Evaluating the performance of an innovative public health insurance: The case of a decentralized province in Argentina

Introduction.

In Argentina, the public health system is deeply decentralized.Differences regarding income distribution and access to health services require the creation of regulatory devices and State intervention.

One of the answers provided by the Buenos Aires Health Ministry was the creation of a Provincial Public Health Insurance, aimed at guarantying access and quality of health services to population without formal health coverage and economic resources to afford one. This program included an innovative mechanism of human resources payment for the public sector– a capitated system with the possibility to generate a plus over the  fixed salary-  and aimed to reach the coverage of 2.4 million of citizens..

Objectives.

To analyze the performance of the strategy in terms of focalization and development of preventive tasks associated to a higher quality at the primary healthcare level.

Methodology.

A database of 1.7 million of consultations in 59 municipalities during the period 2004 to 2006 was analyzed, considering the evolution of preventive and curative consultations. Logistic regression models were implemented to determine the variables conditioning those tendencies (patient age and sex, physicians’ expertise, poverty, population density and health expenditure by municipality, among others).

Results.

The program was appropriately focalized in poor municipalities. Preventive consultations increased 107% during the three year period, and curative consultations decreased by 56%. Preventive consultations were significantly associated with young and female patients, as well as younger physicians. Also, poor and populated municipalities showed high associations with preventive consultations. Differences between municipalities were relevant, showing significant associations on both signs.

Conclusions.

Insurance’s hiring and payment mechanisms, result to be innovative and successful in the context of public health sub-sector, conditioning the professionals to increase their efforts towards higher quality preventive care. The strategy might be seen as one of the instruments with the potential to enhance care quality and performance.