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Results Profile: Argentina Health Reform                                                                  March 30, 2010




 EXPANDING COVERAGE

 Argentina Delivers Care to Mothers and Children




Overview
Since 2002, with International Bank for Reconstruction and Development (IBRD) funding and
expertise, Argentina has delivered health insurance and secure access to health services to
more than one million uninsured pregnant women and children, and has helped drive
immunization rates up to 94%.

   Full Brief—4 Pages
Plan Nacer: Health Insurance for the Poor in Argentina—PDF, April 2010


Challenge
Despite a decade of sweeping health care reforms and high
                                                                      More Results
per capita health spending, Argentina entered the 21st
century with nearly one-third of its population lacking secure

                                                                      1
access to basic health care. Out-of-pocket spending was
high, costing poor families more than 9% of household
income on average.

When economic crisis struck in 2001, poverty rates shot up,
more than half of low-income households lost their health
                                                                      million
                                                                      previously uninsured pregnant
insurance, and health outcomes deteriorated sharply among             women and children who now
the poor. Infant and maternal mortality in particular halted          have health insurance.
their long decline and began to rise again. Results were
worst in the country’s poorest provinces.
                                                                      MORE INFORMATION

Approach                                                               World Bank in Argentina

The government of Argentina launched Plan Nacer in 2004                En Breve: Argentina: Provincial
as a free, voluntary, public insurance program to cover                Maternal and Child Health
uninsured mothers during pregnancy and up to 45 days after             Insurance (pdf)
delivery, as well as children under the age of six. It includes        Results-Based Financing Profile:
three main features: an explicit menu of benefits;                     Plan Nacer (pdf)
disbursements linked to achieving agreed targets; and                  Plan Nacer: An Overview
independent external audits to verify service delivery and
quality.
                                                                   

As part of the Plan Nacer reform effort, the government
changed the operating culture of its health system to offer incentives for performance. IBRD
assisted with this process by providing analytical support to diagnose the main causes of
health system inefficiencies and identify options to better meet the needs of the poor. IBRD
approved a Provincial Maternal Child Health Sector Adjustment Loan to support institutional
changes that would form the foundation for planned reforms. Two additional loans supported
nationwide roll-out.
Argentina’s new health system allocates institutional responsibilities as follows:

       The National Ministry of Health : (i) provides funds to the provinces based on attainment
       of 10 targets, which include both coverage and quality measures; (ii) sets quality
       standards for service delivery; and (iii) supervises provinces’ compliance with standards
       and accountability.

       The provincial governments : (i) identify the target population; (ii) enroll members into the
       program; (iii) contract health service providers to deliver the basic package of services;
       and (iv) establish Provincial Insurance Units.

       Health care providers  offer a specified package of cost-effective activities, while
       increasing quality to attract the beneficiary population. Provincial units reimburse the
       providers on a fee-for-service basis, which the providers can then invest as they see fit
       to improve productivity and quality.

Results
Plan Nacer has contributed to the following results:

       More than one million previously uninsured pregnant women and children now have
       basic health insurance and secure access to services.

       The share of expectant mothers in the poorest northern provinces who receive prenatal
       consultations by Week 20 has risen to 52 percent from 3 percent.

       National immunization rates have reached 94 percent.

       Infant mortality began to decline again and has fallen 20 percent since 2002 (to 13.3 per
       1,000), with the fastest improvement occurring in the poorest provinces.

By moving from a traditional system based on inputs and fixed budgets to one geared around
outputs and results, Plan Nacer has given beneficiaries more influence on service providers,
enhanced transparency, increased accountability and improved public performance.


Toward the Future
IBRD continues to support Argentina in its efforts to achieve the Millennium Development
Goals and its own national health goals. Through 2012, the Provincial Maternal-Child Health
Investment Project will support efforts to update and improve the basic health package and to
expand Plan Nacer to cover other population groups and services. The World Bank has also
provided technical assistance to enhance the Health Ministry’s leadership and management
capacity.



 


                                                       Last updated: 2010-03-30