Public Health Care Units Research Articles

The legal basis for the functioning of teaching hospitals in Poland: selected issues

The teaching hospitals occupy a unique position in the health care system. The specific nature of teaching hospitals calls for a different legal regime from that governing other hospitals. Their activity includes not only the provision of health care, but also teaching, under- and postgraduate training, and conducting research and clinical trials. Teaching hospitals operate as autonomous public health care units endowed with legal personality, founded by institutions of higher education. This fact is not reflected in the provisions of generally applicable law, which lack regulations relating to the particular nature of the activity carried out by this type of health care entity.

Maternal Health Care Expenditure among Women in Rural Areas of Pakistan

Background: With Pakistan failing to achieve Millennium Development Goals we have now entered into a new era of Sustainable Development Goals. Decreasing child mortality, improving maternal health and increasing the proportion of births by trained birth attendants, are the areas with unmet goals. As 29.5% of population of Pakistan is below the poverty line, expenditure on maternal health care services is of great importance as it determines the utilization of health care services to a large extent.Objective: To assess maternal health care expenditure and its sociodemographic predictors in rural Khanewal, Punjab, Pakistan.Methodology: In this cross sectional study average cost on delivery (both SVD and Cesarean section) was assessed in both public and private sector of ruralKhanewal. Total 257 women who had delivered in the last one year were included.Results: Results revealed that 69.3% of mothers were illiterate.56.8% sought antenatal care in public health unit and 43.2% in a private health care facility. 49.8% delivered in a public health unit and 50.2% in private health care facility. Total expense on antenatal care and delivery was found to be <4,000PKR (<$38.16) in 55.6% (reportedly in a public health care unit) and was >16,000PKR (>$152.65) in 23.3% (reportedly in a private health care facility). A significant difference was found between expense, in public vs private sector and SVD vs. C-section.Conclusion: This study revealed that there is high financial cost on maternal health services in both public and private sector of rural Khanewal. Although in private sector the cost is more as compared to public sector but still it is high keeping the notion of free health care services in Pakistan by the government. There-fore it is suggested to improve the quality of health care in public sector and if possible to provide free of cost services to mothers during delivery.

Barriers and Benefits in Telemedicine Arising Between a High-Technology Hospital Service Provider and Remote Public Healthcare Units: A Qualitative Study in Brazil.

In Brazil, the Program for Institutional Development of the Unified Healthcare System (PROADI-SUS) has implemented a telemedicine service for urgent situations and emergencies. It is delivered by a high-technology (HT) hospital to 15 remote healthcare units (RUs) in 11 different Brazilian states. The aim of this study was to investigate possible barriers and benefits in telemedicine service among these units. We performed a qualitative study on the perceptions of physicians involved in telemedicine service in their role as providers and consultants. An individual, semistructured recorded interview was conducted with 28 physicians (17 HT; 11 RU) encompassing telemedicine resources and interaction among HT and RU physicians. Data analysis was performed by Discourse of Collective Subject. We identified the following barriers in the telemedicine service: (1) lack of experience in the use of technology or the quality of the internet signal; (2) the multiplicity of different telemedicine platforms; (3) the quality of the image sent to the HT hospital; (4) the misunderstanding that telemedicine is a time-consuming technology instead of a resource that may help to save lives; (5) not feeling comfortable exposing doubts to other HT colleagues; (6) problems in the management of telemedicine use in the RUs; and (7) political and legal issues. However, important benefits in telemedicine service were also described. The structural barriers should be the target of hospital managers. Development of standard remote care protocols may increase the use of telemedicine and create new work routines. Given the relationship difficulties among the RU and HT doctors during telemedicine consultations, other meetings should be organized to allow more interpersonal interactions. These meetings may also have the goal of sharing outcome indicators of their joint activity in telemedicine to stimulate and make them aware of the benefits of their interaction.

