The political tension over the care of Buenos Aires residents in Buenos Aires public hospitals added a new chapter this week, when the video of a doctor from Argerich went viral, asking where the people who were waiting in a collapsed guard lived and, except for one, all They came from the suburbs of the province of Buenos Aires.
The head of the Buenos Aires Government, Jorge Macri, announced that he will prioritize the health care of the inhabitants of the City in local health centers and the province of Buenos Aires came to the crossroads: “Every day, almost 3 million Buenos Aires residents travel from the suburbs to CABA to work, they spend and generate wealth, and that generates daily life with the health system,” a Buenos Aires spokesperson explained to TN.
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Although as the hours passed, both parties tried to tone down the confrontation, an underlying issue was revealed that goes beyond health care. The fight for shared resources – which during the coronavirus pandemic reached a peak when former President Alberto Fernández readjusted transfers due to the transfer of the Federal Police to CABA to reassign them to the Province – is still in force and no one is willing to give in, even less in times of “no money”.
Public system under tension and underlying issues in dispute
During Axel Kicillof's first term as Buenos Aires governor, Macri was Vicente López's mayor. The communal leaders of Together for Change reported on several occasions that they were discriminated against by the Peronist administration when it came to distributing provincial resources. Now, the balance was even, but the effervescence did not decrease.
The fight over shared funds is the mother of all battles. When co-participation was legislated, the autonomy of the City did not exist and it was only incorporated into the law when it obtained that independence. Buenos Aires administrations have always questioned the gap between what they contribute and what they receive, but the Province also has a similar claim.
The doctor on duty was overwhelmed by the large number of patients who arrived at the Argerich hospital. (Photo: video capture).
“The Province produces 40% of the co-participation and receives 20%, if it had those resources the health system would be better,” they acknowledge near Kicillof, they also point to education and each of the sectors that, they say, require greater presence of the State.
However, they highlight that during the current administration, six hospitals, 156 health centers were inaugurated and more than 300 ambulances were delivered, in addition to the commissioning of many hospitals. In CABA they say that it is not enough.
The AMBA, a region that knows no borders
“According to the rate of use of the public consultation system, 40% are made to Buenos Aires residents and that is a fairly stable figure over the years,” said the Buenos Aires Minister of Health, Fernán Quirós, in Solo una Vuelta Más, by TN. In this regard, he said that the ideal is “for each citizen of the AMBA to have their health system as close as possible” and that “the best thing is for them to have a competent health center in their neighborhood, which will solve 80% or 90% of their lives.” %” of what you need, before being referred to a hospital.
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In the Province, they explain that the more than 3 million people who cross the General Paz or the Pueyrredón Bridge every day to work cannot wait to return to their towns to receive treatment at night in a nearby health center, so they end up generating what they call “daily life with the Buenos Aires health system.” That is what ends up collapsing the public care network, they say in CABA.
The solution? Quirós explained that Macri decided to prioritize and reinforce the care modality that is oriented to the people of Buenos Aires, over the episodic modality, which corresponds to the public hospital network.
According to him, in CABA there are “two modalities of care”, one “that is oriented to the citizen of Buenos Aires, with the CESAC, which is the central reorientation and is completed with a more complete outpatient level” and the other that is “of care episodic, which are hospitals”, where they assist people who do not live in the Capital. “What we are going to do is prioritize the first modality. In this continuous modality we are going to put energy so that all Buenos Aires residents have full access to health,” said the minister.
Those around Kicillof recalled that during the pandemic “17% of Buenos Aires residents were vaccinated in the Province with resources from the Province”, in addition to the fact that thousands of Buenos Aires tourists are treated in Buenos Aires health centers during the summer, weekends. long week and holidays, when they do not have a hospital or a clinic from the CABA health network nearby.
“CABA is the capital of the country, it has national headquarters of all the universities and hospitals, yet the high complexity is done in the province, in hospitals such as El Cruce, Cañuelas, San Martín, Incucai, for example. in transplants,” they said near Nicolás Kreplak, the Buenos Aires Minister of Health.
