Wharton Healthcare Consulting Project in Argentina (August 2005)
Clinica Materno Infantil - Quilmes
Country Background
Argentina is a large, developing country (8th largest in the world) that is only sparsely settled by
37 million citizens at least one third of which are in the Buenos Aires area. While in the past, Argentina
has ranked as among the wealthiest in the world due primarily to their abundant natural resources, their
2001 economic crisis crippled the country. The financial disaster in 2001 reduced the buying power of
salaries by up about two thirds.
In this economic clime, Argentina remains committed to providing universal healthcare. However,
with only $316 per capita spent on healthcare expenses(8.2% in 2005 compared to the US’ 14.9% in 2002),
the resources necessary to provide comprehensive care in a timely fashion to its citizens are not available.
Adding to this challenge is the Argentines’ high level of education and the belief that everyone should be
able to study whatever interests them. This attitude has resulted in a very high number of physicians per
1,000 citizens. In Argentina, there are 2.7 physicians per 1,000 population while in the US the number is
less than 2.5. This results in a significant oversupply of physicians with more physicians being trained
every year. On the other hand, Argentina currently has 75,000 nurses while projections of need call for
over 200,000 nurses. This leads to un- or under-employed physicians performing nursing functions or
functions preformed by residents and fellows in the US. (Meeting Point: Argentina, Managed Care Interface,
July 2005)
While the 2005 Wharton Healthcare consulting group had read about Argentina and their healthcare
system going in, we were unprepared for the way these factors would affect the everyday functioning of the
clinic we had volunteered to help.
The Project
The relationship with this hospital was developed through Professor Rosoff’s connections at Austral
University in Buenos Aires. Skip put us in touch with Drs. Sureda and DeLuca who helped us frame
the scope of the trip. The team decided to focus on the following projects for the 91 inpatient bed
Quilmes clinic:
1) Cost Assessment and an Analysis of the Hospital’s Charges in order to Demonstrate the Value
of its Services to Public and Private Payers
2) Analysis of the Cost of a Patient Bed-Day
3) Process Improvement and Operational Efficiency
4) Analysis of Epidemiological Data in order to better serve the Hospital’s Patient Population and
Community
The Reality
1) and 2) We were able to analyze the cost associated with providing care for maternal, neonatal
and pediatric patients (including the cost of a bed day). However, given the insurance system,
were unable to develop a vehicle for the clinic (clinics in Argentina mean any non-governmental
hospital facility) to use with insurers to justify higher payment rates.
3) Given the state of the billing, financial and accounting systems, we were only able to recommend
the most basic back office improvements. We realized that their saying they used excel did not
denote any proficiency in using that program and that for historical reasons, they were using a
hotel registration system rather than a system designed for medical organizations to handle their
expense tracking. The billing setup was also very manual and there seemed to be significant
resistance to investing in automation despite a very short pay back period.
4) An analysis of epidemiological data painstaking entered manually yielded a number of interesting
epidemiological findings. The most interesting were findings regarding and the factors affecting
Caesarean rates. Despite yeoman’s work by Jay Komarneni to set up a database structure that
the staff at the clinic could continue to use, we were unsure whether the sophistication of the
staff or the exhaustive call on physicians’ time would permit ongoing entry into the database.
Conclusion
We left Argentina having made some significant contributions to the physicians’ and staff’s
understanding of the way their clinic works financially. We supplied them with concrete and measurable
recommendations for improving their billing, finance and reporting functions. We also helped their
physician and administrative leadership understand that there are financial consequences to the medical
decisions made by their physician staff. While we did not accomplish everything we set out to accomplish
(call us over optimistic based on the US systems and technology we were used to), we delivered a substantial
work product which exceeded the clients’ expectations and generated numerous requests for a return visit.
Personally, we learned an incredible amount. We were exposed to a new culture with incredibly
friendly and outgoing people who are justifiable proud of their country. We worked in a healthcare system
that is dysfunctional at best and broken at worst (World Bank loaned $750M in 2003 to overhaul the
system) and saw how people will rise to the occasion to provide healthcare to their patients despite serious
financial difficulty on both sides of the relationship. Finally, we came to appreciate the easy access we have
to data and the business minded approach we have to healthcare in the US.
Our trip to Argentina was a very educational, interesting and challenging experience far superior to
any conference I have ever attended.
