Cablegate: Health Care in Argentina, a Mixed Review

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FM AMEMBASSY BUENOS AIRES
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UNCLAS SECTION 01 OF 05 BUENOS AIRES 003119

SIPDIS

SIPDIS

E.O. 12958: N/A
TAGS: TBIO ECON PREL PHUM AR
SUBJECT: HEALTH CARE IN ARGENTINA, A MIXED REVIEW
(CORRECTED COPY)

REF: A: BUENOS AIRES 0111
B: BUENOS AIRES 3485
C: BUENOS AIRES 3102

1. SUMMARY. The Argentine health care situation can be
compared to a person who has one hand in a pot of hot water
and the other hand in a pot of freezing water: on average,
the water temperature is just fine. While Argentina ranks
thirty-fourth in the United Nations Development Program's
Human Development Index on economic prosperity, longevity,
and education (U.S. is 7; Chile is 43), its health care
system ranks below other middle-income countries in the
region such as Costa Rica and Chile. An estimated 50
percent of the population has no health care coverage, and
must rely on public hospitals whose services are uneven.
Argentina has a high incidence of diseases associated with
lesser developed countries; these include TB, Chagas, dengue
and Hansen's disease.

2. Despite its uneven health care, this "Paris of Latin
America" has become a surgery tourism destination because of
its low prices and highly qualified physicians. State-of-
the-art medical equipment, purchased during the period of
convertibility, when the one peso was worth one dollar is
still in good working condition. Argentines in rural areas
and city slums suffer from lack of medical care. Of the 12.2
million youths and children in the country, 3.5 million live
in urban poverty and 1.4 million are indigent. Problematic
economic conditions have resulted in 16 percent of children
under five suffering from malnutrition. With inflation on
the rise, public hospitals are suffering from lack of funds,
and medical equipment is starting to wear out. Argentine
health resources are straining to provide adequate health
care services for urban shanty town dwellers and
impoverished rural areas. Improving the situation is a
major challenge for the Kirchner Administration that will
require resources, reform and sustained commitment. END
SUMMARY

Excellence in Argentine Health care
----------------------------------
3. Argentina is a Mecca for "medical tourism." Drawn by
state-of-the-art medical treatment, highly qualified
physicians, many with European and American training, and
low prices, increasing numbers of foreigners arrive to mix
surgery with tourism. Top-of-the-line medical equipment,
purchased when one peso equaled a dollar, is still in use,
making it possible to have an MRI for $100, a procedure
which would cost about $1,000 in the U.S. Argentina is the
fifth of 50 countries in the number of aesthetic surgery
interventions according to the International Society of
Aesthetic and Plastic Surgery. Surgery tours to Buenos
Aires are touted on the Web, offering "convenient first
class medical treatments and surgeries with the most
exciting and exotic tourism." Argentina is a center for the
development of new medical procedures and excellent doctors.
Two examples include Dr. Federico Benetti, who developed the
minimally-invasive direct coronary artery bypass as an
alternative to traditional open-heart surgery and Dr. Rene
Favaloro, the first surgeon to plan and perform a heart
bypass operation.
Impact of the 1998-2002 Depression
----------------------------------

4. Beginning in 1998, Argentina's economy went into
recession, which deepened into a full fledged depression and
culminated in financial collapse in 2001-2002. The
depression resulted in a 25 percent drop in GDP,
unemployment of one quarter of the labor force and of
mushrooming of poverty rates exceeding 50 percent of the
population. With unemployment at record levels, public
hospitals became crowded with middle and working class
patients who had lost their jobs, and therefore, their
health insurance. Health care workers were not always paid
on a timely basis and their salaries were reduced in dollar
terms with the devaluation of the peso. Some were paid in
valueless government bonds. The devalued peso could no
longer purchase expensive European and U.S. medicines and
equipment, resulting in shortages of the most basic
medications and supplies, including those for disease
prevention and screening. Argentines reacted to the crisis
by using public health centers in place of private care;
taking their children less frequently to health care centers
for preventive care; and/or canceling their health insurance
altogether. The crisis most affected and continues to
affect those under 15, particularly maternal-infant health.

