Wednesday, April 24, 2013

Free Health Care in Argentina – The Pros and Cons of Using a Public Hospital

(Post updated 12/24/2017 with rules about visiting hours) 

 Free health care was one of the main incentives that convinced my spouse and I to move to Argentina, but what does “free” really mean? Today we discovered the pros and cons of going to a public hospital.

My spouse suffers from a genetic skin disorder called Darier’s Disease. This condition is very difficult to treat and it usually gets worse during the summer months, which we happen to be in right now. This is the worst I’ve seen his skin get in twelve years. If we were in the States, we would have been screwed because we didn’t have health insurance and the medicine he needs is too expensive. But we're in Argentina now, so, we decided to go to the public hospital in Santa Rosa Street in Cordoba Capital. 

We hit our first roadblock when we were told that we needed to create a clinical history folder before seeing a physician. Unfortunately, the records office was on strike until two in the afternoon that day.

While we waited, we witnessed some things that surprised us in a negative way.

Hospital Appearance 
The hospital is a vast labyrinth of corridors, but the walls and doors were in horrible condition. I later learned that they are in the process of renovating, which would explain the paint fumes and dust. The interior isn’t climate controlled, so in this summer heat, we had no air conditioner, and it was uncomfortable.

Friendly and Courteous? 
We noticed that some of the patients were given curt or downright rude responses to their inquiries. Elderly people weren't treated very well at some of the nurse’s stations. Another patient, who was a foreigner from Mexico, was told to go away, and finished his statement with the word “mojado”, which loosely translates to “wetback”. For those of you unfamiliar with the slang term, it’s a derogatory and racist way to refer to a Mexican. We found this type of behavior against foreigners and the elderly to be unacceptable. If I thought there was someone in the hospital who would give a damn, I would have complained, but it was painfully obvious that there wasn’t. So I was angry during most of our waiting period at the hospital. 
On a positive note, I learned that this was a teaching hospital. We saw a lot of young interns walking around and learning new things from the attending physicians. It was like being inside the TV show "Grey’s Anatomy," Argentine style.

At last! It was two o’clock and we were ready to go.

Despite the long line at the records office, we were able to get the clinical history folder done for my spouse within 30 minutes. The clinical history folder contains a patient’s name, patient ID number, address and telephone number. My spouse isn’t a resident yet, but that doesn’t matter. You don’t have to be a resident or a citizen of Argentina to get treated at the public hospital. You just need to pay 3 pesos to open your clinical history, and 45 pesos to see your doctor on the same day. It's 20 pesos if you make a doctor’s appointment in the morning.

Bono (Outpatient Fee) 
You can pay your fee at Caja 1, Caja 2, or Informes
Okay. You know how I said that health care in Argentina is free? That’s not totally true, but it is SUPER affordable! Each hospital service charges a small fee, which must be paid in advance before seeing a doctor. Think of it as an outpatient fee.

Price Breakdown

·         3 pesos (equivalent to 50 U.S. cents) to open your clinical history (one-time fee)
·         20 pesos (equivalent to 3.37 U.S. dollars) for a morning appointment
·         45 pesos (equivalent to 7.51 U.S. dollars) to see the physician the same day

·         43 to 50 pesos (equivalent to 7.17 to 8.34 U.S. dollars) for blood work

·         35 pesos (equivalent to 5.84 U.S. dollars) to go to the emergency room  

·         25 pesos (equivalent to 4.17 U.S. dollars) to see a psychologist

UPDATE: For the past three years, the fees have no longer applied, but rumor has it that the hospital may start charging these small fees again.

The dermatologist asked my spouse to return the next day so that he could participate in a research study for her students. His condition is genetic and rare, so this was a huge opportunity for the dermatologists at the hospital to study Darier’s Disease up close. Since she had been friendly and helpful, he consented to it. 

The dermatologist asked my spouse to return the next day so that he could participate in a research study for her students. His condition is genetic and rare, so this was a huge opportunity for the dermatologists at the hospital to study Darier’s Disease up close. Since she had been friendly and helpful, he consented to it.

