On repeated occasions we have affirmed that the health system is entailing a structural crisis or that health providers are on the verge of collapse. This reality cannot be naturalized, nor understand that things must inexorably end in irrecoverable deterioration.
The impact on the population of a progressive weakening of the health system and particularly of the providers has immediate effects. Delays in shifts, not accessing a consultation, diagnostic processes or indicated treatments that are dilated in time is a problem and we cannot resign ourselves to this damage.
This delay does not respond to causes inherent to the nature of the medical act itself, or to periods of observation for the indicated evolution. The delays are the result of the decoupling of variables that affect theThe economy and sustainability of providers that will be less and less if these working conditions persist
From CAMEOF, the Chamber that brings together ophthalmological practices, institutes and clinics, we have specified five points that need to be addressed to seek solutions that promote sustainability in the quality and quantity of services necessary for our population in terms of visual health.
First: imports. In the immediate term, the greater restriction on imports has a direct impact on the cost structures of ophthalmological organizations, where in a typical organization 40% of theCosts are tied to the dollar by virtue of the high incidence that technology has in the specialty. A stricter trap makes it more expensive and generates a lack of essential supplies for the treatments indicated by ophthalmologists.
Second: The delay in values of the benefits paid by both state, national and provincial social works, as well as union social works and prepaid medical entities. In our costs observatory based on the evolution of these considering the impact of inflation, movements in the exchange rate and parities as of July 2022, the delay reaches to more than 170% in most benefits. Although the SSS (Superintendence of Health Services) has defined increases by authorizing prepaid companies, basically the increase in their fees and their subsequent transfer to providers; in recent times it is not enough and in many cases there are many entities that are not complying with the law.
Third: payments at 120 days. The delay of payment termsthe average time in a survey carried out at the national level amounts to 120 days. This situation under normal conditions constitutes a fiduciary advantage of those who must pay in a timely manner, taking advantage of the basic financial principle, which is the time value of money. Under current conditions, combining the inflationary and exchange effect and the rates at which an organization could be financed in terms of working capital or working capital; these deadlines are unsustainable and the organizations become economically unviable. A financial problem becomes an economic problem.
Fourth, transaction costs. The increase in the so-called transaction costs. CAMEOF’s cost observatory detects the growth of these costs. The so-called agency expenses, product of the growing number of administrative processes and modification in the systems of validation of benefits by social and prepaid works. All the modifications result in a greater administrative burden that falls on doctors’ offices, institutes and clinics. These are costs that a company has to incur when, instead of trying to cover its needs with its own resources or internal processes, it has to go to market in order to meet the growing requirements by incorporating HR and technology. It should be noted that many social and prepaid works have not restored face-to-face care for their members, transferring all these care processes to the providers and the hindrance that this entails for the affiliate/patient. In a particular case, a single administrative office must authorize thousands of surgery orders.
Fifth: The tax burden about health organizations unbearable. Deal with national, provincial and municipal taxes with their distorting effects.
The concurrence of both the tax accumulation effect; understanding by this the cascade effect that occurs when the computation of the tax paid in the previous stage is not admitted, which is why in the following stage tax is paid on tax. A typical case is the gross receipts tax. As well as the accumulation of taxes produces pyramiding effects when the increase in the final price of the good, in this case the service, is greater than the tax actually paid to the Treasury.
The treatment of VAT should also be studied, which is accrued at the time of invoicing benefits that, as we said, are charged after 120 days. Therefore, with this average, health organizations pay the average VAT between three or four months in advance and if for any reason this practice is not paid, it is impossible to recover what has already been paid.
Added to these distorting effects are the check tax and the different advances that must be made on profits, gross income and others that are also paid in advance.
A worrying health situation
These points summarize a picture of the extremely worrying situation that supports the different claims that are issued today from the sector, but they must fundamentally constitute an alarm signal to society.
Less access to health implies a specific deterioration in the quality of life of citizens and the structures, technology and training of HR are not generated from one day to the next. If Argentina loses these distinctive capabilities of the provider sector, it will take decades to recover them, if at all.
At CAMEOF, in this sense, we firmly believe that we must encourage a profound debate on the health system, its financing, its scope, the role of public and private actors, the role and need of intermediaries, and many other central topics in order to channel a dynamic that today naturalizes the crisis as a state of permanent situation.
We are convinced that we must attend this debate all the actors of the system stripped of sectoral or corporate pettiness, dogmatism or prejudice. Assuming with responsibility, technical rigor and decision, modify basic aspects that allow the development of quality health services and accessible to the population of our beloved country to once again be proud of making it possible.
Argentina has historically stood out for its quality of care and it would be nonsense to lose both the technological and human capital that made us a true beacon for different medical specialties.
*Juan Manuel Ibarguren is Mgter. in Health Services Administration and Secretary of CAMEOF.
**Omar López Mato is an ophthalmologist – MN 59216. Director of the Vision Institute. CAMEO member.
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