectified, and purchasing and distribution of key pharmaceuticals could be more cost-effective, among
many other benefits.1
7 © The Economist Intelligence Unit Limited 2021EVOLVING THROUGH CRISIS
HOW ARGENTINA’S HEALTHCARE SYSTEM CAN INCREASE RESILIENCY AND SUSTAINABILITY IN
A POST-PANDEMIC WORLD
Fighting for quality care
T he judicial system in Argentina has outsized influence over healthcare decisions. It is the final
recourse for patients who must sue their insurance provider to receive the care that their doctor
deems necessary.1 These disputes often center on the cost of treatment. The need to litigate to receive
care demonstrates a stark economic disparity in the Argentine healthcare system. Patients dependent
on state insurance and without means of their own cannot hire a lawyer to advocate on their behalf.1
The dependence on litigation also overburdens the judicial system and is expensive for the country.6
Often, the legal conflicts concern expensive medications.2 Increased use of generics and biosimilar
medications could reduce such lawsuits. However, biosimilars cannot be implemented because the
Ministry of Health does not have a clear policy on use. Without an explicit policy from the government,
it falls to the judiciary to decide whether a treatment is unnecessarily expensive for the insurer.
As Mr. Malla pointed out, this system can endanger patients: “Argentina’s judicial system is armed in
such a way that judges deliver health, that is, they replace the doctors’ judgment.” This disconnect
between physicians, payors, judges and patients impedes understanding on all sides. Physicians and
payors must be aligned on medical decisions so patients receive the care they need. Coordination also
improves the sustainability of the healthcare system. As Gustavo Citera, head of the rheumatology
section of the Institute of Psychophysical Rehabilitation, noted: “The best way to solve this problem is
for the prescriber, the payor and the patient to work together.”
8 © The Economist Intelligence Unit Limited 2021EVOLVING THROUGH CRISIS
HOW ARGENTINA’S HEALTHCARE SYSTEM CAN INCREASE RESILIENCY AND SUSTAINABILITY IN
A POST-PANDEMIC WORLD
Delivering on the promise of care
T he current challenges that the Argentine healthcare system faces are manifold.4 No single action
can inspire the systemic changes needed to make the system more sustainable and resilient. But
one way Argentina can improve patients’ quality of care is to embrace technological innovation. Two
ways to do this include adopting a cohesive digital data collection system to increase bureaucratic
efficiency and leverage collective purchasing power, and to embrace innovations such as biosimilars
and generic medicines to improve care and reduce costs.
Moving the healthcare system forward will require buy-in from key decision-makers, including
the federal government, health administrators, clinicians and the patients themselves. Through a
concerted effort to make better use of its extensive resources, Argentina could overhaul its current
system and guarantee that its healthcare is both high quality and equitable.
9 © The Economist Intelligence Unit Limited 2021EVOLVING THROUGH CRISIS
HOW ARGENTINA’S HEALTHCARE SYSTEM CAN INCREASE RESILIENCY AND SUSTAINABILITY IN
A POST-PANDEMIC WORLD
References
1. Vargas-Pelaez CM, Drago MT, Acosta A, et al. Pharmaceutical Policy in Argentina. Pharmaceutical
Policy in Countries with Developing Healthcare Systems 2017;97-121.
2. Vargas-Pelaez CM, Rover MR, Soares L, et al. Judicialization of access to medicines in four Latin
American countries: a comparative qualitative analysis. International journal for equity in health.
2019;18(1):1-4.
3. Maceira D, Apella I, Barbieri E. Análisis del Programa REMEDIAR: Notas sobre Evaluación y
Seguimiento. Inter-American Development Bank. 2005. Available from: https://publications.iadb.
org/publications/spanish/document/An%C3%A1lisis-del-programa-REMEDIAR-Notas-sobre-
evaluaci%C3%B3n-y-seguimiento.pdf
4. Argentina tackles challenges of a decentralised health system. n.d. Oxford Business Group. Available
from: https://oxfordbusinessgroup.com/overview/synchronised-steps-several-measures-under-way-
current-administration-ironing-out-challenges-posed.
5. Marro MJ, Cardoso AM, Leite ID. Regional inequalities in mortality from diabetes mellitus and access
to health in Argentina. Cadernos de Saúde Pública. 2017 Oct 9; 33: e00113016.
6. Abramovich V, Pautassi L. The right to health in the courts: Some effects of judicial activism on the
health system in Argentina. Collective health. 2008; 4: 261-82.
10 © The Economist Intelligence Unit Limited 2021Copyright © 2021 The Economist Intelligence Unit Limited. All rights reserved. Neither this publication nor any part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of The Economist Intelligence Unit Limited. While every effort has been taken to verify the accuracy of this information, The Economist Intelligence Unit Ltd. cannot accept any responsibility or liability for reliance by any person on this report or any of the information, opinions or conclusions set out in this report.
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