Argentine Health Indicators: A Mixed Picture
---------------------------------------------

5. The World Health Organization (WHO) 2005 Report states

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that the 2003 life expectancy at birth for Argentine males
was 71.0 years and for females 78.0. The Economist
Intelligence Unit reported in 2004 an average Argentine life
of expectancy of 74 compared to 68 in Brazil, 76 in Chile
and 78 in the U.S. Sixty percent of deaths occur because of
cardiovascular reasons, tumors or external causes; traffic
accidents cause an inordinate numbers of deaths. Physicians
are concentrated in the largest cities, with a ratio of
doctors to people compared to that in developed countries,
about equal to the U.S. and surpassing Brazil and Chile.
Nurses, however, are in very short supply. Health care
differs widely between rural and urban areas, with uneven
levels of care. An estimated 50 percent of the population
has no health care coverage, and must rely on the public
hospitals whose services are uneven.

Health Issues for Mothers and Children
--------------------------------------

6. UNICEF's most recent report on children published in
December 2005 ranks Argentina as 127 in infant mortality,
better then Bolivia (62), Brazil (88) and Venezuela (125).
UNICEF reports that of the 12.3 million children and youths
in the country, 3.5 million live in urban poverty and 1.4
million are indigent. Even though infant mortality rates
have fallen by 50 percent over the last 20 years, according
to the World Bank, mortality levels in Argentina remain high
relative to countries with similar levels of economic
development that spend less on health (Chile, Costa Rica and
Uruguay). The reduction in infant mortality rates appears
to have slowed in the last few years. Similar trends are
observed in the case of maternal mortality. The widest
differences in health status exist among provinces, with the
poorest regions experiencing a significantly higher
incidence of maternal and child pathologies and infectious
diseases. Illegal abortion and the effects of poverty are
the main cause of maternal mortality in Argentina.

7. Children's health suffers due to the lack of prenatal
care (66 percent of the infant mortality deaths are due to
neonatal causes) and the effects of poverty. Public opinion
and civil society organizations have become more aware of
the health issues confronting children, especially the
poorest, and more programs are being implemented to remedy
some of the inequities. However, the mortality rate is
notably higher among women with low incomes and those who
live in the country's poorer provinces, mostly in northern
Argentina. The mortality rate for the city of Buenos Aires
is 14 deaths per 100,000 live births; in the Province of
Buenos Aires, it is 32; and the Argentine national average
is 44.

8. During the height of the recent economic crisis in
Argentina in 2002, more than 55 percent of the population
under the age of 18 was living in poverty, and more than 24
percent in extreme poverty. Over three million of
Argentina's 7.7 million poor children and adolescents
suffered from hunger according to a report prepared by the
Studies and Training Institute of CTA, a trade union
federation. Official figures indicate that the percentage
of those under the poverty line had risen to 40.2 in 2004.
Again, these statistics do not show acute inequities in some
provinces. The CTA study shows that poverty affects 75.2
percent of children in the northern Chaco province while
42.8 percent of minors under 18 face extreme poverty in
Santiago del Estero province, also in the north.

Chronic Malnutrition
--------------------

9. Chronic malnutrition is more of a problem in Argentina
than starving children, according to Patricia Aguirre,
anthropologist at University of Buenos Aires and Ministry of
Health nutritionist. About 3 percent of children between 0-
7 years in the public health sector are suffering from
chronic malnutrition resulting in stunted growth, while 12
percent suffer a less severe type of malnutrition resulting
in low height for their age, according to Ministry of Health
figures. These numbers have remained approximately the same
on a national level since the late 1990s. About 500
children die of malnutrition each year in Argentina.
According to the Center for Studies on Children's Nutrition,
7.5 percent of babies are born acutely malnourished or
underweight. That number doubles for the poor. As one out
of every two children suffers from anemia, the health
consequences for this generation are considerable. The
northern province of Tucuman is the most affected Argentine
province. In all provinces, at least half of child deaths
could have been prevented according to the Ministry of
Health and the Foundation for the Study and Investigation of
Women (FEIM). Two-thirds of infant deaths are neonatal. A

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mother's malnutrition is also a critical factor in
underweight births, and 33 percent of Argentine mothers are
anemic.

