GARRAHAN HOSPITAL SHOULD STOP DEPENDING ON NATIONAL GOVERNMENT

Garrahan Hospital is a high-complexity pediatric hospital of excellence in medical care, pediatric training and scientific research. Unlike other public hospitals, it is an autonomous entity with financial and administrative independence, run by its own board of directors. Its state funding is provided 80% by the national government and 20% by the Buenos Aires City. It supplements its income with fees in cases where the patient has health insurance.

Professionals complain of low salaries compared to their responsibilities and workload. The Ministry of Health responds that the problem is not a lack of resources but rather poor management that has tolerated an excessive expansion of administrative staff. Despite the hospital’s administrative autonomy, the Ministry of Health has committed itself to combating spurious employment in order to generate surpluses that will allow for improved remuneration for doctors.  

The question is whether the national Ministry of Health should be involved in managing the Garrahan. To answer this question, it is useful to start with a review of the hospitals that are under the national government’s jurisdiction. According to data from the Ministry of Economy for the year 2024, it can be observed that:

• Three national hospitals in Buenos Aires City (including Garrahan) account for 14% of the national Ministry of Health’s budget.
• Another seven national hospitals are in Buenos Aires province (six in the suburbs and one in Mar del Plata), which accounts for 27% of its budget.
• There is one hospital in the province of Santa Cruz which accounts for 2% of its budget.

These data show that the national Ministry of Health allocates 43% of its budget to finance 11 hospitals. Four of them were created by Kirchnerism in Buenos Aires’ outskirts and another one in El Calafate (the former president’s city of origin). The scheme is absurdly arbitrary, as it means that citizens across the country support with their taxes the public hospitals in their provinces and national hospitals in Buenos Aires City, province and El Calafate. The only explanation for this nonsense is policy discretion and patronage at the national level.

The 1853 Argentine Constitution established that the national government only has the powers expressly delegated to it by the provinces (Article 121 CN). In no article of the National Constitution did the provinces delegate public health to the national government. On the contrary, in all provincial constitutions, the provinces expressly reserve responsibility for public health for themselves. This means that it is not appropriate for the national government to finance or manage public hospitals. Therefore, national hospitals should be transferred to the City of Buenos Aires, the Province of Buenos Aires, and Santa Cruz so that they can incorporate them into their provincial network of public hospitals. 

Given the peculiarity of the Garrahan Hospital, which is a national reference and independently managed, the best alternative is to give its property to the medical group that currently supports the hospital. They are the ones who are in the best position to pay good salaries by combining medical excellence with good management. Funding should come from social security and prepaid healthcare plans for the services provided to their members and from the provinces in the case of patients without coverage referred from provincial public hospitals. In other words, to save the Garrahan, its administrative and financial autonomy must be strengthened by freeing it from its subordination to the national Ministry of Health.

Respecting the distribution of powers under the National Constitution adds equity in health care and creates incentives to improve management. It is of strictly distributive justice to correct the asymmetry of provinces that do not take responsibility for all public hospitals operating in their territory. In this process of reorganization, the particularities of the Garrahan Hospital make it advisable that its administration be assumed entirely by its doctors so that medical excellence is accompanied by good management.