Neighbourhood Determinants of Caries Experience in Preschool Children: A Multilevel Study

Objectives: To investigate the association between neighbourhood factors and decayed, missing, and filled teeth (dmft) index among preschool children. Methods: The sample of this cross-sectional study comprised 1,110 children (0-5 years old) clustered in 16 official neighbourhoods of Canoas city, southern Brazil. Multilevel binomial models were used to estimate the association of contextual variables at neighbourhood level (Human Development Index, average income, and public primary health care units) with two oral health outcomes: decayed teeth (dt) and missing or filled teeth (mft), after adjusting for individual variables (gender, age, maternal education, equivalent household income logarithm, household, and point of care). Results: Overall, 24.9% of the sample had dental caries experience (dmft >0), and 92.3% of the dmft was untreated caries. There was no statistical significant association (p > 0.05) of contextual characteristics with the decay component. The teeth of children living in richer areas had 2.87 (95% CI: 1.05-7.86) times more chances of being treated (mft component). Variance attributed to neighbourhood level was estimated as 5.9% (p < 0.01) and 4.1% (p = 0.17) for dt and mft, respectively, in adjusted models. Conclusions: Intra-urban areas seem homogeneous, with small variability between neighbourhoods, having no contextual effect on untreated dental caries (dt). Contextual variables may influence treatment access (mft) through the use of dental services in preschool children.

Clinical Features and Treatment Outcomes of Patients with Drug-Resistant and Drug-Sensitive Tuberculosis: A Historical Cohort Study in Porto Alegre, Brazil

PurposeTo evaluate the clinical features and treatment outcomes of patients with pulmonary tuberculosis, stratified by level of drug resistance.MethodsThis was a historical cohort study based on data from the II National Anti-Tuberculosis Drug Resistance Survey (2006–2007) collected at eight participating health care facilities in Porto Alegre, southern Brazil. The cohort was followed for 3 years after the start of treatment.ResultsOf 299 cases of smear-positive pulmonary tuberculosis included in the study, 216 (72.2%) were diagnosed at five public primary health care units and 83 (27.8%) at three public hospitals. Among these cases, the prevalence of drug-resistant tuberculosis was 14.4%, and that of multidrug-resistant tuberculosis was 4.7%. Overall, 32.0% of drug-resistant and 2.0% of multidrug-resistant cases occurred in previously treated patients. The most common comorbidity in the sample was HIV infection (26.2%). There was no association between drug-resistant or multidrug-resistant tuberculosis and sociodemographic variables. Cure was achieved in 66.7% of patients, and the default rate was 21.2%. The 2-month sputum conversion rate was 34.2%, and the relapse rate was 16.9%. Patients with drug-resistant tuberculosis had lower rates of cure (45.2%) and 2-month sputum conversion (25%), as well as a higher relapse rate (30.7%).ConclusionThese results highlight the urgent need for a more effective TB control program in this geographical setting, with a major emphasis on treatment of drug-resistant and multidrug-resistant tuberculosis.

Subjective assessment of kinesitherapy as an element of comprehensive rehabilitation process of subjects with lower spine pain

Łubkowska Wioletta, Polec Justyna, Szark-Eckardt Miroslawa, Żukowska Hanna. Subjective assessment of kinesitherapy as an element of comprehensive rehabilitation process of subjects with lower spine pain. Journal of Education, Health and Sport. 2016;6(2):255-266. eISSN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.46656 http://ojs.ukw.edu.pl/index.php/johs/article/view/3398 https://pbn.nauka.gov.pl/works/717132 The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation. Part B item 755 (23.12.2015). 755 Journal of Education, Health and Sport eISSN 2391-8306 7 © The Author (s) 2016; This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 05.01.2016. Revised 12.02.2016. Accepted: 21.02.2016. Subjective assessment of kinesitherapy as an element of comprehensive rehabilitation process of subjects with lower spine pain Łubkowska Wioletta¹, Polec Justyna¹, Szark-Eckardt Miroslawa ² , Żukowska Hanna ² ¹ Department of Physical Education and Health Promotion, University of Szczecin, Poland ² Kazimierz Wielki University in Bydgoszcz, Poland Abstract Background. Spinal pain has triggered interest in many fields of medicine, such as orthopedics, neurology, rheumatology, and rehabilitation. Despite ongoing development of surgery techniques, a major role is played by fitness improvement treatments, which need to be promoted. The aim of the research was a subjective assessment of kinesitherapy as an element of comprehensive rehabilitation process of subjects with lower spine pain. Material/Methods. This paper has an empirical character. The research was conducted amongst a randomly selected group of 60 patients of Independent Public Health Care Unit in Choszczno, Poland (rehabilitation at an outpatients’ clinic), aged 20-51. All of them were subjected to a series of 10 kinesitherapy treatments. The research used diagnostic polling method and the following techniques: survey and implicit interview. Results. The research proved that after completion of 10 treatments, the subjects noticed a significant improvement of their health. Kinesitherapy helped return to an active professional life for those who were forced to resign or suspend their work. Subjects reported that 10 kinesitherapy treatments were enough to notice their effectiveness in lumbar spine pain reduction. Kinesitherapy treatments resulted in a reduced usage of painkillers. Conclusions. There is evidence of positive impact of physical exercise on treatment results and beneficial effects in patients with spinal pain. Proper education aimed at changing bad habits and advising how to care for spine may be a powerful way to fight for health. Keywords: spine, pain syndromes, lumbar spine, kinesitherapy, curative exercises, improving fitness.

