Local health systems: analysis of the relationship between insurance and contract and payment mechanisms in Cordoba, Salta and Tucuman

Abstract

INTRODUCTION: The contracting and payment mechanisms in health generate different impact on the quantity and quality of medical services, the transfer of risk among actors and the efficient use of resources. OBJECTIVES: To analyze the market structure of health services in the provinces of Cordoba, Salta and Tucuman during the past five years. We considered the local socioeconomic and health conditions, institutional framework, the history of the most relevant actors, and their behaviour in response to the structure. The methodology included a mapping of key actors in the health sector in each province and the administration of a questionnaire to a sample of local public and private health institutions. RESULTS: The results show that the provincial ministries of health are the primary funders of the public services and the national insurance for retired people (PAMI) and the provincial social insurances are the primary funders of the private system. CONCLUSION: PAMI has a national policy which makes itself less flexible to consider the local particularities, while the provincial social insurances present themselves as idiosyncratic actors, being more receptive to local demands. If PAMI were coordinated with the structure of the local social insurance and the ministries of health, it could be achieved homogeneous models of health care and payment mechanisms, generating incentives for a more efficient resources allocation and equity in health.