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UNCLAS SECTION 01 OF 05 BUENOS AIRES 003119 
 
SIPDIS 
 
SIPDIS 
 
E.O. 12958: N/A 
TAGS: TBIO ECON PREL PHUM AR
SUBJECT:  HEALTH CARE IN ARGENTINA, A MIXED REVIEW 
(CORRECTED COPY) 
 
REF: A: BUENOS AIRES 0111 
     B: BUENOS AIRES 3485 
     C: BUENOS AIRES 3102 
 
¶1.  SUMMARY.  The Argentine health care situation can be 
compared to a person who has one hand in a pot of hot water 
and the other hand in a pot of freezing water:  on average, 
the water temperature is just fine.  While Argentina ranks 
thirty-fourth in the United Nations Development Program's 
Human Development Index on economic prosperity, longevity, 
and education (U.S. is 7; Chile is 43), its health care 
system ranks below other middle-income countries in the 
region such as Costa Rica and Chile.  An estimated 50 
percent of the population has no health care coverage, and 
must rely on public hospitals whose services are uneven. 
Argentina has a high incidence of diseases associated with 
lesser developed countries; these include TB, Chagas, dengue 
and Hansen's disease. 
 
¶2.  Despite its uneven health care, this "Paris of Latin 
America" has become a surgery tourism destination because of 
its low prices and highly qualified physicians.  State-of- 
the-art medical equipment, purchased during the period of 
convertibility, when the one peso was worth one dollar is 
still in good working condition.  Argentines in rural areas 
and city slums suffer from lack of medical care. Of the 12.2 
million youths and children in the country, 3.5 million live 
in urban poverty and 1.4 million are indigent.  Problematic 
economic conditions have resulted in 16 percent of children 
under five suffering from malnutrition.  With inflation on 
the rise, public hospitals are suffering from lack of funds, 
and medical equipment is starting to wear out.  Argentine 
health resources are straining to provide adequate health 
care services for urban shanty town dwellers and 
impoverished rural areas.  Improving the situation is a 
major challenge for the Kirchner Administration that will 
require resources, reform and sustained commitment.  END 
SUMMARY 
 
Excellence in Argentine Health care 
---------------------------------- 
¶3.  Argentina is a Mecca for "medical tourism."  Drawn by 
state-of-the-art medical treatment, highly qualified 
physicians, many with European and American training, and 
low prices, increasing numbers of foreigners arrive to mix 
surgery with tourism.  Top-of-the-line medical equipment, 
purchased when one peso equaled a dollar, is still in use, 
making it possible to have an MRI for $100, a procedure 
which would cost about $1,000 in the U.S.  Argentina is the 
fifth of 50 countries in the number of aesthetic surgery 
interventions according to the International Society of 
Aesthetic and Plastic Surgery.  Surgery tours to Buenos 
Aires are touted on the Web, offering "convenient first 
class medical treatments and surgeries with the most 
exciting and exotic tourism."  Argentina is a center for the 
development of new medical procedures and excellent doctors. 
Two examples include Dr. Federico Benetti, who developed the 
minimally-invasive direct coronary artery bypass as an 
alternative to traditional open-heart surgery and Dr. Rene 
Favaloro, the first surgeon to plan and perform a heart 
bypass operation. 
Impact of the 1998-2002 Depression 
---------------------------------- 
 
¶4.  Beginning in 1998, Argentina's economy went into 
recession, which deepened into a full fledged depression and 
culminated in financial collapse in 2001-2002.  The 
depression resulted in a 25 percent drop in GDP, 
unemployment of one quarter of the labor force and of 
mushrooming of poverty rates exceeding 50 percent of the 
population.  With unemployment at record levels, public 
hospitals became crowded with middle and working class 
patients who had lost their jobs, and therefore, their 
health insurance.  Health care workers were not always paid 
on a timely basis and their salaries were reduced in dollar 
terms with the devaluation of the peso.  Some were paid in 
valueless government bonds. The devalued peso could no 
longer purchase expensive European and U.S. medicines and 
equipment, resulting in shortages of the most basic 
medications and supplies, including those for disease 
prevention and screening.  Argentines reacted to the crisis 
by using public health centers in place of private care; 
taking their children less frequently to health care centers 
for preventive care; and/or canceling their health insurance 
altogether.  The crisis most affected and continues to 
affect those under 15, particularly maternal-infant health. 
 
