The four key topics that were discussed in a meeting of the Ministry of Health with the prepaid companies

The meeting was on Thursday at 11, just 14 hours after the national network in which President Javier Milei reported the core of the kilometer decree that is the protagonist of almost all of the political conversation these days. The place: one of the various corners of the Ministry of Health. The axis: refine details about the deregulation of prepaid fees and, it was found, four important issues in the functioning of the Argentine health system were also discussed.

Since the change of presidential command, the Ministry of Health (now led by Mario Russo) has attempted to pick up the gauntlet of several claims choked for years by health providers and financiers. The fact that the meeting in question had prepaid companies as interlocutors has its reason, and that is that, whether through a social work, PAMI, by hospital referral or individually, private medicine provides services that USA about 70% of the population.

Regardless of where the Government’s consideration of the problems postponed for years finally leads, the mere listening from the official environment (with a nod from the Minister, indicated the source consulted) pleases the sector.

The topics in the pipeline were four: the Mandatory Medical Plan (PMO), disability coverage, the format for purchasing high-cost supplies and medications, and the always postponed health technology evaluation agency.

The meeting was attended by Minister Mario Russo, the Superintendent of Health Services, Enrique Chiantore, and at least one representative of the Argentine Health Union (UAS), which between chambers and associations of prepaid, sanatoriums and other providers brings together some 1,500 entities.

What mobilized the meeting was the issue of deregulated fees, in addition to the novelty that users will be able to derive their contributions directly to the prepaid ones, without triangulating with social works, establishes the decree.

As reported Clarion, the Minister asked for “freedom but with prudence”, in reference to not trying to recover all the arrears of the quotas at once. Hit people as little as possible.

Of the other topics discussed, the always discussed Mandatory Medical Plan (PMO) stands out, created in 1995, during Menemism, although the germ of creating a basic health basket dates back to Law 23,661, of 1989.

Is “always discussed“, For two reasons. The first is the limited access to this basic basket, only guaranteed by the prepaid ones and for a portion of those who have social work, which excludes, for example, those of provincial origin, the PAMI and, of course, the population that is served in public hospitals and has no coverage.

But, in addition, the financiers who cover the PMO constantly complain about the permanent expansion of benefits and medicationsaccording to the 30 resolutions and decrees that, in this sense, have been rewriting the coverage included in recent decades.

Government sources denied that these issues had been discussed with the prepaid companies on Thursday, but Clarion was able to obtain very precise details (and from a reliable source) about that exchange.

Regarding the PMO, who spoke with this medium reflected that it became an “extensible fund, with an indeterminate list of benefits, whose financing was never reviewed.” That is why “the Argentine health system ended up being defunded and that is why it even ended. reducing doctors’ fees.”

As it turned out, cutting the PMO is not being considered, but not so much because of a lack of desire as because of the recognition that “they are acquired rights and it would be very difficult to do so.” What there was was – without much more detail – “an objective analysis of the need to redesign the way the entire PMO is financed.”

The conversation focused on disability had the same tone (a redesign), which focused on criticizing the “integrated systems” policy. Basically, the confluence of health, education and transportation coverage, which must cover social and prepaid works.

It is a debatable topic and, above all, very sensible. Hay 1.5 million people with a Single Certificate of Disability, but an enormous under-registration is estimated. The figure would be around 4 to 5 million.

For funders, when Education and Transportation was included, the “logical” coverage was distorted, which until then only included the medical spectrum and rehabilitation. Thus, the claim that now falls on Russo is to find a way to “make viable” (in the sense of transferring) everything that is not health to the corresponding portfolios.

Leaving aside the harm that greater bureaucratization of coverage could represent for patients, the person who spoke with this medium assured that “there was very good dialogue” with the Minister, but recognized, however, that “this type of issue can be difficult.” ”. to modify, due to legal resources that often do not allow progress.”

One of the great complaints of prepaid and social works is the issue of high-cost treatments and medications, also called “catastrophic”, due to its ability to ruin a family’s economy. We are talking about supplies and technologies that can represent thousands of dollars weekly or monthly to alleviate specific conditions.

The first issue that was discussed on Thursday is to launch an agency that has been promoted for many years and that was actually created (you could say, “instants ago”), in July, by a decree of former president Alberto Fernández (322/2023 ). ): a health technology assessment agency that reviews what funders like to call “cost-effectiveness.” How reasonable it is, in the cost benefit relationcertain medication or treatment.

The one promoted by the past administration was titled National Commission for the Evaluation of Health Technologies and Clinical Excellence (CONETEC), but it is not too similar to what health providers and, possibly, Russo himself would like to have, much more similar to the National Institute for Health and Care Excellence (NICE) in England, a body that provides national guidance and advice to improve health and social care, but is not governmental.

“It would be an agency with suitable professionals, independent of governments; that could evaluate the cost-effectiveness of treatments and medications, see generic options and establish parameters that exceed those of the ANMAT, an organization that defines whether a drug is approved or not, but that says nothing about who it is good for or what it is for. . “Illnesses are useful,” the source explained.

“The opinions will be non-binding, but mandatory consultation for judges when coverage is judicialized,” he described.

The last article discussed also points – like everything these days – to savings. This time, in relation to the purchases of high-cost medications, which are currently carried out in a decentralized manner.

It may seem minor, but it is an issue that has been highlighted for years by renowned health economics analysts, who observe enormous waste (in bureaucracy, in money…), given the terrible management of State purchases in this area. . of health.

As explained by the person who gave the details of the meeting, “it is as if there were a single supplier and multiple buyers, which causes the negotiating power to decrease greatly.” Who are these “multiple buyers”? It is a long list, which includes the prepaid, the provincial social works, the unions, the PAMI, the national Health portfolio… Each sphere negotiates its prices instead of doing so jointly.

The intention is either to promote centralized negotiation or, instead, to propose a centralized purchasing scheme. “I am more inclined to specify the first one, since centralized purchasing would involve different pitfalls,” he said.

One of them, how to efficiently distribute purchases, “which could be a problem for patients, due to time issues.” On the other hand, “with a common negotiation but the logistics under the responsibility of each financier, this problem would be overcome,” the person explained, and closed: “The negotiator, from now on, should be the Ministry of Health of the Nation.”