Transcript 5th International Conference “Health Insurance in Transition”

TRACK E
Status of Emergency Medicine
Around the World
1
Status of Emergency Medicine
in Argentina
Dr. Marcelo Muro
9/2003
2
EM in Argentina
Overview
Country information

EM specialty status

EM system information
Challenges /innovative strategies
Difficulties and pitfalls.
Summary
3
EM in Argentina
Country information
Southest country in America.
Almost 4 million km2. 8th in the world.
3000 km. Long- 1200 km wide.
4 seasons during all the year.
Highest mountains in America in the west.
2000 km. Atlantic Ocean Coast in the east.
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EM in Argentina
Country information
37.000.000 inhabitants.
60% of them live in 10 biggest cities.
Coexist big cities with large uninhabitated areas
Great differences between them.
+ than 50 % poor.
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EM in Argentina
Country information
Variable health cover. Average 50 %.
The worst Socioeconomical condition .
Many Health Private and Worker Unions
institutions shut.
Increase of public health services demand.
No National Emergency real System ,
interaction or resources for EMS
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EM in Argentina
Health General information
Life Expectancy is near 80 in high class.
21/oo children mortality in poor provinces.
Cardiovascular , Cancer and Trauma lead
mortality causes in all ages.
Infections and nutrition diseases are the
pediatric major problems.
Increase of Intentional trauma and
Tuberculosis prevalence.
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EM in Argentina
Health Care System
County and Provincial organizations more
important than National.
Only in 8 Big cities: high complexity available
in public health.
Incomplete National Health Insurance.
No integrated data register systems.
FD : 4000 public beds - 2000 in private.
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EM in Argentina
Health Care System
Inconsistent distribution of Primary care
programs.
Less Prepaid medical assistance response.
Disappearance of workers unions health
institutions.
Private Medicine for High social class.
Unequal use of Medicine protocols
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EM in Argentina
Medical Education
10 National 12 Private medical schools.
7 years to graduate.
50% follows Residences to specialization
Specialty: Complete Residence or 5 years
assistance to a specific Unit .
Specialist recertification each 5 years.
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EM in Argentina
Emergency Medicine Status
EM is not a National specialty.
Cardiologists, Clinics, Anesthesiologists,
Surgeons, Intensive care, in Prehospital.
Multiple specialties in Emergency Rooms.
The ghost of Emergency medicine specialists.
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EM in Argentina
Emergency Medicine Education
The way to the recognition and the change
The 80´s in EM.
3 fellowships 2 years long available .
2 EM residence models: basic/ postbasic.
EM instructor in all specialties .
The use international EM protocols.
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EM in Argentina
EM System information
Coexist aspects from Franco–German and Anglo–
American models= Mixed model.
Large areas with poor emergency response
organization.
Developing or “Mature” care systems in some of
the biggest cities (county)
Underdeveloped systems in rural regions
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EM in Argentina
EM System information
Different Emergency development stages.
Unequal Emergency training attempts
Poor use of Emergency protocols
People misuse Emergency Care resourses.
In cities phisicians in the street.
Firemen, nurses, paramedics? .
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EM in Argentina
Pre-hospital emergency care
Type 2 ALS , BLS units.
Phisician in cities. Variable EM training.
Some MCI trucks in specific points.
Dispatchers + medical coordinator.
Public EMS County budget: free.
Private: prepaid + fee for service.
Poor integration between private/public.
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EM in Argentina
In-hospital emergency care
Regional distribution for diseases.
Major EM patients in public hospitals.
Multi-specialty model.in ER..
Best EM Schools in Public hospitals.
Poor relationship with other services.
Only few quality and research programs.
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EM in Argentina
Challenges and Strategies
Recognition of EM as a specialty.
The political fondness for EM..
Generalization of EM Protocols.
The training programs , are adequate?
Integration with the other services .
Unify Data resgistration = research.
Optimize the regional solutions.
.Avoidance of Robinson Crusoe syndrome.
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EM in Argentina
Challenges and Strategies
Development of Emergency Residences.
Define the needed laws.to get the recognition
Continue with International EM programs.
Discussion of the human structure of ER.
Train all the crew.
Acceptance of the mixed model situation.
Research, quality, correct use of Ems.
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EM in Argentina
Difficulties and pitfalls
The Finantial problem..
Politics discontinues EM programs.
Distances and isolated areas.
The old model and trade union pressions.
The resistence to change.
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EM in Argentina
Summary
The mixed model
Big distances , people in Cities.
In the way of the recognition of EM
ACLS,BTLS,PHTLS, ATLS available.
Incipient research process.
The need to integrate.
EM is in the best moment of history
20
EM in Argentina
Chance or Reasons?
Reasons or barbarism.
Casualidad ó causalidad?
Causalidad ó barbarismo
Ernesto Sabato
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EM in Argentina
THANK YOU FOR YOUR
ATTENTION
MUCHAS GRACIAS POR SU
ATENCION
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