10. Children today are at additional risk from
tuberculosis, HIV/AIDS, environmental health-related
diseases. Argentina's TB rate has increased since 2002,
particularly in children between 5 and 9 years.
Transmission of the HIV virus from mother to child during
pregnancy and nursing accounts for 7 percent of new HIV
cases reported in Argentina, giving the country the highest
rate of such transmission in South America. The problem is
concentrated in the City of Buenos Aires and surrounding low-
income areas where an estimated 70 percent of the country's
130,000 HIV/AIDS cases occur. (REF A) One-third of all
diseases that affect children under the age of five years
are caused by environmental factors according to the WHO.
Additionally, some Argentine children face great health and
safety perils as the children of "cartoneros" (street
scavengers). (REF B)

Hansen's Disease , Chagas, TB...
--------------------------------

11. Due to deteriorating public and private health
environments, poor nutritional habits, and a lower standard
of living, Argentina has a high incidence of diseases
associated with lesser developed countries. These include
hantavirus, leishmaniasis, dengue, chagas, tuberculosis,
hepatitis, diarrhea, trichinosis, and HIV-AIDS. Argentina
has very high levels of meat consumption and children are
fed meat very early resulting in cases of hemolytic-uremic
syndrome, due to consumption of bad meat. The Ministry of
Health reports that Argentina has had an average of about
500 new cases of Hansen's Disease per year over the past ten
years.

Smoking/Drinking/Drugs/Traffic as Killers
-----------------------------------------

12. Smoking, alcohol and drug-related diseases as well as
bad driving habits shorten lives in Argentina, as in many
other countries. More than 46 percent of adult men, 34
percent of adult women, and 30 percent of youth smoke. The
rate of alcoholism in poor urban areas is more than three
times the rate found in higher-income areas. The WHO ranks
Argentina fifteenth of countries with the highest mortality
due to alcoholic liver disease (2001 data). Health problems
and social harms associated with unsafe and illegal drug use
include HIV, hepatitis, and other infections;
criminalization; and social exclusion. Traffic deaths in
Argentina are double the U.S. rate (15.2 for every 100,000
residents): 29.7 deaths for every 100,000 residents with an
average of 30 deaths per day, according to the Road Safety
and Education Institute.

Persons with Disabilities
-------------------------

13. WHO estimates suggest that 10 percent of the Argentine
population has some kind of disability. Government
officials believe, however, that the percentage is only 7 to
8 percent of the total population, while social
organizations estimate 15 percent. While there is no
agreement on the numbers, there is agreement that there are
significant regional differences in the rates of those
affected and the treatment available. Outside of the major
urban areas one may expect to confront a serious shortage of
trained health professionals who can treat disabilities.
Legislation exists; lack of implementation and oversight
appear to be the problems.

Organization and Provision of Health Services
---------------------------------------------

14. In the 1990s, the national public health system was
decentralized and the administration of public hospitals
transferred to provincial administrations and
municipalities. The Ministry of Health is charged with
standardizing, regulating, planning, and evaluating health
care activities in the country as well as producing
epidemiological statistics. The health care system includes
public and private hospitals on national, provincial and
city levels, public and private clinics, and first-care
health centers, particularly in rural areas. Additionally,
some of the "obras sociales" (public health trust funds)
have their own medical care clinics for workers. Obras
sociales are administered by trade unions or professional
organizations with oversight by the National Social Security
Administration.

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Mainstay of the Health System, the Public Hospital
--------------------------------------------- ----

15. The public hospitals provide care to the poor and
indigent who have no medical coverage and to those with
insufficient coverage. The public hospital provides free
services for foreigners (legitimate tourists as well as
"short-term immigrants" from neighboring countries who come
to obtain medical services). They serve higher-income-
earners who are attracted by the reputation of a particular
institution or its medical personnel or technological
capacities. Additionally, they are responsible for
providing essential health emergency services, training
professionals to the graduate and postgraduate level
(including many from other Latin American countries), and
biomedical research.

