Healthcare this way

My right leg has been behaving strangely as of late, which I blame on my new jogging habit, though I knew there was something wrong with it before. My knee feels a bit hurt all the time, and a kind of weakness propagates upward from there. I let it pass for a while since it looked like a simple adjustment from sedentarism to a regime of consistent exercise, although weirdly it didn't bother me at all while jogging. But now it's bothering me even as I stand or walk. I can give up jogging, but I go everywhere on foot.

Given that, I need to go to a doctor, and I thought it'd be interesting to speak of medicine in Argentina. I've read a lot of reports of foreign visitors and expats marvelling about the quality and price of health care here, and especially the existence of universal socialized medicine. The latter is not something you usually hear much about, since people with $$$ don't really need to go there. The most expensive quality medical treatment you can find in Argentina is still a bargain compared to the costs of medicine in the United States or Europe.

If you have a good salary, you can pay for a private health insurance plan. They're not cheap, and they've become extremely restricted — you can get away with emergency service and basic treatment, but not surgery or other complicated procedures, for which you have to pay additional money. Alternatively, if you're working en blanco (formally registered), you may have a health plan associated with your union. It won't get you everything you need for free, but you can get away with simple medical matters for a few pesos.

However, if you don't have money or a job, or you don't have a unionized healthcare plan, or your plan is insufficient, you'll have to brace yourself and go look for attention in the public health system. There's a provincial system, with hospitals in large towns and cities, smaller health centers in small towns, and little primary care centers everywhere, covering the entire area of Santa Fe. Overlaid with it there are local (municipal) health centers, which are usually coordinated with the provincial system. Rosario, being much larger than any other city, is a special case, and even more so because of the constant competition and bickering between the provincial and the municipal governments. The municipality manages several major hospitals on its own, including one for emergencies and one for children, and a multitude of primary centers.

The provincial health system is divided for administration into several Health Zones, each divided in turn into Programmatic Areas, each one having one base hospital and several primary care centers. The main difference regarding patient attention is that the provincial centers accept people from anywhere in Santa Fe (and even outside), while Rosario's municipal centers tend to send non-rosarinos elsewhere. I worked in one of the three largest provincial hospitals in Argentina and I can tell you that the quality of medical attention can range from very good to atrocious, depending on luck and on the good will of the doctors and employees; I don't know about the municipal hospitals. There's an unspoken assumption (acknowledged by the provincial officials) that Rosario's public health is better managed, though I couldn't tell for sure; conversely, the handling of internal jurisdictions, finance and large amounts of patients in the provincial system's hospitals is completely chaotic, in part because the hospitals were left to their own devices during the Reutemann administration.

Picture this: a large organization, self-ruled, with huge expenses, led by an unelected political official appointed by a faraway authority and with lesser authorities partly elected by votes of its employees (usually bought or pressured by a politically-connected union, if not entirely forged), which receives money from its higher authority but must not answer for it, and needs to gather extra money to work but cannot formally ask the patients for that money since in theory the public health system is free and the government is proud of that. This mess could be maybe corrected by re-centralization and enforced by tight controls, but that would make the central Health Ministry accountable for each little fault. With formally autonomous, self-managed hospitals, that responsibility is diluted.

Anyway, tens of thousands of people seek public health care in Rosario every day, and they get it, maybe after long waits or in less-than-optimal conditions, but usually from decently good professionals. If you want to become a doctor, you need to do your residence in a public hospital, and everybody knows that those young, eager residents are the ones that really do the grunt work in hospitals. Moreover, it's still a source of status for a doctor to serve in a public hospital, if only for short periods, even while he or she has a private practice; and hospitals are also schools, so residents always receive advice from qualified specialists. It's possible to give birth to a child, to have a serious fracture mended, or to get years of treatment for cancer in a public hospital for nothing, or at the very least for a fraction of the cost of private medicine, in any major public hospital in Santa Fe.

This is sadly not true of all of Argentina. Many patients in the interior of the country don't have a half-decent coverage, and need to travel long distances to their provincial capitals or even to other provinces. Some end up here in Rosario, others go to Buenos Aires. (I remember once a patient from Paraguay got a mammography in my hospital. She travelled once a year to Argentina to visit her extended family, and it was cheaper for her to pay a few pesos and get a decent study while she was staying here.) Some complex and expensive treatments, such as the ones surrounding pediatric bone marrow transplants, are only available in Buenos Aires. All in all, this makes it more attractive to live in a big city... and it's one of the reasons why poor small-town and countryside residents migrate here. The only way to fix that is simply to take good health care closer to them.

In the meantime, I'm going to take care of myself... My leg's going to see a doctor in the neighbourhood's community center, four blocks away — the 'hood is poor but the community center has at least a few specialists and, importantly, an X-ray machine!