Contrasting Clustering in Health Care Provision in Romania: Spatial and Aspatial Limitations

Despite its over 26 years of continuous efforts to reform the health care system, Romania is facing serious problems in meeting population health care needs, mainly due to chronic underfunding of public health care units, shortage of medical personnel, lack of GP in rural areas. The economic crisis has deepened these problems, making the access to health care more difficult for disadvantaged or vulnerable groups of population. Poor health status of the population, the demographic aging, the large share of socio-economic dependent population and the high level of chronic diseases incidence all lead to increased health care need therefore healthcare costs. Health care activity is mostly based on the public sector and is financed from public funds; although private health services have had an extraordinary development recently, they are restrictive for the most of the population due to high costs and geographic location. Geographical distribution of medical personnel reveals major disparities among regions and in particular between urban and rural areas: less than 20% of the physicians (5,592 from 52,541 in 2012) are practicing in rural areas, 66% of the medical personnel being concentrated in six large cities while 5% of the rural communities have no doctor. Over 15,000 health professionals (30% of total) have left Romania since 2007 and about 40% of the medical graduates (2,500) are emigrating every year. By using quantitative and GIS techniques, this study is aiming to examine the spatial distribution of healthcare resources in order to point out the large rural-urban divide in health care provision and to highlight the deep territorial discrepancies related to supply of health services and potential population needs.

Finanse samodzielnych samorządowych publicznych zakładów opieki zdrowotnej po wejściu w życie ustawy o działalności leczniczej

Finanse samodzielnych samorządowych publicznych zakładów opieki zdrowotnej po wejściu w życie ustawy o działalności leczniczej

Independent public healthcare unit as an entrepreneur – considerations based on the Act on Medical Activity

Abstract An entrepreneur is someone that engages in a business activity on their own behalf. An entrepreneur might be a natural person, legal person and an organizational unit without legal personality, to which the legal capacity is given by a separate act. Regarding the current legislation, Supreme Court rulings and opinions contained in publications, the authors discuss the legal aspects of entrepreneur’s running an autonomous public health care facility. Since the act on medical activity has become law, both the status of health care facilities and the case law concerning their status as enterprises changed.

Prevalence of syphilis in pregnancy and prenatal syphilis testing in Brazil: birth in Brazil study.

