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Equity gaps in access to primary health-care centres in Argentina

Date: Poster sessions
Source: Forum 11
Authors: Daniel Maceira, Senior Researcher, Department of Health Economics, Center for the Study of State and Society (CEDES), Argentina
with Cintia Cejas, Pedro Kremer and Sofia Olaviaga

Abstract

Segmentation of the Argentina health system structure forces the public health system to concentrate its efforts mainly on people without formal health coverage, resulting in a systemic bias towards higher epidemiological and financial risks. In order to avoid resources being misallocated, alternative types of services should be considered based on the needs of the poor, using primary health care centres (PHC) and hospitals. An inadequate geographical distribution of PHCs affects both service delivery and effectiveness of programmes based on such centres, with serious implications for equity of access. In this context, the current study analyses PHC geographical distribution, between and within provinces (among municipalities), linking them with indicators of health care needs (populations without formal health coverage).

As different levels of urbanisation lead to alternative supply requirements (e.g. dispersion, fixed costs), the analysis is adjusted by scale factors, creating density quarters by municipalities. Data was obtained from the 2001 National Census and the Ministry of Health Statistics Department.

Country results show a median of 3183 people without health cover for each PHC, with significant differences between and within provinces. For example, La Rioja province reports a 15 times lower average than Greater Buenos Aires (543 vs. 8325). Both cases may be associated with inadequate resource allocation, reflecting sub- utilization and overload of infrastructure, respectively. Important differences are also found within each province, with a 3400% difference among municipalities in Buenos Aires province. Differences of PHC distribution among provinces arise because health- care policies promoting access apply to the jurisdiction of each health authority, and are linked to the nature of the national decentralization model. This is not the case within each province, however, where variation between municipalities with similar socioeconomic characteristics highlight a lack of equitable and effective criteria for resource allocation based on health care needs.