2023-08-21 16:46:25
The physician and public health specialist, Arnaldo Medinaexplained the importance of the public system in society and stated what would be the risks of a privatization. “These competitions generate quality problems and a lot of stress in the health workers”, he stated in Modo Fontevecchiaby Net TV y Radius Profile (FM 101.9).
I would like you, in a didactic way, to explain to us what Javier Milei’s health plan consists of and why 30 years ago the same could have been applied…
There is no program, there are some statements and assumptions that are in the discourse.
One assumption is that for mercy private healthcare is better than public healthcare because there is competitionand one statement is to finance the demand, the technical name for “health vouchers”, which means that people can freely choose which health service they go to, whether public or private.
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There are several discussions and debates regarding the role of the State, and the dilemmas about whether health is a public or private good, or even whether it is a right or not.
It is considering, as health insurance, a proposal that not even liberal countries raise it. For example, England applied it 30 years ago and now it doesn’t even occur to them.
These competencies generate quality problems and high stress on health workers.
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It is registered in England increased postoperative infections in cardiovascular surgeries, many children died, and people with disabilities no longer have access because profitable services are closed and, in addition, they generate bankruptcy.
In which countries was it applied that could be comparable?
In Latin America, the one that deepened this the most was Colombiawhich created insurance based on a market that competes between public and private and are equal, that is, a hospital can be publicly owned but he invoices everything he does through tariffs, even the smallest.
In this sense, one does not know if a hospital is public or private. But that model, in Colombia, brought various problems: everything has to be billed and administrative costs rise enormously. 25% of the expense is administrative.
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It is not usual for the administrative cost to be 25%, normally it is between 3% and 4%…
Yeah, it’s crazy. But there are two things: on the one hand, these companies that manage the funds have their profitability and, like everything else, they have to be invoiced. It is a very intense control and audit system.
On the other hand, It is the health care companies that regulate the admission of patients to hospitalsso it is very difficult for a patient to enter, it takes months.
We doctors want our patients to be cured, so they are admitted as an emergency so that they don’t take long to be treated, which means that this part of the health service is always full.
The Government regulated a law for medical records
It is a system that today they want to reform in the current government of Colombia, but it is costing because there are very large economic interests in these companies.
You mentioned the case of England earlier…
In England, National Health ServiceIt is a system that has a lot of prestige, it is like an international lighthouse that, generally, advances most of the innovations.
In the nineties, Margaret Thatcher It took this pseudo-market model to the extreme (because it was fundamental among public services, although some private ones appeared that later grew). For example, they have family doctors, no one goes to the hospital directly, they are known as systems oriented to primary care Of the health.
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These doctors functioned in a system where hospitals competed in the offer of services for doctors and patients to choose, but a lot of marketing began to appear from these hospitals to doctors and many stopped being profitable, which generated a social and economic problem. made them have to go back with the measures, and no government resists that.
The most important thing is the quality problems that I mentioned above. In the English system they move a lot by reports, they ask a prestigious person to make a report and, based on that report, they did a whole major review.
It was so important that in the political definition, when Tony Blair took office, he raised andThe change from the concept of competitiveness to that of collaboration.
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These proposals are based on real problems that exist. It must be accepted that there are accessibility and quality problems in health systemsThere cannot be hospitals that have queues to take turns, for example.
There are also problems in private hospitals, these are issues that must be solved. But It is not disputed that the tool is to generate such competitive environments.
This definition of Tony Blair, which does not matter because he is English and was given many years ago, gives rise to saying that hoy the model that is proposed is that of networksteamwork and generating a collaborative work environment using a lot of digital health, quality programs, working on motivation.
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We no longer speak of human capital, but of human talentbecause the most important challenge that health organizations have is creativity, innovation, very complex answers have to be given and the best of people is required.
The health system is the people who are in it.
This is achieved with teamwork environments and with dynamics that allow collaborative fieldsbecause competition leads to the opposite.
Claudio Mardones (CM): How would it impact, in terms of public health, removing the obligation of the Comprehensive Sexual Education Law? How long until it is applied normally?
It is important to apply the Comprehensive Sexual Education Law. It depends on the policies that are carried out to know how much is missing. With proposals that remove support for this law, it will not be applied.
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We support her one of the 10 points that we ask candidates for is this law.
There are fundamental questions: on the one hand, the unwanted pregnancies (mainly in adolescents) and the use of contraceptive methodsthat it is very important that the State provides them and that it insures them through the public system.
The other issue is prevention of sexually transmitted diseases. Today we have a problem with HIV and syphilis. These are difficult things to solve, where in certain groups, mainly from vulnerable sectors, STDs become difficult to address.
Scientifically, there are many reasons why one should think that through this law many health problems can be solved.
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Unwanted teenage pregnancy is beginning to be solved with this law, it appears in the statistics.
(CM): You said that they are preparing a decalogue of 10 proposals from the association for all the candidates, what are the other 9?
It is not just our association, there are all the scientific societies: infectology, pediatrics, vaccinology, etc.
We are concerned about the hierarchy of health in the scheme of government, specifically if it is going to be a Ministry or not. It has to be, that is very important to us, especially coming out of a pandemic.
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Health has to be at a hierarchical level of decision, to make the important decisions that must be made in the health system. On the other hand, there is the issue environmental. Today, a large part of our health system is threatened by environmental problems, mainly those extractivist technologies, the use of toxic agrochemicals, among others.
After, we are concerned about the application of the ESIas well as infectious-contagious diseases, such as dengue or STDs. We are interested in knowing what policies are going to be carried out with these diseases.
Another very important question They are the policies that will be taken regarding high-cost drugs provided by the State. The population receives the medicines free of charge and today a report from the Ministry of Health came out which raises, for example, the cost that a person with diabetes would have if this free measure did not exist. It’s very important not to go back on that.
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We are also interested in knowing what will be done with “orphan diseases”, where there is not much research in terms of new drugs if the state is not there.
Another point is regarding science and technology: We are interested in knowing what support the investigation will havewhat will be the budget of the universities and the CONICET. This is very important for the health system.
VF JL
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