PAMI
Encyclopedia
PAMI is a public health insurance agency in Argentina
managed by the Ministry of Health.
s, the indigent, and veterans of the 1982 Falklands War
.
PAMI maintains 36 regional offices and 550 local offices for its over 4 million enrollees. The agency provides free medicine to 650,000 pensioners and retirees, 87 % of whom earn the minimum pension
of around us$300 a month. Another 13 % receive a benefit of the high cost of their treatment, in cases where this exceeds a retiree's income. The agency covers 100 % of the cost of drugs to treat cancer
, AIDS
, and other chronic medical conditions. Medications for hypertension
, which affects nearly nine of out of ten seniors in Argentina, are covered with a 80 % discount, including prescription drugs for cholesterol
and cardiovascular disease
. The agency covers over 2,000 stent
insertions annually, as well as over 6,000 pacemaker
implants (70 % of those provided in Argentina).
PAMI covers around 25 million doctor's visits and nearly 2 million prescriptions annually. Surgical procedures covered by the agency in 2009 included over 55,000 for cataracts, 50,000 intraocular lens
es, 20,000 hip and knee surgeries, and 700 organ transplant
s. Other benefits include kinesiology
, legal aid
, mental health
, and funeral
expense assistance. Benefits represent 10 % of the total pension payments issued by ANSES
, the national social security
agency. The real market value of the medical services, medicine, and other services provided by PAMI, however, amount to 30 % of retirees' income. the total expenditure on drugs for PAMI in 2010 was almost us$750 million; were retirees to pay the market price of these drugs, their cost would have approximated us$3 billion. Private health insurance
is widely available in Argentina. The cost of premiums for those over age 60 would be unaffordable to most retirees, however, as these average around us$150 per person per month.
s, as well as by immigrant associations. Health care co-operatives developed into employer and trade union
sponsored obras sociales beginning in 1910. They expanded rapidly during the administration of President Juan Perón
from 1946 to 1955, when unionization was fostered. Health coverage for senior citizens remained sparse, however, and those who could retain their obra social generally received less adequate care than younger enrollees.
PAMI was thus established to absorb the growing number of seniors on the initiative of Social Welfare Minister Francisco Manrique
, and was signed into law by President Alejandro Lanusse via Decree 19.032, on May 13, 1971. The insurer functioned only in Buenos Aires
at its outset, though by 1976, it had opened offices in all the nation's provinces
. PAMI established a network of affiliated general practitioner
s, and negotiated rates and prices with other obras sociales, health care federations such as the Argentine Medical Association
, and with local governments. It also financed other needs affecting seniors, notably a mortgage
loan program benefiting thousands whose homes were slated for demolition in 1978, during the construction of new freeways in Buenos Aires by Mayor Osvaldo Cacciatore
.
The prolonged economic downturn of the 1980s affected the agency's finances, however. President Raúl Alfonsín
placed PAMI under Federal intervention
in March 1988, and appointed the former Governor of Buenos Aires, Dr. Alejandro Armendáriz
, as head of the Crisis Management Commission. The agency's finances were stabilized by September, and the crisis commission was dissolved in favor of a panel presided by Argentina's two leading senior citizens' advocacy group
s. PAMI was restored to solvency while adding spousal benefits and vacation subsidies for beneficiaries. Accordingly, Alfonsín signed Law 23.660 on January 5, 1989, which made affiliation in PAMI mandatory for all registered employees, and enacted a 6 % payroll tax
to that effect.
The agency's financial crisis was compounded by a series of administrative crises during the subsequent administration of President Carlos Menem
. Menem's third appointee to the post, Matilde Menéndez, and most of her board of advisers would be indicted for fraud
stemming from contracts signed during her 1992—94 tenure. The 1995 recession cut its revenues from us$3.1 billion to us$2.4 billion, and led to a us$1.2 billion debt. Alejandro Bramer Markovic was appointed in 1996 with a mandate to eliminate waste, fraud, and abuse at the insurer, only to resign the following year amid accusations of excessive spending on outside auditing services. His successor, Víctor Alderete, remained at the post until the end of Menem's presidency in 1999. His tenure, however, was marked by subcontractor
cost overruns, and he faced over 20 charges to that related to these.
PAMI had entered a crisis stage. The agency's annual budget declined to us$900 million in 2003. Coverage, in addition, was managed through a system consisting of 72 intermediaries whose costs reached 50 % of the agency's benefits spending, and the resulting deficits at PAMI prompted a reduction in prescription drug coverage to 40 % by 2003. These developments led most retirees to opt out of the system, and membership declined from four million in 1992 to 900,000 by 2003, or fewer than one fourth of Argentine seniors.