Argentine Health Indicators:  A Mixed Picture 
--------------------------------------------- 
 
¶5.  The World Health Organization (WHO) 2005 Report states 
 
BUENOS AIR 00003119  002 OF 005 
 
 
that the 2003 life expectancy at birth for Argentine males 
was 71.0 years and for females 78.0.  The Economist 
Intelligence Unit reported in 2004 an average Argentine life 
of expectancy of 74 compared to 68 in Brazil, 76 in Chile 
and 78 in the U.S.  Sixty percent of deaths occur because of 
cardiovascular reasons, tumors or external causes; traffic 
accidents cause an inordinate numbers of deaths.  Physicians 
are concentrated in the largest cities, with a ratio of 
doctors to people compared to that in developed countries, 
about equal to the U.S. and surpassing Brazil and Chile. 
Nurses, however, are in very short supply.  Health care 
differs widely between rural and urban areas, with uneven 
levels of care.  An estimated 50 percent of the population 
has no health care coverage, and must rely on the public 
hospitals whose services are uneven. 
 
Health Issues for Mothers and Children 
-------------------------------------- 
 
¶6.  UNICEF's most recent report on children published in 
December 2005 ranks Argentina as 127 in infant mortality, 
better then Bolivia (62), Brazil (88) and Venezuela (125). 
UNICEF reports that of the 12.3 million children and youths 
in the country, 3.5 million live in urban poverty and 1.4 
million are indigent.  Even though infant mortality rates 
have fallen by 50 percent over the last 20 years, according 
to the World Bank, mortality levels in Argentina remain high 
relative to countries with similar levels of economic 
development that spend less on health (Chile, Costa Rica and 
Uruguay).  The reduction in infant mortality rates appears 
to have slowed in the last few years.  Similar trends are 
observed in the case of maternal mortality.  The widest 
differences in health status exist among provinces, with the 
poorest regions experiencing a significantly higher 
incidence of maternal and child pathologies and infectious 
diseases.  Illegal abortion and the effects of poverty are 
the main cause of maternal mortality in Argentina. 
 
¶7.  Children's health suffers due to the lack of prenatal 
care (66 percent of the infant mortality deaths are due to 
neonatal causes) and the effects of poverty.  Public opinion 
and civil society organizations have become more aware of 
the health issues confronting children, especially the 
poorest, and more programs are being implemented to remedy 
some of the inequities.  However, the mortality rate is 
notably higher among women with low incomes and those who 
live in the country's poorer provinces, mostly in northern 
Argentina.  The mortality rate for the city of Buenos Aires 
is 14 deaths per 100,000 live births; in the Province of 
Buenos Aires, it is 32; and the Argentine national average 
is 44. 
 
¶8.  During the height of the recent economic crisis in 
Argentina in 2002, more than 55 percent of the population 
under the age of 18 was living in poverty, and more than 24 
percent in extreme poverty.  Over three million of 
Argentina's 7.7 million poor children and adolescents 
suffered from hunger according to a report prepared by the 
Studies and Training Institute of CTA, a trade union 
federation.  Official figures indicate that the percentage 
of those under the poverty line had risen to 40.2 in 2004. 
Again, these statistics do not show acute inequities in some 
provinces.  The CTA study shows that poverty affects 75.2 
percent of children in the northern Chaco province while 
42.8 percent of minors under 18 face extreme poverty in 
Santiago del Estero province, also in the north. 
 
Chronic Malnutrition 
-------------------- 
 
¶9.  Chronic malnutrition is more of a problem in Argentina 
than starving children, according to Patricia Aguirre, 
anthropologist at University of Buenos Aires and Ministry of 
Health nutritionist.  About 3 percent of children between 0- 
7 years in the public health sector are suffering from 
chronic malnutrition resulting in stunted growth, while 12 
percent suffer a less severe type of malnutrition resulting 
in low height for their age, according to Ministry of Health 
figures.  These numbers have remained approximately the same 
on a national level since the late 1990s.  About 500 
children die of malnutrition each year in Argentina. 
According to the Center for Studies on Children's Nutrition, 
7.5 percent of babies are born acutely malnourished or 
underweight.  That number doubles for the poor.  As one out 
of every two children suffers from anemia, the health 
consequences for this generation are considerable.  The 
northern province of Tucuman is the most affected Argentine 
province.  In all provinces, at least half of child deaths 
could have been prevented according to the Ministry of 
Health and the Foundation for the Study and Investigation of 
Women (FEIM).  Two-thirds of infant deaths are neonatal.  A 
 
BUENOS AIR 00003119  003 OF 005 
 
 
mother's malnutrition is also a critical factor in 
underweight births, and 33 percent of Argentine mothers are 
anemic. 
 
