2024-04-14 02:18:18
The considerable and consecutive increases in prepaid medicine fees that have occurred in recent months force a debate that goes beyond the way in which these figures attack the empty pockets of the middle class. A broader look at the health care situation in Argentina is essential, where More and more people are fearfully considering canceling their prepaid plan, knowing that they will have to seek care in underfunded public hospitals. And this, despite the fact that private services increasingly resemble public ones, in terms of waiting times, quality of care and fees paid to doctors.
With more than 50 years of experience in Medicine, Dr. Hugo Esteva accepted the invitation of The Press to analyze the current reality of the health system and prepaid medicine.
“I witnessed how the prepaid companies started. They were born as a way to care for poor cousins. That is, people who had the social level to be cared for privately – and I’m talking about the beginning of the 70s, when I was halfway through my residency in Surgery – and who began to not have the money to pay fees and private sanatoriums. “So, some groups of people began to realize that a system could be created in which people would associate and thereby gain the right to be cared for.”recalled Esteva, a thoracic surgeon and member of the National Academy of Medicine.
“Swiss Medical started around 1977. It was said that they built that sanatorium on Pueyrredón Avenue, at least the operating room part, based on the nurses and instruments from the Hospital de Clínicas. Since then, it began to grow explosively”he related, and then added: “When I was simultaneously a provider and partner of that prepaid company, they invited me back to an end-of-year meeting at which Claudio Belocopitt spoke. (owner of Swiss Medical and currently president of the Argentine Health Union, the federation that brings together associations linked to the country’s private health sector)in a really insolent tone.”
According to Esteva, on that occasion the businessman “he talked about Swiss Medical but he didn’t say a single word about health.” In that same meeting, Belocopitt made a “premonitory” statement (or a threat): “Whoever is not in the (prepaid) system is going to be left out of everything”said the thoracic surgeon.
The truth is that in the construction of this private health care mechanism, the doctors, sanatoriums and other institutions that appear in the prepaid cards – called “providers” – have been trapped with miserable fees and deferred payments for several months. .
And, faced with this reality, opportunism also arises. “A number of my colleagues appear on the prepaid cards where they appear as ‘doctor so-and-so and team.’ So, when the patient has to have surgery, the owner of the equipment tells him that his team will operate on him and that if he wants a “personalized” surgery – that is, for him to operate on it – then he has to pay outside, without a receipt, in dollars. … I have never asked for something like that in my life because it seems like the latest thing to me, because you break your word with respect to the company and with respect to the patient.”emphasized Esteva, who said that while he was providing his services to Swiss Medical and Osde, he told these two companies how inappropriate he considered this practice. “But they made a face as if to say ‘well, what are you going to do’… They prefer a criminal who is within their norm and not a guy with freedom”lament.
Regarding the current scenario, the academic described: “We have medical fees that are getting worse and worse and a government like the one we have had until now, forcing the prepaid companies to take charge of expensive treatments – which the prepaid companies are probably a little right about, which costs them a fortune because the laboratories have lowered less than them. So I think it has been difficult for them. But the ones who suffer are the associates, who pay more and more and have more restrictions while the doctors charge rubbish and have to do this shameless thing, which is asking for fees outside (something that practically everyone asks for).”
Along these lines, Esteva considered: “The fact is that this entire system has been prostituted. It is not a clear, clean system, but it is progressively prostituted and managed by a living barbarian who has gradually become the boss of all this, but every time he appears in the media, which he loves, he comes out as a victim: Mr. Belocopitt.
– Will the considerable increases in monthly payments solve the situation?
– It is going to solve the situation for Mr. Belocopitt, but do not think that it is going to solve it for the doctors nor do you think that it is going to solve much for the sick. For this to work, there would have to be real control by a decent State. If people like some of our colleagues who are in public health were at the head of these things, I think this could be fixed but by putting very clear rules and restrictions on those who have wanted to make this something totally commercial. I’m not saying that prepaid companies don’t have to earn, but they have to have a limit.
– The justification given is that health costs are so high that it is not enough for them. How much is true?
– The only decent system that I have seen and that as far as I know worked has been the one proposed by my head of Surgery and that lasted a breath as Secretary of Public Health in the Lanusse era, which was Dr. Mario Brea, who proposed what were called “community hospitals”, such as the Private Community Hospital of Mar del Plata.
This idea of hospitals, which are managed by a professional administrative body plus people from the community – who are representatives of the sick -, and some representative of the unions that are there, controlled by each other, seems to me that could have worked very well. .
At that time all the small private sanatoriums attacked Brea, without knowing the matter. It took a lot for the Mar del Plata Community Hospital to stay on its feet and I think they have done something pretty good. That is to say, it is not impossible. The point is that there are people who know and are decent. These people exist in Argentina, but you will not find them managing a hospital almost purely with the union, as happens today with the Hospital de Clínicas.
I’m sure there are people who can make the system work, which isn’t that complicated either. That medicine is sad throughout the world is true. We already know that. But because economic interests prevail more than others.
The current government says that everything has to be private, that it has to be governed by the interests of supply and demand. That doesn’t work for health. That is not enough for health. There has to be an official mechanism that makes that effort that the private sector does not make. The ancients already said it and it was modernized by Father Leonardo Castellani, who maintained that the State is there to administer justice, to wage war and to make roads. The latter means doing what the private sector cannot do, making the path and, once that path is made, we all walk that path. But that first impulse has to be done by the whole, which is the State.
– Is Argentina’s health system, both public and private, in intensive care today?
– The situation is serious. The thing is that doctors still have a vocation. It is a pleasure to hear the discussions in the athenaeums, the willingness to propose the best solutions, the love of doctors with their profession. This has not been lost despite everything.
Yes, it is true that love for one’s neighbor is not seen much in the office, because many patients tell me: “Oh doctor, that’s great, you checked me, the other doctor was looking at the computer.” That aspect has to be vindicated, the mass nature of medical education has to end…
– Therefore, consider that this situation of health decline is reversed with the intervention of the State…
– A small and efficient State. It doesn’t have to be the enormous behemoth that maintains hospitals that are full of lazy people, dominated by unions. What has to change is the mentality. This government is not going to achieve this by making the State disappear. What it has to do is small and efficient. The formula is not that difficult… although I recognize that it is not easy to put into practice either.
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