The administrations of Presidents Néstor
and Cristina Kirchner prioritized the agency in their budget policy, and from 2003 to 2010, budgets for PAMI increased from 2.6 billion pesos
to 15.6 billion pesos, or 500%. Its related social assistance programs were expanded, and 800,000 seniors received nutritional
, rent, and other assistance from PAMI. The agency's chronic deficits were reversed, and by 2010, it maintained a reserve fund of around us$1.75 billion. Its enrollment also recovered, and services were provided to a total of 3.7 million patients in 2009, or 89 % of the agency's members.
Argentina
Argentina , officially the Argentine Republic , is the second largest country in South America by land area, after Brazil. It is constituted as a federation of 23 provinces and an autonomous city, Buenos Aires...
managed by the Ministry of Health.
Overview
Administered under the aegis of the Instituto Nacional de Servicios Sociales para Jubilados y Pensionados (National Institute of Social Services for Retirees and Pernsioners, or INSSJP), PAMI serves senior citizenSenior citizen
Senior citizen is a common polite designation for an elderly person in both UK and US English, and it implies or means that the person is retired. This in turn implies or in fact means that the person is over the retirement age, which varies according to country. Synonyms include pensioner in UK...
s, the indigent, and veterans of the 1982 Falklands War
Falklands War
The Falklands War , also called the Falklands Conflict or Falklands Crisis, was fought in 1982 between Argentina and the United Kingdom over the disputed Falkland Islands and South Georgia and the South Sandwich Islands...
.
PAMI maintains 36 regional offices and 550 local offices for its over 4 million enrollees. The agency provides free medicine to 650,000 pensioners and retirees, 87 % of whom earn the minimum pension
Pension
In general, a pension is an arrangement to provide people with an income when they are no longer earning a regular income from employment. Pensions should not be confused with severance pay; the former is paid in regular installments, while the latter is paid in one lump sum.The terms retirement...
of around us$300 a month. Another 13 % receive a benefit of the high cost of their treatment, in cases where this exceeds a retiree's income. The agency covers 100 % of the cost of drugs to treat cancer
Cancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...
, AIDS
AIDS
Acquired immune deficiency syndrome or acquired immunodeficiency syndrome is a disease of the human immune system caused by the human immunodeficiency virus...
, and other chronic medical conditions. Medications for hypertension
Hypertension
Hypertension or high blood pressure is a cardiac chronic medical condition in which the systemic arterial blood pressure is elevated. What that means is that the heart is having to work harder than it should to pump the blood around the body. Blood pressure involves two measurements, systolic and...
, which affects nearly nine of out of ten seniors in Argentina, are covered with a 80 % discount, including prescription drugs for cholesterol
Cholesterol
Cholesterol is a complex isoprenoid. Specifically, it is a waxy steroid of fat that is produced in the liver or intestines. It is used to produce hormones and cell membranes and is transported in the blood plasma of all mammals. It is an essential structural component of mammalian cell membranes...
and cardiovascular disease
Cardiovascular disease
Heart disease or cardiovascular disease are the class of diseases that involve the heart or blood vessels . While the term technically refers to any disease that affects the cardiovascular system , it is usually used to refer to those related to atherosclerosis...
. The agency covers over 2,000 stent
Stent
In the technical vocabulary of medicine, a stent is an artificial 'tube' inserted into a natural passage/conduit in the body to prevent, or counteract, a disease-induced, localized flow constriction. The term may also refer to a tube used to temporarily hold such a natural conduit open to allow...
insertions annually, as well as over 6,000 pacemaker
Pacemaker
An artificial pacemaker is a medical device that uses electrical impulses to regulate the beating of the heart.Pacemaker may also refer to:-Medicine:...
implants (70 % of those provided in Argentina).
PAMI covers around 25 million doctor's visits and nearly 2 million prescriptions annually. Surgical procedures covered by the agency in 2009 included over 55,000 for cataracts, 50,000 intraocular lens
Intraocular lens
An intraocular lens is an implanted lens in the eye, usually replacing the existing crystalline lens because it has been clouded over by a cataract, or as a form of refractive surgery to change the eye's optical power. It usually consists of a small plastic lens with plastic side struts, called...
es, 20,000 hip and knee surgeries, and 700 organ transplant
Organ transplant
Organ transplantation is the moving of an organ from one body to another or from a donor site on the patient's own body, for the purpose of replacing the recipient's damaged or absent organ. The emerging field of regenerative medicine is allowing scientists and engineers to create organs to be...
s. Other benefits include kinesiology
Kinesiology
Kinesiology, also known as human kinetics is the scientific study of human movement. Kinesiology addresses physiological, mechanical, and psychological mechanisms. Applications of kinesiology to human health include: biomechanics and orthopedics, rehabilitation, such as physical and occupational...