OBJECTIVE Determine the coverage rate of syphilis testing during prenatal care and the prevalence of syphilis in pregnant women in Brazil.METHODS This is a national hospital-based cohort study conducted in Brazil with 23,894 postpartum women between 2011 and 2012. Data were obtained using interviews with postpartum women, hospital records, and prenatal care cards. All postpartum women with a reactive serological test result recorded in the prenatal care card or syphilis diagnosis during hospitalization for childbirth were considered cases of syphilis in pregnancy. The Chi-square test was used for determining the disease prevalence and testing coverage rate by region of residence, self-reported skin color, maternal age, and type of prenatal and child delivery care units.RESULTS Prenatal care covered 98.7% postpartum women. Syphilis testing coverage rate was 89.1% (one test) and 41.2% (two tests), and syphilis prevalence in pregnancy was 1.02% (95%CI 0.84;1.25). A lower prenatal coverage rate was observed among women in the North region, indigenous women, those with less education, and those who received prenatal care in public health care units. A lower testing coverage rate was observed among residents in the North, Northeast, and Midwest regions, among younger and non-white skin-color women, among those with lower education, and those who received prenatal care in public health care units. An increased prevalence of syphilis was observed among women with < 8 years of education (1.74%), who self-reported as black (1.8%) or mixed (1.2%), those who did not receive prenatal care (2.5%), and those attending public (1.37%) or mixed (0.93%) health care units.CONCLUSIONS The estimated prevalence of syphilis in pregnancy was similar to that reported in the last sentinel surveillance study conducted in 2006. There was an improvement in prenatal care and testing coverage rate, and the goals suggested by the World Health Organization were achieved in two regions. Regional and social inequalities in access to health care units, coupled with other gaps in health assistance, have led to the persistence of congenital syphilis as a major public health problem in Brazil.

Workplace violence and occupational stress in healthcare workers: a chicken-and-egg situation-results of a 6-year follow-up study.

Violence at work (WV) is an important occupational hazard for health care workers (HCWs). A number of surveys addressing the causes and effects of WV have shown that it is associated with work-related stress. However, it is not clear what direction this relationship takes, that is, whether job strain facilitates aggression against HCWs or WV is the cause of job strain. From 2003 to 2009, HCWs from a public health care unit were asked to self-assess their level of work-related stress and to report aggression that occurred in the 12-month period preceding their routine medical examination. In 2009, physical and mental health and job satisfaction were also assessed. A total of 698 out of 723 HCWs (96.5%) completed the study. Job strain and lack of social support were predictors of the occurrence of nonphysical aggression during the ensuing year. HCWs who experienced WV reported high strain and low support at work in the following year. The experience of nonphysical violence and a prolonged state of strain and social isolation were significant predictors of psychological problems and bad health at follow-up. The relationship between work-related distress and WV is bidirectional. The monitoring of workers through questionnaires distributed before their periodic examination is a simple and effective way of studying WV and monitoring distress. The findings of the present study may facilitate the subsequent design of participatory intervention for the prevention of violence in healthcare facilities. This should always be accompanied by measures designed to reduce strain and improve social support.

Factors associated with bullying at nurses' workplaces

To identify nurses who are subject to workplace bullying and its associated factors. Descriptive and exploratory study with a quantitative approach. The sample consisted of 199 nurses working in public and private sectors (N=388). For data collection, a graphic socio-professional questionnaire and the Leymann Inventory Psychological Terrorization were used, both in print or electronic format (May/September 2010). According to the data collected, 11.56% of the participants had been subject to bullying. Multivariate analysis showed that having children, working at Public Healthcare Units, working at an institution for a period between one and three years, currently dealing with acts of bullying and to feel bullied are risk factors for bullying. This study permitted a better understanding of the factors associated with bullying; however, a research based on samples of Brazilian nurses is only the first step to evaluate other factors of influence related to the organizational context.

FRI0426 Distribution of short and long-term sick leave in musculoskeletal disorders

BackgroundMusculoskeletal diseases are major causes of sick leave. The patterns of short and long term sick leave in the different disease groups are not well studied.ObjectivesTo examine variations in the...

Ocena satysfakcji pacjentów przeprowadzona w Szpitalnym Oddziale Ratunkowym w Kraśniku

Introduction. Knowledge about patients’ requirements during hospital stay is very important in the management of healthcare institutions. Studying the level of patients’ satisfaction is a good example of recognition of their expectations. Aim. The aim of this study was to evaluate patients’ level of satisfaction with stay and service at the District Hospital Emergency Department of Autonomous Public Health Care Unit in Kraśnik (SPZOZ). Material and methods. In December 2011, a survey was conducted among patients treated in the emergency department of the District Hospital Emergency Department in Kraśnik SPZOZ. The study was based on voluntarily completed anonymous patient satisfaction surveys. The survey consisted of 29 closed questions, grouped into seven thematic blocks (modules). Results. The obtained results have given more than good overall result (4.56). Very good rating has been given to modules: admission to Hospital Emergency Department (HED), HED premises, nursing care, diagnosis, medical care. The worst scores have been given to the environment module, where the respondents expressed their dissatisfaction with hospital parking and the number of shops and service facilities in the hospital. Conclusions. Patients of HED in Kraśnik positively assess the quality of care there. The study of satisfaction level of outpatients in the hospital is a good way to learn the strengths and weaknesses of the HED.