¶10.  Children today are at additional risk from 
tuberculosis, HIV/AIDS, environmental health-related 
diseases.  Argentina's TB rate has increased since 2002, 
particularly in children between 5 and 9 years. 
Transmission of the HIV virus from mother to child during 
pregnancy and nursing accounts for 7 percent of new HIV 
cases reported in Argentina, giving the country the highest 
rate of such transmission in South America.  The problem is 
concentrated in the City of Buenos Aires and surrounding low- 
income areas where an estimated 70 percent of the country's 
130,000 HIV/AIDS cases occur.  (REF A)  One-third of all 
diseases that affect children under the age of five years 
are caused by environmental factors according to the WHO. 
Additionally, some Argentine children face great health and 
safety perils as the children of "cartoneros" (street 
scavengers).  (REF B) 
 
Hansen's Disease , Chagas, TB... 
-------------------------------- 
 
¶11.   Due to deteriorating public and private health 
environments, poor nutritional habits, and a lower standard 
of living, Argentina has a high incidence of diseases 
associated with lesser developed countries.  These include 
hantavirus, leishmaniasis, dengue, chagas, tuberculosis, 
hepatitis, diarrhea, trichinosis, and HIV-AIDS.  Argentina 
has very high levels of meat consumption and children are 
fed meat very early resulting in cases of hemolytic-uremic 
syndrome, due to consumption of bad meat.  The Ministry of 
Health reports that Argentina has had an average of about 
500 new cases of Hansen's Disease per year over the past ten 
years. 
 
Smoking/Drinking/Drugs/Traffic as Killers 
----------------------------------------- 
 
¶12.  Smoking, alcohol and drug-related diseases as well as 
bad driving habits shorten lives in Argentina, as in many 
other countries.  More than 46 percent of adult men, 34 
percent of adult women, and 30 percent of youth smoke.  The 
rate of alcoholism in poor urban areas is more than three 
times the rate found in higher-income areas.  The WHO ranks 
Argentina fifteenth of countries with the highest mortality 
due to alcoholic liver disease (2001 data).  Health problems 
and social harms associated with unsafe and illegal drug use 
include HIV, hepatitis, and other infections; 
criminalization; and social exclusion.  Traffic deaths in 
Argentina are double the U.S. rate (15.2 for every 100,000 
residents):  29.7 deaths for every 100,000 residents with an 
average of 30 deaths per day, according to the Road Safety 
and Education Institute. 
 
Persons with Disabilities 
------------------------- 
 
¶13.  WHO estimates suggest that 10 percent of the Argentine 
population has some kind of disability.  Government 
officials believe, however, that the percentage is only 7 to 
8 percent of the total population, while social 
organizations estimate 15 percent.  While there is no 
agreement on the numbers, there is agreement that there are 
significant regional differences in the rates of those 
affected and the treatment available.  Outside of the major 
urban areas one may expect to confront a serious shortage of 
trained health professionals who can treat disabilities. 
Legislation exists; lack of implementation and oversight 
appear to be the problems. 
 
Organization and Provision of Health Services 
--------------------------------------------- 
 
¶14.  In the 1990s, the national public health system was 
decentralized and the administration of public hospitals 
transferred to provincial administrations and 
municipalities.  The Ministry of Health is charged with 
standardizing, regulating, planning, and evaluating health 
care activities in the country as well as producing 
epidemiological statistics.  The health care system includes 
public and private hospitals on national, provincial and 
city levels, public and private clinics, and first-care 
health centers, particularly in rural areas.  Additionally, 
some of the "obras sociales" (public health trust funds) 
have their own medical care clinics for workers.  Obras 
sociales are administered by trade unions or professional 
organizations with oversight by the National Social Security 
Administration. 
 
 
BUENOS AIR 00003119  004 OF 005 
 
 
Mainstay of the Health System, the Public Hospital 
--------------------------------------------- ---- 
 
¶15.  The public hospitals provide care to the poor and 
indigent who have no medical coverage and to those with 
insufficient coverage.  The public hospital provides free 
services for foreigners (legitimate tourists as well as 
"short-term immigrants" from neighboring countries who come 
to obtain medical services).  They serve higher-income- 
earners who are attracted by the reputation of a particular 
institution or its medical personnel or technological 
capacities.  Additionally, they are responsible for 
providing essential health emergency services, training 
professionals to the graduate and postgraduate level 
(including many from other Latin American countries), and 
biomedical research. 
 