, legal aid
Legal aid
Legal aid is the provision of assistance to people otherwise unable to afford legal representation and access to the court system. Legal aid is regarded as central in providing access to justice by ensuring equality before the law, the right to counsel and the right to a fair trial.A number of...
, mental health
Mental health
Mental health describes either a level of cognitive or emotional well-being or an absence of a mental disorder. From perspectives of the discipline of positive psychology or holism mental health may include an individual's ability to enjoy life and procure a balance between life activities and...
, and funeral
Funeral
A funeral is a ceremony for celebrating, sanctifying, or remembering the life of a person who has died. Funerary customs comprise the complex of beliefs and practices used by a culture to remember the dead, from interment itself, to various monuments, prayers, and rituals undertaken in their honor...
expense assistance. Benefits represent 10 % of the total pension payments issued by ANSES
ANSES
ANSES is a decentralized Argentine Government social insurance agency managed under the aegis of the Ministry of Labor and Social Security. The agency is the principal administrator of social security and other social benefits in Argentina, including family and childhood subsidies, and...
, the national social security
Social security
Social security is primarily a social insurance program providing social protection or protection against socially recognized conditions, including poverty, old age, disability, unemployment and others. Social security may refer to:...
agency. The real market value of the medical services, medicine, and other services provided by PAMI, however, amount to 30 % of retirees' income. the total expenditure on drugs for PAMI in 2010 was almost us$750 million; were retirees to pay the market price of these drugs, their cost would have approximated us$3 billion. Private health insurance
Health insurance
Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care expenses among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is...
is widely available in Argentina. The cost of premiums for those over age 60 would be unaffordable to most retirees, however, as these average around us$150 per person per month.
History
Historically, health expenses in Argentina were met on an out-of-pocket basis, or through a number of mutual aid societies and health care co-operatives established by guildGuild
A guild is an association of craftsmen in a particular trade. The earliest types of guild were formed as confraternities of workers. They were organized in a manner something between a trade union, a cartel, and a secret society...
s, as well as by immigrant associations. Health care co-operatives developed into employer and trade union
Trade unions in Argentina
Trade unions in Argentina have traditionally played a strong role in the politics of the nation. The largest trade union association, the Confederación General del Trabajo has been a force since the 1930s, and approximately 40% of workers in the formal economy are unionized.- The FORA :The...
sponsored obras sociales beginning in 1910. They expanded rapidly during the administration of President Juan Perón
Juan Perón
Juan Domingo Perón was an Argentine military officer, and politician. Perón was three times elected as President of Argentina though he only managed to serve one full term, after serving in several government positions, including the Secretary of Labor and the Vice Presidency...
from 1946 to 1955, when unionization was fostered. Health coverage for senior citizens remained sparse, however, and those who could retain their obra social generally received less adequate care than younger enrollees.
PAMI was thus established to absorb the growing number of seniors on the initiative of Social Welfare Minister Francisco Manrique
Francisco Manrique
Francisco Manrique was an Argentine naval officer, journalist, policy maker and presidential candidate.-Life and times:...
, and was signed into law by President Alejandro Lanusse via Decree 19.032, on May 13, 1971. The insurer functioned only in Buenos Aires
Buenos Aires
Buenos Aires is the capital and largest city of Argentina, and the second-largest metropolitan area in South America, after São Paulo. It is located on the western shore of the estuary of the Río de la Plata, on the southeastern coast of the South American continent...
at its outset, though by 1976, it had opened offices in all the nation's provinces
Provinces of Argentina
Argentina is subdivided into twenty-three provinces and one autonomous city...
. PAMI established a network of affiliated general practitioner
General practitioner
A general practitioner is a medical practitioner who treats acute and chronic illnesses and provides preventive care and health education for all ages and both sexes. They have particular skills in treating people with multiple health issues and comorbidities...
s, and negotiated rates and prices with other obras sociales, health care federations such as the Argentine Medical Association
Argentine Medical Association
The Argentine Medical Association is the principal professional association of physicians in Argentina. It is a medical non-profit organization with headquarters in Buenos Aires.-Overview:...
, and with local governments. It also financed other needs affecting seniors, notably a mortgage
Mortgage
A mortgage is a security interest in real property held by a lender as a security for a debt, usually a loan of money. A mortgage in itself is not a debt, it is the lender's security for a debt...
loan program benefiting thousands whose homes were slated for demolition in 1978, during the construction of new freeways in Buenos Aires by Mayor Osvaldo Cacciatore
Osvaldo Cacciatore
Osvaldo Cacciatore was an Argentine Air Force officer and former de facto Mayor of Buenos Aires during the National Reorganization Process military dictatorship.-Early life:Osvaldo Andrés Cacciatore was born in Buenos Aires in 1924...
.