Prevalence of HCV among the young male blood donors of Quetta region of Balochistan, Pakistan

BackgroundHepatitis C, caused by hepatitis C virus (HCV) is a contagious disease of the liver which infects more than 170 million people world-wide and around 16 million in Pakistan. HCV associated infection spreads mainly by blood-to-blood contact. In recent years, many studies have been conducted to determine the prevalence of HCV infection in Pakistan; however, no data is available on HCV infection from the largest province of Pakistan. Therefore, the present study focuses on the prevalence of HCV infection in the young male blood donor population of Quetta region of Balochistan, Pakistan.MethodsA total of 356 blood samples were collected from blood donors (age range 17–25 years) at Combined Military Hospital (CMH), Quetta, Balochistan, Pakistan. Blood samples were screened for HCV positivity by Immunochromatographic test (ICT) and Enzyme Linked Immunosorbant Assay (ELISA).ResultsOut of 356 blood samples, the overall HCV prevalence was 20.8%. Among the HCV positive cases, the age group with 25 years was more frequently infected with a prevalence of 26.3%.ConclusionsThe present study provides the preliminary information about high HCV prevalence among the young male donor population in Balochistan province. This data may be helpful in formulating public health strategy for the prevention of risk factors associated with spreading of the disease. Furthermore, we recommend that in public sector hospitals and health care units ELISA should be preferred for anti-HCV detection over ICT.

The contribution of EU funds in investments of the Independent Public Health Care Unit in Kraśnik

Poland’s accession to the EU has opened unique opportunities for the development of our macroregion. The opportunities are created by, inter alia, the Structural Funds that balance the gap between different regions. In the whole country a significant number of operational programs providing financial support for the most important social problems of the regions have been implemented. Some of them concern a specific area dealing with health and social policy. The authors present the relevance of targeting structural funds in the health care area on the example of poviat healthcare unit, namely Independent Public Health Care Unit in Krasnik (SPZOZ Kraśnik). A few years ago this unit had the old, worn-out hospital buildings and depleted medical equipment. With several EU projects implemented under the Integrated Regional Operational Programme, Infrastructure and Environment Operational Programme, the Regional Operational Programme of Lubelskie Province and the Lublin Foundation EKOFUNDUSZ, it acquired funds for the implementation of such tasks as thermal modernization of hospital buildings, reconstruction of the operating theater and specialist outpatient clinics, purchase of modern, medical specialized equipment, computerization of the unit and the implementation of the new information technologies (among others, e-health services). These actions resulted in nearly 18 million PLN obtained from the EU funds and the total amount of the investments held in this period was more than 25 million PLN. At present it is difficult to imagine SPZOZ Kraśnik without these necessary investments. Great involvement in these activities of the Poviat Starosty in Kraśnik should be noted here. Kraśnicki Poviat, as the founding body of SPZOZ in Kraśnik has allocated nearly 7.8 million PLN for investments co-financed by the EU funds as so called “own contribution” and constantly supervised the work in this field. At present, it can be seen that the lack of financial support from the European Union funds could result in lower level of provided health services, and even the elimination of health care units.

MANAGING PUBLIC HEALTHCARE UNITS IN POLAND – RESEARCH FINDINGS

Managing public health care units has failed to attract the attention of decision-makers to date. This laissez-faire approach of sorts creates an environment in which these units have to face an evergrowing competition on the part of their non-public rivals. This paper starts with an analysis of the background of changes in the management of public health care units which have occurred in Poland in recent years. Next, described are the findings from a study concerning management quality conducted in 2003–2008 in public health care units in Poland. The research was based on a model developed specifically to that end involving the compliance of health care units with the regulations currently in force and good management practices. The survey consisted of a questionnaire composed of closed questions. In total, 154 units were surveyed (51 of them twice), which were divided into the following groups: surgical hospitals, non-surgical hospitals and other units. The results obtained indicate that the units were managed in very different ways. The best results were obtained by voivodship surgical hospitals, the poorest – non-surgical hospitals. Results of every repeated survey were decidedly better than those of the first one. These better results were related to the achievement of goals, which were adopted by the participants after the first survey. It is hard to overrate the part played in the management of health care units by their founding bodies, which can motivate them to achieve better results. On the other hand, lack of the commitment on the part of the owner has a demotivating impact on the way the health care units are managed.

