41 health system. Argentina was in need of reforms in the public health sector to address problems of equity and efficiency with an approach that was centered on the health of the entire population. Argentina’s provincial autonomy was very weak; the responsibilities of the different levels of government in public health care needed urgent review; and the adoption of great reformwas necessary. Argentine president Néstor Kirchner and the Ministry of Health worked together to modify the most important determinants of health with actions that would enhance the quality of life and improve healthy conditions among all Argentines. To address these issues, in 2004 Argentina designed a new health model, Plan Federal de Salud, based on the construction of universal health care programs, which are effective in improving the health of the population while achieving universal coverage. The Plan Federal de Salud introduced Plan Nacer for infants and pregnant women, and in 2012 it expanded to include all women and children and uninsured men in 2015 (Glassman & Temin, 2016). Plan Nacer Objectives and Design Plan Nacer was designed to reduce the gap in effective coverage within the public sector, particularly with regard to infant and maternal mortality. Plan Nacer’s first objective was to reduce infant mortality by 20% to 30% within 10 years by increasing access to health care among uninsured children (under 6) and pregnant women. The second objective was to ameliorate the structure of financing by shifting its management from the federal level to the provincial level, giving responsibility to the provinces to deliver sufficient health care services within their jurisdictions. Providers and health staff worked to help uninsured pregnant women and children enroll. When enrolled, women and children benefited from free access to Plan Nacer’s health benefits (Measham, 2009). By 2012, around 2 million women and children were enrolled into Plan Nacer (Glassman & Temin, 2016). To realize these objectives, Plan Nacer implemented a results-based financing mechanism. At the national level, it supported the establishment of publicly funded maternal and health insurances that prioritized basic health services (Measham, 2009). At the provincial level, the plan provided additional resources, such as medical equipment, transportation services, and training to reduce the gap in coverage under a results-based financingmechanism (Glassman & Temin, 2016). National contributions funded by the World Bank provided a capitation payment of an estimate of $4 per month per person enrolled in the program. Around 2% to 4% of that amount was given to provinces as an incentive to deliver sufficient health care services, and the rest was used to reimburse providers for health services provided to Plan Nacer beneficiaries. At the provider level, a fee-for-service set by the national government was awarded to health providers based on the number of services they delivered to members enrolled in Plan Nacer. Plan Nacer’s design also gave health providers autonomy to decide how to use those resources and funds, promoting productivity and empowering personnel. The results-based financing mechanism became a powerful tool because it improved the quality of public health and introduced changes in basic services in the medical framework (Measham, 2009). Plan Nacer initially targeted the most vulnerable groups in the poorest provinces with the inclusion of the indigenous population, those employed by the informal sector, and pregnant women and infants. Plan Nacer identified their target populations by reviewing data from the census, household surveys, and newborn registries. The program hired health workers to help infants and pregnant women enroll in the insurance, and several health workers even visited poor neighborhoods in low-density areas going from house to house to enroll the eligible population. Plan Nacer focused on addressing the main causes of infant and maternal mortality, such as diarrhea, inadequate prenatal care, pregnancy complications, and infections. Pregnant women were offered prenatal care services, delivery care, treatments to reduce premature births, and more. Infants were offered services including neonatal and postnatal care, immunizations, and checkups. Services later were expanded to include preventative treatments and complex
RkJQdWJsaXNoZXIy MTA0OTQ5OA==