Private healthcare in a segmented system: Emergence, development and equity impacts in Argentina

This article analyses the emergence, expansion and consolidation of private healthcare in Argentina, emphasising the pivotal role of public policy in this process. Initially, the establishment of a union-based, mandatory social health insurance system, which largely outsourced its service delivery, created a market for private sector expansion. Subsequently, the deregulation of social health insurance further stimulated private sector growth by allowing formal workers to change insurers and, in practice, opt for a private plan. This fuelled the private sector’s expansion in the health insurance market, partly financed by workers’ mandatory wage contributions. While public healthcare increasingly concentrated on serving the uninsured population, the private sector consolidated providing services for obras sociales , offering health insurance plans to formal workers opting out of social insurance, as well as to individuals directly purchasing coverage, and healthcare services to users buying out-of-pocket. The analysis underscores the combination and sequence of policy decisions that shaped a segmented healthcare structure, illustrating the multifaceted interactions, complementarities and cross-subsidies between public, social insurance and private healthcare providers and financiers. Furthermore, it discusses the equity implications arising from the commodification of health and the social stratification of effective access to healthcare.