The Minister of Health of the Nation, Mario Lugones, signed a provision for the creation of the good practices guide with the aim of ensuring efficient compliance with judicial mandates by health insurance providers and prepaid medicine companies. Resolution 4912/2024 was published in the Official Bulletin and aims to promote technical cooperation to improve equitable coverage of health services, under criteria of quality and efficiency, in line with Decree number 70/2023 which promotes agile changes for transparency and continuous improvement of systems and processes.
Provinces and the Autonomous City of Buenos Aires are invited to adhere to this resolution. The Health System is divided into Public, Private, and Social Security subsectors, each with its own subdivisions. The Public subsector is divided into National, Provincial, and Municipal, while the Social Security subsector includes National Health Insurance, PAMI, Provincial Health Insurance and those of the Autonomous City of Buenos Aires, Health Insurance of the Armed Forces and Security, Health Insurance of National Universities, and Health Insurance of the Legislative and Judicial Powers.
On the other hand, the Private subsector is composed of prepaid medicine entities. These subsystems are affected by the judicialization of disputes between users and health service providers, public or private, regarding the provision of medications and medical treatments, using precautionary measures as a procedural resource.
After receiving complaints from clients, especially from self-employed individuals facing issues when using private health services without prior notification from health companies, this provision was taken. Many members reported to the Superintendence of Health Services and the ordinary Justice that health companies received their contributions but did not provide the corresponding services, leading to an increasing judicialization of health.
This situation generated resource deviations and a lack of solidarity in the health system. To address these issues, a mechanism of articulation with the Judicial Power was established to improve the coordinated functioning of the Health System and optimize service coverage, strengthening coordination, predictability, and efficient management of resources to protect the beneficiary population of the system.
