16 March 2007

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!


  1. I had my torn meniscus repaired last year. After running 17 marathons, I guess I was just asking too much of that knee. I am still not able to get it back into running shape. I hope yours is better soon.

    I actually miss running, and Buenos Aires is nice and flat.

  2. Pablo – I hope that your leg/knee problem isn’t too serious. “Runner’s knee” is a common type of sports injury (although the term includes several problems). I had this several years ago when I started running again. After I had healed, I was able to resume running but had to wear an elastic band around the base of one knee when exercising. I’ve been fine ever since.

    I also wear orthotic inserts in my shoes, since most running shoes provide little cushioning. I find it particularly difficult to run around BsAs, because of the uneven pavement, and so I try to run in the parks (even though they’re not always flat or rock-free.

    You might want to check on the soles of your shoes for uneven wear, to see if you’re overpronating (rolling to the inside) – it’s one of the most common problems with runners. It’s also easily correctible with an orthotic insole.

    Sports Medicine and Orthopedic doctors see these problems frequently, and there are many articles about the causes and treatments on the web.



  3. Anonymous15:45

    I don't understand you... honestly. Looks to me that you defend president Kirchner and criticize everything else about your country. I really don't get you. You should be more consistent. You can be very confusing and conflicting in your views and comments.

  4. Gabby, I think you haven't been paying attention. I don't speak in black and white. I don't belong to Kirchner's party and I don't answer to the opposition either. I'm neither anti-Argentinian nor think that everything in Argentina is perfectly OK. Please read carefully. If there's something in particular you find confusing, just ask.

  5. Anonymous22:02


    Good for you... you are consistent.

    D for Disorientation sounds like the perfect name for your blog, Pablo.

    I will take your advise and pay more attention next time.


  6. Anonymous09:59

    Hallo Pablo,

    I work in my country's health care system as well.I am very interested to find out what employment opportunities are available for health care professionals in Argentina.More specific - in the dental field. Perhaps you can help?

  7. Anonymous13:10


    After reading your blog more carefully, I concluded that I should apologize to you. My mistake was that I was taking you seriously.


  8. Pablo - how was your visit to your local medical center? There have been several bloggers reporting recently markedly different experiences depending on where they went and whether they were going public or private facilities.

    When you go to a public facility, are the doctors you see all internists? What happens if you need to see a specialist? How readily available are diagnostic tools such as MRIs and ultrasounds in public healthcare?

    If you need extensive treatment in a public facility, does the government (city, provincal etc.) pay for everything? How would you imagine that the cost may influence how good the treatment is in such a situation.

    If you have an medical emergency, can you go to the ER of any hospital and get treatment? (that's how it is in the US now, even if you have no medical insurance).

    SInce I've been living in the US, I've always been fortunate to have been covered by private medical insurance (through employment). I've always been able to choose which physicians I've seen, and can go directly to a specialist when it's necessary.




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