The prolonged economic downturn of the 1980s affected the agency's finances, however. President Raúl Alfonsín
Raúl Alfonsín
Raúl Ricardo Alfonsín was an Argentine lawyer, politician and statesman, who served as the President of Argentina from December 10, 1983, to July 8, 1989. Alfonsín was the first democratically-elected president of Argentina following the military government known as the National Reorganization...
placed PAMI under Federal intervention
Federal intervention
Federal intervention is an attribution of the federal government of Argentina, by which it takes control of a province in certain extreme cases. Intervention is declared by the President with the assent of the National Congress...
in March 1988, and appointed the former Governor of Buenos Aires, Dr. Alejandro Armendáriz
Alejandro Armendáriz
Alejandro Armendáriz was an Argentine physician and politician.-Early career:Armendáriz was born in Saladillo, a pampas town in the Province of Buenos Aires, in 1923. His family relocated to the city of Buenos Aires in 1940, where he graduated from the Marist College of San José , the following year...
, as head of the Crisis Management Commission. The agency's finances were stabilized by September, and the crisis commission was dissolved in favor of a panel presided by Argentina's two leading senior citizens' advocacy group
Advocacy group
Advocacy groups use various forms of advocacy to influence public opinion and/or policy; they have played and continue to play an important part in the development of political and social systems...
s. PAMI was restored to solvency while adding spousal benefits and vacation subsidies for beneficiaries. Accordingly, Alfonsín signed Law 23.660 on January 5, 1989, which made affiliation in PAMI mandatory for all registered employees, and enacted a 6 % payroll tax
Payroll tax
Payroll tax generally refers to two different kinds of similar taxes. The first kind is a tax that employers are required to withhold from employees' wages, also known as withholding tax, pay-as-you-earn tax , or pay-as-you-go tax...
to that effect.
The agency's financial crisis was compounded by a series of administrative crises during the subsequent administration of President Carlos Menem
Carlos Menem
Carlos Saúl Menem is an Argentine politician who was President of Argentina from 1989 to 1999. He is currently an Argentine National Senator for La Rioja Province.-Early life:...
. Menem's third appointee to the post, Matilde Menéndez, and most of her board of advisers would be indicted for fraud
Fraud
In criminal law, a fraud is an intentional deception made for personal gain or to damage another individual; the related adjective is fraudulent. The specific legal definition varies by legal jurisdiction. Fraud is a crime, and also a civil law violation...
stemming from contracts signed during her 1992—94 tenure. The 1995 recession cut its revenues from us$3.1 billion to us$2.4 billion, and led to a us$1.2 billion debt. Alejandro Bramer Markovic was appointed in 1996 with a mandate to eliminate waste, fraud, and abuse at the insurer, only to resign the following year amid accusations of excessive spending on outside auditing services. His successor, Víctor Alderete, remained at the post until the end of Menem's presidency in 1999. His tenure, however, was marked by subcontractor
Subcontractor
A subcontractor is an individual or in many cases a business that signs a contract to perform part or all of the obligations of another's contract....
cost overruns, and he faced over 20 charges to that related to these.
PAMI had entered a crisis stage. The agency's annual budget declined to us$900 million in 2003. Coverage, in addition, was managed through a system consisting of 72 intermediaries whose costs reached 50 % of the agency's benefits spending, and the resulting deficits at PAMI prompted a reduction in prescription drug coverage to 40 % by 2003. These developments led most retirees to opt out of the system, and membership declined from four million in 1992 to 900,000 by 2003, or fewer than one fourth of Argentine seniors.
The administrations of Presidents Néstor
Néstor Kirchner
Néstor Carlos Kirchner was an Argentine politician who served as the 54th President of Argentina from 25 May 2003 until 10 December 2007. Previously, he was Governor of Santa Cruz Province since 10 December 1991. He briefly served as Secretary General of the Union of South American Nations ...
and Cristina Kirchner prioritized the agency in their budget policy, and from 2003 to 2010, budgets for PAMI increased from 2.6 billion pesos
Argentine peso
The peso is the currency of Argentina, identified by the symbol $ preceding the amount in the same way as many countries using dollar currencies. It is subdivided into 100 centavos. Its ISO 4217 code is ARS...
to 15.6 billion pesos, or 500%. Its related social assistance programs were expanded, and 800,000 seniors received nutritional
Food policy
Food policy is an area of public policy concerning the production, distribution, and consumption of food. The policy consists of setting goals for food production, processing, marketing, availability, access, utilization and consumption, and describes the processes for achieving these goals...
, rent, and other assistance from PAMI. The agency's chronic deficits were reversed, and by 2010, it maintained a reserve fund of around us$1.75 billion. Its enrollment also recovered, and services were provided to a total of 3.7 million patients in 2009, or 89 % of the agency's members.