For the Buenos Aires management, the solution is to understand the AMBA as an area that in health matters crosses the borders between City and Province, something that JxC tried during the management in which Horacio Rodríguez Larreta and María Eugenia Vidal coincided and that Quirós himself headed, but that today seems far from being achieved.
“There are hundreds of thousands of Buenos Aires residents who are treated in PBA health centers and vice versa; and it's okay, so be it. Understand once and for all that the PBA and the CABA are and function as a conglomerate and it is impossible to divide medical care taking General Paz as a reference; “We have to think about the health system as a whole,” said Daniel Gollán, Kicillof's former Minister of Health.
Doctors and patients in the middle
While CABA and PBA share responsibilities, what happens in the public health system goes through another channel, fundamentally at a time when increases in prepaid fees led to an increase in demand in hospitals and healthcare centers; added to the people who lost their social work, becoming unemployed or working informally.
As if that were not already enough stress on the system, doctors explain that low salaries expel many professionals from the public system and that the lack of updating of fees by prepaid companies does the same in clinics, which is why it is increasing. plus attention in offices.
Doctors warn that patients are treated in the wards due to the delay in consultations (Photo: GCBA).
Both PBA and CABA recognize that, in this context, the health system is under stress, but they deny that it is collapsed. Quirós asked to differentiate a guard, like what went viral in the video, from what happens in the clinics and in the Province they assure that the people of Buenos Aires are treated in the Capital due to a matter of customs rather than due to failures in the system itself.
In fact, they said that they added 30,000 doctors per year to the health system, all residents were transferred to the ward for three years and 7,000 nurses were added to the ward.
However, Alejandra Lupis, president of the Meléndez section of CICOP – the province's professional association – told TN that the salary of a plant entry is $480,000 and an on-call doctor's salary is $546,000. In addition, she assured that in Buenos Aires public hospitals “there is a lack of supplies, hospitalization capacity was reduced and demand is at least maintained” and that “the budgets that are approved are very low.”
“People are turning to the public system due to the increase in prepaid, added to the fact that three out of ten people stopped taking medications for chronic diseases and that generates stress in the guards, as in the case of cancer or disability,” they said from the province.
“The public health system of the city of Buenos Aires is collapsed, not because of the number of people who come to work in the city, which is what they propose in the province, but because of the lack of planning on the part of the province of Buenos Aires. a health system that cares for people who live and not work in the province,” said David Barbieri (MN 92401), head of the Intensive Care Unit at Álvarez Hospital.
For the doctor, “this is a systematic issue in the province, which goes through all governments,” regardless of political color. Something like this is acknowledged by the Kreplak minister, although they are responsible for highlighting the progress of the last four years, even in the midst of the pandemic.
Barbieri said that added to this were “people who have fallen out of the prepaid or social work system, which generated an overload in the public network” and those who approach a hospital because “they give them more answers than in the private or “They give less thought to resolve some issues.”
“The shift systems are extremely overwhelmed, they come with a delay in what is the outpatient clinic, and they end up reverting to the ward, because people say 'they don't treat me in the office, I can't get an appointment in the office, I go to the ward', which is a poor use of the system,” he explained.
“We really don't believe it is a problem of CABA versus the Province. The health situation in the country has been deteriorating for years and in this context it is felt much more. Everything adds and everything subtracts, both for the hospital workers and for those who come to receive care,” Lupis explained.
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Carina Balasini (MN 104.407), intensive care doctor and member of the Argentine Society of Intensive Care (SATI), said that “outpatient consultations are complicated,” but that in the ICUs “everything is resolved regardless of place of residence, nationality.” , nor social work.”
Something similar was pointed out by Eleonora Cunto (MN 66,908), head of intensive care at the Muñiz Hospital, who assured that in that health center “there is no fight between what is the PBA and the CABA; There is no discussion, the suffering, the sick are cared for.” “The situation in hospitals is always the same, it was never super fantastic, we always had to fight it and we always have to be on the side of those who have the least,” she added.