My spouse was taken to a classroom full of interns, instructors, and specialists. They took photos, poked, and prodded the infected skin regions of his body. He later told me that he felt a little embarrassed by the experience, but if there was a chance that the study would help them develop better treatments for him and others like him, it was worth the discomfort. 
Lab for blood work and other analysis

After the “think tank” session was over, his dermatologist ordered blood work and biopsies to be performed on his skin infection. The tests totaled 300 pesos, equivalent to 50 U.S. dollars. This included an MRI test to ensure that his liver was healthy enough to handle the Soriatane pills that the dermatologist wanted to prescribe. 

Steps To Take When Visiting the Public Hospital 

Step 1: Report to the area where they hand out appointments. This is called “central de turnos”. Take a number and have a seat. When they call you up to the window, tell them which specialist you want the appointment for (cardiology, general medicine, dermatology, etc.). I recommend that you see a general doctor first. You can request that by asking for an appointment for “medicina familiar”. 

(Update: 2017: You now have to show up to the central de turnos at 5 in the morning if you want to be one of the lucky 40 who get an appointment. But keep in mind that they don't start handing out appointments until 7 in the morning. However, if you don't get there ahead of time, you'll never get an appointment.) 

Let them know if you prefer a morning appointment or an afternoon appointment. You will have to provide them with your ID. You can use your passport if you don’t have a DNI. You will need to give them your address and phone number as well. They will provide you with two slips of paper, similar to a store receipt. This will show proof of your appointment/s. You don’t have to pay anything at this point.

Step 2: On the day of your appointment (NOT BEFORE), you present the proof of appointment slip, and the slip to open up your clinical history folder at register 1 or register 2, (known as caja 1 or caja 2), located next to the hospital’s main entrance. You can also pay your lab fees here as well. 

Step 3: If this is your first time, you need to go to the records office where you’ll see two lines. The line on the left is to retrieve your clinical history folder. If this is your first time, you’ll need to wait in the line on the far right and advise the clerk at the front desk that you want to open your clinical history. They’ll either walk you to the back office to take down your information, or you can give them your passport, proof of payment and appointment slip. They will take it, create a clinical history folder, and present it to you with your new patient card ID, which looks like a yellow index card.

Step 4: With your patient ID card, clinical history folder, and proof of payment, you can now go see your doctor.

Historia Clinica 
Your historia clinica (patient/clinical history folder) is where your physician/s will write down the date they saw you, your reason for seeing them, their observations, and course of treatments. They’ll also place your lab results in here as well.

Patient ID 
The yellow index card that the records office will provide you contains your patient ID number. You will need to present this card whenever you go to the records office to retrieve your clinical history folder, and when you see your doctor. 

Emergency Room 
Expect a long wait if you go to the emergency room at the public hospital in Santa Rosa Street. However, you will be seen regardless of the time of day or night. Don’t forget to pay the 35-peso fee first. If register 1 or 2 (caja 1 or caja 2) are closed, you can pay the fee at the security office next to register 1 (caja 1). If that office is closed, simply walk over to the emergency room and they can help you figure out how to pay the outpatient fee.

Visiting Hours 

If you or a relative have to stay in the hospital overnight, visitors have to adhere to visiting hours, which begins at 5 p.m. Unfortunately, only one person is allowed to go in at a time, and once visiting hours are over, you have to leave the patient's room. This I find disturbing. In the States, you can stay with someone day and night in a hospital room to watch over your sick loved one. If I were ever in this situation at the public hospital in Argentina, the staff and I would have some serious issues.  

Some Advice 
You’ll need lots of patience and a thick skin to overcome some of the rudeness of certain hospital staff, particularly those at the records office where you will need to retrieve your clinical history folder.

Morning appointments are cheaper, but you’ll have to wait a couple of days or even a week to see your doctor.

Afternoon appointments are a bit more expensive, but you can see the doctor the same day.

You’re not likely to find anyone that speaks anything other than Castilian/Argentine Spanish. So, if you’re not very good at speaking it, then I recommend that you ask a Spanish speaking friend to accompany you.

I can’t guarantee that everyone will have the same experience that we did at the public hospital in Cordoba. Just keep in mind that while there are some people that will test your patience, there are those that are just as friendly and willing to help too.

Below you will find a video tour of key places at the public hospital in Cordoba.