16. A 2003 WB report points out, however, that the public
hospital system is "floundering" under all its
responsibilities. WB's diagnosis is that the public
hospital system exhibits serious structural deterioration
and managerial inefficiency; a high degree of administrative
centralization at the provincial level; rigidity in its
staffing structure and labor relationships; no adequate
system of incentives; inadequate information systems on
which to base decision-making and control; serious deficits
in facilities and equipment maintenance; poor articulation
with social security, financial resource allocation
constraints, and a system of management ill-suited to its
size. These characteristics severely limit public
hospitals' ability to provide service to the non-insured.

The Health Insurance System
---------------------------

17. Public health care is publicly financed and is open to
all comers. The private health insurance plans, or "pre-
pagas," (pre-paid), are supported by members' fees. Social
security health care is financed by employers. The Civil
Association of Integrated Medical Activities (ACAMI) states
that 55 percent of Argentines had no health care coverage in
2004. Regional differences are pronounced: 30 percent lack
coverage in the city of Buenos Aires, 50 percent in greater
Buenos Aires (home to 8.5 million people), and 70 percent in
the country's poorest provinces such as Santiago del Estero,
Formosa, Corrientes and Chaco, all in the north.

Pensioners Health Care
----------------------

18. PAMI (Programa de Atencion Medica Inegral) finances
health care for over three million pensioners (91 percent of
the population over 65 is covered by PAMI). With its large
deficit, poor services and deficient oversight, PAMI is
suspected of widespread corruption according to the WB,
local companies and the Economist Intelligence Unit.

Health Professionals
--------------------

19. The most recent 2005 Ministry of Health data shows that
there are 32.1 doctors and 3.8 nurses for every 10,000
inhabitants. (Note: Low status and low salaries, about
$300-400 a month, for nurses, have left them in short
supply). According to a recent interview with the Rector of
the University of Buenos Aires (UBA), the quality of medical
education between public and private universities is
unequal. UBA graduates 40 percent of those who enter the
program, a reasonable number according to international
parameters. Health Minister Gonzalez Garcia has publicly
stated that Argentina has a high rate of doctors per capita,
but that they are poorly trained. He emphasized that there
is a need to modify the medical curriculum two to three
times in every doctor's course of study due to advances in
technology and information. (For example, none of the
medical schools of the national public universities offer
training in rehabilitation and/or disability as part of
their regular curriculum. No training is available to
general practitioners or to medical doctors who are not
disability specialists.) Stating his opposition to
unlimited entrance to medical schools, a hot topic of public
discussion currently, Gonzalez Garcia said, "We must not
train more doctors but better qualified doctors because
Argentina cannot afford to waste its limited resources."

Investment in Health
--------------------

20. The Kirchner administration and earlier national
governments have implemented emergency measures in response
to the crisis in the health sector. These included the 2002

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declaration of a national health emergency that remains in
force, several WB and IDB financed projects related to
maternal-child health and insurance programs, primary health-
care reform including training programs for health
professionals, food kitchens, and subsidies and training for
unemployed heads of households. The Government is planning
to spend $7.3 billion in social welfare programs.

COMMENT
-------

21. Argentines who live in metropolitan areas generally
receive good medical care, except the slum dwellers who
often fail to seek help, particularly preventive care.
However, there is a striking difference in the level of care
in the north, where there is a much larger indigenous
population and extreme rural poverty. Despite low pay and
an oversupply of doctors, young Argentines continue to flock
to the medical school which is free and open to all
applicants. Even the Minister of Health has criticized the
ability of medical schools to produce competent physicians.
Doctors warn patients against using physicians under 40
years of age. With a severe shortage of nurses, uneven
medical education for doctors, and medical equipment showing
wear, the GOA and provincial governments face a serious
challenge. Most of the population in the disadvantaged
provinces, all in the north, already has inadequate medical
care. President Kirchner has acknowledged the significant
deterioration in the health section. However, the question
remains whether the Federal government, together with the
provinces and other health care stakeholders, can meet the
health care needs of all of Argentina's population.
Improving the situation is one of major challenges facing
the country. END COMMENT

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