¶16.  A 2003 WB report points out, however, that the public 
hospital system is "floundering" under all its 
responsibilities.  WB's diagnosis is that the public 
hospital system exhibits serious structural deterioration 
and managerial inefficiency; a high degree of administrative 
centralization at the provincial level; rigidity in its 
staffing structure and labor relationships; no adequate 
system of incentives; inadequate information systems on 
which to base decision-making and control; serious deficits 
in facilities and equipment maintenance; poor articulation 
with social security, financial resource allocation 
constraints, and a system of management ill-suited to its 
size.  These characteristics severely limit public 
hospitals' ability to provide service to the non-insured. 
 
The Health Insurance System 
--------------------------- 
 
¶17.  Public health care is publicly financed and is open to 
all comers.  The private health insurance plans, or "pre- 
pagas," (pre-paid), are supported by members' fees.  Social 
security health care is financed by employers.  The Civil 
Association of Integrated Medical Activities (ACAMI) states 
that 55 percent of Argentines had no health care coverage in 
¶2004.  Regional differences are pronounced:  30 percent lack 
coverage in the city of Buenos Aires, 50 percent in greater 
Buenos Aires (home to 8.5 million people), and 70 percent in 
the country's poorest provinces such as Santiago del Estero, 
Formosa, Corrientes and Chaco, all in the north. 
 
Pensioners Health Care 
---------------------- 
 
¶18.  PAMI (Programa de Atencion Medica Inegral) finances 
health care for over three million pensioners (91 percent of 
the population over 65 is covered by PAMI).  With its large 
deficit, poor services and deficient oversight, PAMI is 
suspected of widespread corruption according to the WB, 
local companies and the Economist Intelligence Unit. 
 
Health Professionals 
-------------------- 
 
¶19.  The most recent 2005 Ministry of Health data shows that 
there are 32.1 doctors and 3.8 nurses for every 10,000 
inhabitants.  (Note:  Low status and low salaries, about 
$300-400 a month, for nurses, have left them in short 
supply).  According to a recent interview with the Rector of 
the University of Buenos Aires (UBA), the quality of medical 
education between public and private universities is 
unequal.  UBA graduates 40 percent of those who enter the 
program, a reasonable number according to international 
parameters.  Health Minister Gonzalez Garcia has publicly 
stated that Argentina has a high rate of doctors per capita, 
but that they are poorly trained.  He emphasized that there 
is a need to modify the medical curriculum two to three 
times in every doctor's course of study due to advances in 
technology and information.  (For example, none of the 
medical schools of the national public universities offer 
training in rehabilitation and/or disability as part of 
their regular curriculum.  No training is available to 
general practitioners or to medical doctors who are not 
disability specialists.)  Stating his opposition to 
unlimited entrance to medical schools, a hot topic of public 
discussion currently, Gonzalez Garcia said, "We must not 
train more doctors but better qualified doctors because 
Argentina cannot afford to waste its limited resources." 
 
Investment in Health 
-------------------- 
 
¶20.  The Kirchner administration and earlier national 
governments have implemented emergency measures in response 
to the crisis in the health sector.  These included the 2002 
 
BUENOS AIR 00003119  005 OF 005 
 
 
declaration of a national health emergency that remains in 
force, several WB and IDB financed projects related to 
maternal-child health and insurance programs, primary health- 
care reform including training programs for health 
professionals, food kitchens, and subsidies and training for 
unemployed heads of households.  The Government is planning 
to spend $7.3 billion in social welfare programs. 
 
COMMENT 
------- 
 
¶21.  Argentines who live in metropolitan areas generally 
receive good medical care, except the slum dwellers who 
often fail to seek help, particularly preventive care. 
However, there is a striking difference in the level of care 
in the north, where there is a much larger indigenous 
population and extreme rural poverty.  Despite low pay and 
an oversupply of doctors, young Argentines continue to flock 
to the medical school which is free and open to all 
applicants.  Even the Minister of Health has criticized the 
ability of medical schools to produce competent physicians. 
Doctors warn patients against using physicians under 40 
years of age.  With a severe shortage of nurses, uneven 
medical education for doctors, and medical equipment showing 
wear, the GOA and provincial governments face a serious 
challenge.  Most of the population in the disadvantaged 
provinces, all in the north, already has inadequate medical 
care.  President Kirchner has acknowledged the significant 
deterioration in the health section.  However, the question 
remains whether the Federal government, together with the 
provinces and other health care stakeholders, can meet the 
health care needs of all of Argentina's population. 
Improving the situation is one of major challenges facing 
the country.  END COMMENT 
 
¶22. (U) To see more Buenos Aires reporting, visit our 
classified website at: 
http://www.state.sgov.gov/p/wha/buenosaires 
 
GUTIERREZ