Government slashes funding for pensioners’ medical services

The government has cut payments to doctors working for PAMI, the public agency that provides medical and social services to pensioners. On Monday, doctors who treat PAMI affiliates began a 72-hour strike after the government changed the system regulating their pay last week. Health workers say that while that change was announced as an increase to their income, it effectively means “a substantial cut” of their earnings, estimated at 50% in some cases. PAMI is the largest health insurance agency in Argentina. Most pensioners, as well as certain welfare beneficiaries, depend on it to access medical services. Each person insured by PAMI is assigned a family doctor, who is one of the ones affected by the recent measure. Family doctors perceive a fixed rate for each patient assigned to them. On Monday, that rate was doubled from AR$946 per patient monthly (around US$0.68 at the official exchange rate) to AR$2,100 (US$1.51). However, the union representing PAMI doctors, APPAMIA, denounced that this is “an undercover cut to medical work” because, at the same time, the administration eliminated the payment they received for each appointment. Under the new system, doctors are paid a fixed rate per patient but can no longer bill per visit, which accounted for a significant share of their earnings. The changes also eliminated bonuses for doing professional training courses. “The result is clear: we earn more per assigned patient, but we lose much more through what has been eliminated,” APPAMI said in a statement.  They added that, until now, their earnings for each appointment allowed them to sustain themselves economically, and they were able to charge up to 140 appointments each month through PAMI. “Now, that income is gone,” they said. According to the doctors, a US$1.51 payment for each patient “does not cover basic operational costs” of their practice, such as the rental of their offices, supplies, and services. The union said the fixed rate for each patient should be at least AR$6,500 (US$4.7) to cover those costs and their medical services and that the latest measure not only affects doctors but also the quality of the medical attention received by their patients. Pensions were one of the main sectors affected by the 30% public funding cuts President Javier Milei enacted when his administration rose to power in December 2023, as part of his zero-deficit goal. What the government says PAMI sources said that doctors “are not having their income cut” but that the government is instead “standardizing” their pay. As an example, they said that a family doctor with 800 assigned patients had a 121% increase to their monthly income. “This provides an increase to the fixed income of family doctors and aims to organize and plan the institute’s investment in this area by monitoring any potential deviations that may arise,” they said. However, a source from PAMI acknowledged to the Herald that doctors will no longer earn a rate per appointment and said that their income will now depend on how many patients are assigned to them. This means the system will now favor a fixed rate instead of an income that could vary month to month depending on the number of patients they saw. For patients, it could mean longer waiting times, as well as the loss of their assigned family doctor, as many couls possibly decide to leave PAMI and begin charging for visits privately. PAMI sources told the press they took the decision after they discovered cases of potential fraud, such as doctors declaring they saw patients in different cities far away from each other. Doctors’ work will now be more controlled thanks to this change, they stated. The agency added that they are committed to considering increasing the fixed rate “as the situation becomes more organized.” “For now, this is the budgetary effort the institute can make,” they said.