Strengthening third level health care services: Experiences from the Argentinean northwest

Context. Extreme fragmentation in the Argentine health care model reduces risk pooling capacity to cover equitable access, affecting family’s share of income devoted to health. Specially, some interventions related to high cost-low occurrence illnesses become financially catastrophic for most vulnerable population.  

Objetive. This study analyses the capacity of public and private third-level-of-complexity providers at the provincial level within the Argentine Northwest to solve population needs. Additionally, the document researches on the rationality of patients´ referrals within each province, between provinces of the same region, and outside the region, to national acknowledged hospitals. By identifying most relevant actors of local health care systems, and understanding conducts and incentives of each of them, the paper looks for a common public policy agenda, with recommendations to improve the third level of health care services under an equitable, cost-effective framework.  

Methods. Qualitative and exploratory study, performed between July and November of 2007 in six Argentinean provinces. The methodology includes sociosanitary data analysis, in-depth interviews to key informants and analysis of economical data on costs and expenditures among provinces.

Results. The six provinces under analysis show idle-capacity to manage high complexity interventions, concentrated in capital cities. Nevertheless, perceived quality was mentioned by financing actors as the main variable influencing the selection of providers, beyond objective indicators of effectiveness and costs. That leads to losses in resource allocation, local under-provision and high transaction costs in the national chain of patients’ derivations. Patients, in turn, suffer monetary and emotional losses due to temporary disarray, relying in informal ties and local NGOs to cover their needs during the intervention.

Conclusions. A national-wide strategy to design, formalize and regulate referral flows is needed, as well as a federal provider regulation and certification process.