Informe Nº: 21/02/2018
The death of a renowned Buenos Aires journalist and deputy in a routine diagnostic medical procedure causes consternation. An endoscopy –which is a study of frequent use in medical practice and, in general, of high levels of safety– ended up in the abrupt death of the patient. Beyond the fact that this case is under judicial investigation, the seriousness of the subject deserves a more general assessment.
One reliable source of information is the Healthcare Access and Quality Index published by the prestigious medical journal, The Lancet. This is an indicator that seeks to measure health system quality in 195 countries based on death rates of 30 avoidable death factors. One of them is the “Adverse Effects of Medical Treatments” that measures mortality due to complications caused by medications, medical devices and incidents that occurred during medical and/or surgical care due to an abnormal reaction of the patient or a subsequent complication. In other words, deaths caused by errors in the medical treatments.
The indicator adopts values between 0 and 100. The higher the value, the lower the frequency of deaths due to adverse effects of medical treatments. Looking at countries in the region, it can be seen that:
This data shows that the number of deaths due to adverse effects of medicine in Argentina is significantly higher than in neighboring countries. Certainly, this type of indicators are far from perfect and they may be biased, but the magnitude of differences between Argentina and its neighbouring countries is very suggestive. Thus, the case of the journalist and legislator is more resonant because she was a public person that lived in Buenos Aires, but it is highly probable that it is one of the thousands of anonymous deaths caused by bad practices in the application of the medical treatments.
In the organization of the Argentine health system prevails disarticulation and overlapping between public hospitals, social security sickness funds and prepaid health insurance. Citizens make a huge financial effort to sustain them, but a large part of the resources are diluted in inefficiency and high permeability to corruption. The refusal to measure quality makes imposible to recognize and reward those who do their job well and identify and penalize those whose medidal practices is bad.
One of the main factors explaining the health system mayhem is the mistaken idea that poor results are due to lack of resources and not to poor management. Within the generalized process of decadence, the traditional actions of the national Ministry of Health do not contribute to any improvement. On one hand, because it self-assign the role of system’s governing body, when in fact it is not since in Argentina’s constitutional order regulation and control of the health system correspond to the provinces. On the other, because it induces waste of resources with national health programs that overlap with provincial and municipal functions. The national government distributes drugs, medical devices, money for hospitals repairments or pay part of the wages of the provincial and municipal health public centers. This can be very attractive from the political point of view, but for health management it is very inefficient and induces the provincial health authorities to abandon central roles such as quality control of medical practices, among others.
An important role that should be played by the national Ministry of Health is to establish a quality measurement and accreditation system to publish with rigor, objectivity and transparency the results of the medical interventions of public and private medical providers throughout the country. With this tool the population would be able to know what is done with the resources that they invest in the health system and it can be the foundation for a system of financial rewards to professionals and health institutions that strive for training and the pursuit of medical excellence, and penalize mediocrity.