THE IMPACT AND IMPORTANCE OF STAKEHOLDERS OF THE HEALTH UNITS TO THE MANAGERIAL DECISION-MAKING PROCESS

The purpose of this study is to demonstrate practical experience of the managerial decision-making process allowing of the impact and importance of stakeholders of the health units. The empirical evidence, gathered among selected public and private health care units form the region of Silesia, presents different approach to the decision-making process according to the stakeholder’s impact and importance for the entire entity. The study concentrate mainly on public health care units, in view of the importance of its numerous stakeholder groups, as well as special connections, relations and influence they imprint on decision-making process.

Effect of a 36-month Pharmaceutical Care Program on the Coronary Heart Disease Risk in Elderly Diabetic and Hypertensive Patients

To examine the effect of a pharmaceutical care program on the coronary heart disease risk in elderly diabetic and hypertensive patients. A total of 200 elderly (> 60 years) diabetic and/or hypertensive patients were recruited into a randomized, controlled, prospective clinical trial with a 36-month follow-up, developed in a public primary health care unit in a municipality in the Brazilian State of Sao Paulo. A range of clinical measurements were evaluated at the baseline and up to 36 months afterwards. The intervention group patients received pharmaceutical care from a clinical pharmacist, whereas the control group patients received their usual care from the medical and nursing staff. The Framingham scoring method was used to estimate changes in the 10-year coronary heart disease risk scores of all the patients. A total of 194 patients completed the study. Significant reductions (p < 0.05) in the mean values (baseline vs. 36 months) for the systolic blood pressure [156.7 mmHg vs 133.7 mmHg; P < 0.001), diastolic blood pressure (106.6 mmHg vs. 91.6 mmHg; P < 0.001),fasting glucose (135.1 mg/dL vs. 107.9 mg/dL; P < 0.001), hemoglobin A1C (7.7% vs. 7.0%; P <0.001), triglycerides (206.0 mg/dL vs. 152.5 mg/dL; P < 0.001), low-density lipoprotein (LDL)cholesterol (112.4 mg/dL vs. 102.0 mg/dL; P < 0.001), high-density lipoprotein cholesterol (55.5 mg/dL vs. 65.5 mg/dL; P < 0.001), total cholesterol (202.5 mg/dL vs. 185.9 mg/dL; P < 0.001), body mass index (26.2 kg/m2 vs. 26.1 kg/m2; P < 0.001), and abdominal circumference (103.2 cm vs. 102.5 cm; P= 0.001) were observed in the intervention group, whereas no significant changes were verified in the control group. The mean Framingham risk prediction score in the intervention group was 6.8% at baseline and decreased to 4.5%; P < 0.001) after 36 months, but remained unchanged in the control group. The pharmaceutical care program resulted in better clinical measurements and reduced the cardiovascular risk scores in elderly diabetic and hypertensive patients over a 36-month period.

The health system of Argentina

This paper describes the health system of Argentina.This system has three sectors: public, social security and private.The public sector includes the national and provincial ministries as well as the network of public hospitals and primary health care units which provide care to the poor and uninsured population. This sector is financed with taxes and payments made by social security beneficiaries that use public health care facilities. The social security sector or Obras Sociales (OS) covers all workers of the formal economy and their families. Most OS operate through contracts with private providers and are financed with payroll contributions of employers and employees. Finally, the private sector includes all those private providers offering services to individuals, OS beneficiaries and all those with private health insurance.This sector also includes private insurance agencies called Prepaid Medicine Enterprises, financed mostly through premiums paid by families and/or employers.This paper also discusses some of the recent innovations implemented in Argentina, including the program Remediar.