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Argentina’s economic crisis has physicians working to deal with astronomical costs
At the end of 2001, the Argentine peso was severely devalued. The situation is still grim, but the medical community maintains hope.
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BUENOS AIRES – The fall of the Argentine peso at the end of 2001 has meant devastation for the entire country. Medicine has not been exempt from these effects.
Unemployment has soared, and although physicians maintain their ability to care for patients, they see patients postponing treatment because of the cost of medical care.
Physicians have seen their practices affected by hyperinflation in parallel with a plummet in their incomes. Although physicians are maintaining hope, some are more confident than others that the crisis will resolve.
The root of the crisis lies in corruption that went unchecked for several decades and finally reached a head at the end of 2001, when Argentina could not make its loan payment to the International Monetary Fund. When a loan extension was denied, the country took drastic actions to maintain a reserve of funds by freezing the bank accounts of its citizens, which caused an uproar of protests and looting.
The aftershocks of the upheaval are still being felt, with inflation, high unemployment rates, higher crime rates and a disproportionate effect on the health care system, said Arturo Maldonado Bas, MD, chief professor of ophthalmology at the University of Córdoba.
“What’s left is a great imbalance because you are earning the same as before but in pesos that signifies sometimes [many] times less” than when the currency’s value was pegged to the dollar, Dr. Maldonado Bas said. “We have tried to accommodate everybody by reducing costs in many areas, but the public health system is in a very grave situation.”
Cutting back on cost
The University Hospital in Córdoba is funded largely by the university there. The hospital receives an annual budget of 180,000 pesos, which Dr. Maldonado Bas said is now enough to cover expenses for only 1 month of the year. The rest of the year, the hospital manages with a self-support system by means of contributions requested from the patients to the hospital.
For Dr. Maldonado Bas, cutting back on costs has meant not replacing equipment and using cheaper IOLs and viscoelastics. This means using a rigid IOL instead of a foldable, and as a result a larger incision. Although patients’ vision is still restored, this represents a setback in care. Whereas with a foldable IOL patients can achieve optimal vision within 24 hours, they now have to wait 14 days for clearer vision, he said.
“For what the physician gets paid, the costs of cataract surgery aren’t covered,” said Carlos J. Argento, MD, president of the Argentine Society of Ophthalmology, professor and chairman of ophthalmology at the Universidad de Buenos Aires and chairman of the Instituto de la Vision in Buenos Aires. Because surgeons often have to buy their supplies from U.S. companies in U.S. dollars, their level of reimbursement does not cover the cost of procedures and necessary supplies, he said.
| Problems for industry, too |
| The political and economic instability in Argentina have made it an unfavorable region in which to do business. Like physicians, the manufacturers of medical devices and supplies are also struggling to withstand the crisis. “It’s our intention to stay in Argentina also during bad times because we do believe in the potential of this country, and we are also convinced this operation can be financially healthy,” said a local Brazilian manager of a major international ophthalmic pharmaceutical company, who requested anonymity. “Through this trust, we will keep promoting our products, keeping jobs above all and contributing to the country in this turnaround process.” According to this source, the ophthalmic market in Argentina has dropped by up to 40% in U.S. dollars, in addition to a steep decline in units sold. Mediphacos, based in Brazil, has also stayed in Argentina when other companies opted to close or move their business elsewhere. “In contrast to other companies, Mediphacos has expanded its operations and investments in Argentina during 2002,” said Marcelo Soares, director of commercial development at Mediphacos. “We believe the worst is over, although we still foresee difficult times ahead. However, we are certain that Argentina will eventually recover its economy.” |
“With fewer examinations being done, the public’s health is going to be jeopardized,” he added.
Argentine surgeons who spoke to Ocular Surgery News said the problem is on two levels. For physicians, they continue to deliver care, but their pay is affected. For patients, they are feeling the economic effects of crisis and may be putting their health care second because of it.
“In a patient with glaucoma, medical treatment may cost between 100 and 200 pesos, but their salary is between 300 and 500 a month, so the patient cannot detract from the 500 pesos he has to live from and spend 120 for treatment. It’s a very serious problem,” Dr. Maldonado Bas said.
In his clinic, there has been a drop of 30% in patients coming for cataract surgery consultations. For every 100 patients in need of surgery, 30 opt to postpone it, he said. Dr. Argento agreed.
“The standard of living for middle class life in Argentina is definitely going to be reduced. A country that has capitation and high lending … will weaken the middle class,” Dr. Argento said.
Political corruption
The reasons for the current crisis are many, but surgeons who spoke to OSN said corruption in both the public and private sector is one of the problems.
“I think the situation in Argentina is neither economic or political. It is a problem of the highest level of corruption that exists at all levels, and a country can’t go on with the corruption that exists here,” Dr. Argento said.
“There are various aspects to the problem because the economic fallout of the country is due to a defiance of those in government for the last 16 years,” Dr. Maldonado Bas said. “They incurred external debt to a terrible extent.”
According to Dr. Maldonado Bas, money handled by the government was routinely displaced. Although Argentina was able to pay its debts and keep its peso-to-dollar par through the sale of several state-owned enterprises, the inability to maintain this balance indefinitely finally sparked the economic crisis and the devaluation of the peso.
The mishandling of funds at the heart of the crisis is something all too prevalent in Latin America, Dr. Argento said.
There is corruption in the major political parties, and its influence has reached medicine and affected its ability to provide proper care, he said. Even the insurance companies are to blame for part of the crisis, he added. Surgeons expect several years of hardship to ensue.
“It’s a very sad situation,” Dr. Maldonado Bas said. “This is such a rich country, but there are still a lot of good people. In the hospital I see people working and living honestly, people who earn 150 dollars are working as if they earned 500.”
Insurace coverage
Surgeons say their primary concern is management of their patients under the tight constraints of the economic crisis. In Argentina, 95% of people are now insured through the public health care system, said Enrique Malbrán, Jr., MD, who practices in Buenos Aires.
Like the other surgeons, Dr. Malbrán noted that the high cost of supplies because of the peso devaluation has generated restrictions that sometimes weaken the physician-to-patient relationship. He said insurance that pays the same amount, despite the higher cost of supplies, leaves some cases uncovered.
“I think there are more hard times ahead of us than the ones we’ve endured this year,” Dr. Malbrán said. “In these last few months, there has been some stability in Argentina, but the problem of costly supplies will continue and will affect decisions in administering medical treatments.”
Elections next year could bring a new president and political philosophy to Argentina. With the right party in place, the economic crisis could normalize in 2 to 3 years, Dr. Maldonado Bas speculated.
For Your Information:
- Carlos J. Argento, MD, can be reached at the Instituto de la Vision, Marcelo T De Alvear, 2261 Buenos Aires, Argentina; (54) 1-14-827-7900; fax: (54) 11-4-822-8374; e-mail: argentoo@fibertel.com.ar.
- Enrique Malbrán Jr., MD, can be reached at parera 164, Capital Federal, 1014 Buenos Aires, Argentina; (54) 1-81-58-144; fax: (54) 11-4815-1303; e-mail: emalbranjr@ciudad.com.ar.
- Arturo Maldonado Bas, MD, can be reached at the Clinica de Ojos Maldonado Bas, Achával Rodríguez 544, X5000BKL Córdoba, Argentina; (54) 351-468-6500; fax: (54) 351-463-4411; e-mail: malbas@satlink.com; Web site: www.clinicamaldonadobas.com.ar.