38 and inequities in health care for all citizens (Kirchner, 2004). Plan Federal de Salud described Argentina’s current state of health and detailed reasons why it needed change, established future health targets, outlined strategies to ameliorate health, and provided descriptions of new public health programs. Argentina began its focus on infants and pregnant women, through the innovative Plan Nacer (Measham, 2009), because they were perceived to be the most vulnerable and the most affected by the health disparities. Furthermore, a focus on one population would make it easier for the government to monitor and analyze health outcomes before expanding to the less vulnerable populations. Consequently, it is evident that maternal and infant health played a critical role in the evolution and transformation of public health in Argentina. Over the years, Plan Nacer continued to expand and gradually began transforming Argentina’s public health. The government worked hard to overcome challenges and strengthen the dynamics of Argentina’s health facilities; data collection, record keeping, and health outcomes improved. Plan Nacer was critical to increase the availability of health care services. In particular, it shifted from a traditional input-based finance system to a results-oriented incentive framework that rewarded providers with more funding, if they showed increased efficiencies in health care coverage, delivery, and productivity (Cortez & Romero, 2013). Argentina began to see a successful upgrade in infanthealthandmortality soon after Plan Nacer’s implementation. This article describes the evolution of the Argentine health care system, with a specific focus on the innovative Plan Nacer. Future programs aimed at providing universal health care in Argentina should implement a similar design to that of Plan Nacer. Historical Background Historically, Argentina’s health system is split into the public, social security (retirement income support and health insurance), and private sectors (Rubinstein et al., 2018). In 1994, Argentina’s national constitution guaranteed universal health care to everyone (Kirchner, 2004). Thus, the public sector provides free healthcare toall Argentines, andevento tourists. Today, the social security sector consists of over 300 obra sociales (insurance plans) that vary in quality. Argentina’s social security is funded by contributions from employees and employers; it is managed by trade unions, monitored by the government, and outsourced to private providers. The private sector has approximately 200 organizations, small networks and entities that provide coverage nationally or locally (Pan American Health Organization/World Health Organization [PAHO/WHO], 2017). The social security sector provides health insurance for formal sector employees (Rubinstein et al., 2018), whereas private insurance is for individuals who can afford to pay a higher price for faster and more efficient care. In the late 1990s and early 2000s, prior to the economic crisis, approximately 36% of Argentines were registered to and covered by public insurance, 48.8% by social security, and 8.6% by private insurance, while the rest of the population, mostly rural, still did not have access to health insurance (PAHO/WHO, 2017). After the economic crisis, more people began relying on public insurance. By 2017, 60% of those in poverty relied on public coverage (Rubinstein et al., 2018). The public sector provides free health care services to all, but mostly the uninsured, those who are employed by neither the government nor the private sector and therefore are not registered to any insurance (Rubinstein et al., 2018). It is funded by taxes and managed by several government unions that can vary depending on the region. The standard of public health care in major cities such as Buenos Aires is very high, but quality can vary greatly in other parts of the country, especially in rural areas (PAHO/WHO, 2017). In major cities, hospitals can provide assistance quickly and efficiently during an emergency; however, in rural areas, care may be limited. Although the government strives to provide good quality medical care to all its citizens, often only those living in major cities receive high-quality care. A majority receiving public health care, however, are poor and live in rural areas where the quality of health care services is uneven and where they often are underserved in terms of preventative care.
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