Dr. Carlos Alberto Díaz. Associate Professor at ISALUD University. [1]
We do not know clearly what the direction of the process of transformation of Argentina will be in economic, political, social and health matters, they are a set of questions, but nothing, it will be as before. In current health management, there are some trends that on the one hand if the country stabilizes economically and grows for several years, there will be a growth of the extractive and financial sector, following the current that occurs in serious countries in the search for development such as Australia or others.
These trends are hegemonic in the Western world, but with worrying actions linked to the soundness of state policies and the strength of democracies and their institutions.
Positioning in this age of knowledge produces an interest in access to data, information, for use for any purpose, which will lead to new disputes and wars for expansionist hegemony on the planet, and for the last throes of fossil fuels like gas and oil, which do not find a real substitute.
These health trends will also be based on excellence in care, improved accessibility, value-based medicine, and patient-centered, to give more life to the years.
The technological solutions, Theses on new information systems, monitoring, follow-up, precision diagnostic devices, the interpretation and algorithms of the data that come from people in their contact with the health system and new forms of personalized treatment, not one-size-fits-all, like the creation of knowledge-based solutions, The application of data, its interpretation, constant learning, will be clearly superior in terms of results and patients, and an active adaptation to the demands of the environment, to the greater longevity of the population. These changes are accelerated by the adoption of new technologies, processes, and care models to improve the efficiency, effectiveness, quality, and sustainability of the health system.
It is not something that will happen only in an instant, in the next year, but if it will be dizzying and unaccustomed, due to a discovery, or a macroeconomic trend only, it is a competition with substantial investments from the big players in the market. Because many of these advances are under the influence of the interests of Mega companies, such as Microsoft, Google, Amazon, Baidu, Nvidia, Salesforce CRM, Meta and IBM that are also being introduced into health systems, since the mining of their data is very valuable and valued, a new and juicy business for those who own it. store and resell it.
However, despite the optimism with these alternatives you can always be worse, especially if those who fall into the well do not stop digging and making things worse, that is us, longing for a past that was not better. You can also be better, but to do so you must make policies to achieve improvement in the quality of services, efficiency, access to health, divestment, medicine or health management of the six Ps, and incorporate advances in digitalization, information management, robotics and deep learning.
Progress must be made in improving the health of the population in a sustainable way and changing several of the paradigms that have been drawn up by the management so far, from the episodic model of care only for acute pathology to another of disease management, network, regionalization, access to primary care, containment of inflation in health, of changes in the sector’s tax policy, of training the necessary human resources and distributing them better, of not using them as an adjustment variable, of continuity of care. In the micro with the development of specific areas of microsystems of care at all levels.
The evolution has to start in the political system with stewardship, budget and financing, in the mismanagement, with the strengthening of the management of the facilities and the evolution in the transitions of the patients’ journeys in the system, that the passive attitude of waiting for demand to advance in a more proactive concept of covering the gaps in the detection and screening of cervical cancer is abandoned, in the detection and non-pharmacological management of diabetic patients, in changes in healthy lifestyle habits in relation to sedentary lifestyle, hypercholesterolemia and control of arterial hypertension.
Health management is a recursive cycle made up of planning, execution, communication, coordination, control, evaluation, participatory management, all its aspects are enhanced, leaving improvements that make you climb some steps.
The use of information systems, new technologies for data analysis and effective, assertive communication, independent knowledge and scientific evidence are imperative.
Those who perform health management must understand that it is a critical discipline today, which deals with directing and coordinating resources, the appropriate installation of skills and competencies to ensure the best possible agency relationship. It involves a variety of managerial functions and actions, with the central concept that management is not stocked, that it is always necessary to exercise presence, leadership, walk, have reliable information to make decisions in the short term to achieve the desired future, understanding that there are no short-term decisions, everything we do impacts the future we want, but that we will have to build. The three levels of management are very important, complementary, synergistic and in the end make the evolution reach the citizens. Managers must ensure that patients receive safe, effective, and needs-centered care.
The three levels, Macro-Meso-Micro, must collaborate and work towards a common goal. With a collaboration between the different entities and health professionals.
There are several models of health management, which must be characterized by addressing the following components: collection, budgeting, financing and coverage. Payment systems as appropriate incentives. Salaries as recognition of employees. Integrated care strategies. Planning, organization and structure. The processes of care. Patient management, access, management of diagnostic and treatment resources. Digitalization. Information analysis, quality management, safety, clinical guidelines and continuous improvement. The main focus or direction of decisions and actions must also be established.
In this detail, it defines the values (solidarity, universality, equity, integration, regionalization and strengthening of human resources), the priorities (ensuring access, based on primary care), the goals to address the challenges and how we will achieve the objectives (execution, payment conveniences and forms of execution). These components of management, both in financing, organization and structure, improvement in care processes, quality, among others, interact and combine at the different levels of management.
Financing alone is shown to be not enough, it is necessary to collect enough to provide what is indicated as a basket of benefits, set a budget, establish what is covered, how it is done, to whom, how, with what structures. In short, financing is not only about raising money, but also about the way in which economic resources are collected and distributed and what we have to achieve with them. What needs to be done, what results are expected, in what time, with what structure. That we propose as viable. Define if anything is going to be modified in the budgeting systems of hospitals and purchasing. Which will remain as national establishments and which provincial in the first place. Then we will ask you about your area of influence and programmatic. That we will encourage them to achieve based on factors of production, use and quality, also involve the private sector and non-profit entities in the information systems. That the members of the health provider companies will be asked to provide information about vaccination, waiting lists, prevention coverage, and the management of hypertensive patients, diabetics, those with incipient renal failure, in patients with COPD, in the screening of the main cancers, the greatest freedom of individuals is achieved when they are healthy, will be a fundamental factor in achieving an increase in the gross domestic product. Reduce bureaucracy, how care is organized, the assignment of roles and responsibilities. Generate a framework for the development of strategic plans.
In Argentina, several management models coexist, in terms of financing there is the Bismarck model, where funds for patient care are based on the contribution of workers and the contributions of employers, an instance that is clearly related to the purchasing power of wages, with two factors that affect this source of financing that are on the one hand the loss of wages with respect to inflation which annualized is close to seven percentage points. That there is also an inflation in health whose causality is multiple, but that there are several causal factors. Some can be managed. Others do not. Or that they are for the moment complex to manage. But we can all improve. This analysis of inflation in health affects the health insurance sector, the prepaid and the Ministries of Health.
The second model is the Beveridge, in force in Argentina of universal coverage based on taxes partially transferred to the provincial autonomies, but which ensures that all citizens can be treated in any hospital in the Republic.
Finally, the liberal model or free market model with a small group of private contracts in the field of health that is one million seven hundred thousand people that correspond to private contracts attended by the prepaid. The other affiliates of the prepaid health systems who have the highest incomes and who made the option for one of these private entities deriving as part of the payment of their beneficiary quota, the contributions and contributions, which affects the highest salaries, producing a skim to the solidarity system of social security.
As can be seen and known, there is overlapping coverage, organizational anarchy, lack of traditional strategic planning, with an eminent aspirational issue of citizens to improve their social status by switching to a prepaid plan.
We will not have a system until we decide how we will improve the «universality» so fatally unequal and inequitable, crystallized by the power of payment and the postal code.
[1] Specialist in Internal Medicine, Intensive Care, Nephrology and Public Health. Director of the Specialty in Economics and Health Management.
