De Simone draws attention to the lack of support for palliative care programmes in Argentina’s health care system and highlights the under-treatment of pain and other symptoms:

‘There is…a misdistribution of “acute and chronic beds”, with a high prevalence of ‘acute’ hospitals and a lack of palliative care programmes. A research study on terminally ill cancer patients performed 10 years ago showed that pain and other symptoms were mostly under-treated, and that there were adjustment disorders in nearly half of patients’ families.’²⁹

In 2001, the total health expenditure per capita in Argentina was 1,130 international dollars (Intl $) representing the highest figure in the region.³⁰ This health expenditure compares with other South American countries as follows: Uruguay $ 971; Colombia $ 356; Peru $231 and Ecuador and Bolivia $ 177 (both countries shows the lowest figure in the region) (Table 8).³¹

Table 8: Total health expenditure capita (Intl $) in countries of South America, 2001

Country	Total health expenditure per capita (Intl $, 2001)
Argentina	1,130
Uruguay	971
Chile	792
Brazil	573
Suriname	398
Venezuela	386
Colombia	356
Paraguay	332
Peru	231
Ecuador	177
Bolivia	177

Total health expenditure in Argentina represents 9.5 % of GDP. This compares with 10.9% in Uruguay (the highest percentage in the region); 7.0 % in Chile; 5.5% in Colombia; 4.7% in Peru and 4.5% in Ecuador (the lowest percentage in the region) (Table 9).

 Table 9: Total health expenditure as a percentage of GDP: countries of South America for 2001

Country	Total health expenditure as % of GDP (2001)
Uruguay	10.9
Argentina	9.5
Suriname	9.4
Paraguay	8.0
Brazil	7.6
Chile	7.0
Venezuela	6.0
Colombia	5.5
Bolivia	5.3
Peru	4.7
Ecuador	4.5

Although official data are currently unavailable, it is thought that the devaluation of Argentina’s currency in 2001 has significantly altered these figures.

Table 10 shows the principal sources for public and private health expenditure in the country.

Table 10: Selected national health accounts indicators (2001 estimates)³²

	Value
Indicator
Per capita GDP in international dollars	11,920
Total health expenditure
Total expenditure on health as % of GDP	9.5
Public health expenditure
General Government expenditure on health as % of total expenditure on health	53.4
Per capita government expenditure on health in international dollars	604
Sources of public health expenditure
Social security expenditure on health as % of general government expenditure on health	58.6
Private health expenditure
Private expenditure on health as % of total expenditure on health	46.6
Sources of private health expenditure
Prepaid plans as % of private expenditure on health	31.1
Out-of-pocket expenditure on health as % of private expenditure on health	62.40

The WHO overall health system performance score places Argentina 75/191 countries. This composite measure of overall health system attainment³³ is based on a country’s goals relating to health, responsiveness, and fairness in financing. The measure varies widely across countries and is highly correlated with general levels of human development as captured in the human development index.

The health system is organized around three main providers:

• the public sector - which supplies free clinical care for hospital inpatients and outpatients. A charge is made to outpatients for medicines. This sector covers about 50% of the population
• ‘mutuals’ or social plans (around 300 in number) - administered by trade unions. Employers and employees each pay a fixed fee. The ‘mutual’ covers the cost of medical care and medicines in varying proportions; differences between the fixed fee and the actual cost of treatment is paid by the patient. In the past, these plans have usually covered around 45% of the population, although the percentage has fallen recently due to increasing unemployment - with more people resorting to provision within the public sector provision
• the private sector – where patients meet the total cost of their medical care; this sector covers around 5% of the population.

There are more physicians (150,000) than nurses (85,000) in Argentina; there are also more medical specialists than general practitioners or family doctors.