Radiography of a bastion of La Cámpora: criticism of Luana Volnovich’s PAMI for delays and lack of control
The PAMI, the largest social work in Latin America with 4.8 million members, administered a budget of $456 billion in 2021, it has 14,000 employees and it has a territoriality only comparable to Anses, with 600 assistance agencies and 38 Local Management Units (UGL) throughout the country. But nevertheless, faces serious control problems and strong criticism for delays and inconveniences in benefits and for the lack of doctors and pharmacies in the interior.
On the political control, on the other hand, there is no doubt: it resides in The Campora since Luana Volnovich took over as executive director in 2019. The official’s vacation on an island in the Mexican Caribbean with her second in command and partner, Martin Rodriguez, unleashed a scandal at the request of the president Alberto Fernandez for its officials to rest in the country and the obstacles to tourism abroad established by the Government. But disobedience did not cost Volnovich or his partner his job. Campers will continue to build power from there.
Beyond the tourist scandal, Volnovich’s management faces criticism for inconveniences in benefits, delays of up to three months for specialties; the lack of doctors and pharmacies inside the interior, and for having fired some 400 people for “political” reasons. In addition, the leadership is accused of using the structure to make “partisanship” with the vaccinations against Covid-19. Volnovich herself was shown with Máximo Kirchner and Axel Kicillof in those posts.
“From when it was created in 1971 to today, 90% of the time this non-state public entity was intervened by shift executives,” he describes. the defender of the Third Age, Eugene Semino. “It is an illegality, there is no control of Congress. Nobody audits it, the trustee is PAMI staff”, he adds.
Semino recalls that at the end of 2003 a commission was set up, which he was a member of, to carry out a court audit: “It could not be done because there were no balance sheets, as there are none today. The PAMI is like the drug cartels in reverse, they receive money in black and launder it; the social work receives it blank and nobody knows what it does”.
Specialists estimate that more than 30% of the social work budget goes to medicines and another similar percentage to personnel. On the flap “active transparency” on the PAMI website, the last budget published is that of 2019. The queries made by this newspaper to the organization’s spokespersons about the budgets of the last two years, the forecasts for 2022, the funds allocated to the different areas, the amount updated providers and capitation payments were not answered. The only indication was to check on that page.
The PAMI budget was $212,000 million in 2019, jumped to $326,255 million a year later and reached $456,400 million in 2021: it increased a 119% more in that period. Although the Frente de Todos highlights the provision of free medicines from PAMI to differentiate itself from the priorities of the Cambiemos administration, the The expense item that grew the most in 2021 was advertising: 759% year-on-year. According to the National Directorate of Official Advertising of the Ministry of Media and Public Communication, dependent on the Chief of Staff, in response to a request for public information, these resources went from $27,135,740 to $232,245,563.
Social work hasmore than 8,000 GPs, 17,000 providers and 14,000 pharmacies, as it says on its website. All the sectors consulted for this note preferred to speak without identifying themselves. They ensure that there is no accumulated debt Y that payments are made “more or less in a timely manner.” The agency is the only one in the country of this size with capitated system.
Elena Torres is oncology patient of PAMI Avellaneda and account that takes almost three years without controls: “There are no doctors in the clinics, they pass me from one to another, they give shifts for months later and they don’t give explanations. My family doctor since March 2020 who does not attend: he gives the prescriptions with his secretary. At PAMI no one responds.”
From Villa Merlo (San Luis), Raquel Silva, 65 years old, assures that she has several complaints made in the social work, with documentation included because the attention is a “disaster”. point out that there is three dentists for 12,000 members and that he already denounced two of them in the social work for poor performance. There is no gynecology specialization and refer patients to Villa Mercedes or to the capital, 200 kilometers away. “For a manography it is the same, a horror”, he defines.
Semino characterized as “dramatic” the situation from the benefits. The services “arrive late or are not given”, all “enhanced” by the pandemic. He questions that, after two years, the primary consultation is still virtual and that the Referral to specialists takes “between two and three months”, same as the low and medium complexity studies.
It also highlights the lack of beds for chronic patients and the suspension of home admissions. “All this ends up aggravating the patient’s condition or makes them choose to enter the system through the emergency room,” he adds.
the national deputy Grace Ocana, former Minister of Health and former director of PAMI, ratifies the existence of delays. “The income is not enough for all the coverage, so this type of maneuver is used,” he says.
From the associations that bring together the clinics and sanatoriums point out that no debt Y that 2021 closed “relatively well” due to an agreement of 33% of rise in the capita in the second semester, to which was added a extraordinary bonus of 10% of that value in September and one of 75% that is receivable.
Thus, the referents maintain, the cost increase of last year was compensated but not that of 2020. They underline that the value of $1300 per capita It is insufficient”. Social work pays one half of the capitation after 30 days and the other half after 90. A family doctor with about 700 capitas charges around $100,000 a month.
One last change is that outpatient benefits they are no longer paid per capita but per internship. “It is being launched, it already applies to some -they explain from a provider clinic-. They will be paid as the benefits of more complexity, of the third level”.
A former director of an LGU from the interior points out that in the high complexity there are few authorized centers and overpricing or cartelization are frequent; He also admits that in smaller provinces there are problems because there are few clinics.
Claims are even higher for rehabilitation and mental health care, segments in which affiliates claim that there are no answers. The parents of Carol Lencinas, 98 and 88 years old, depend on agency 4 of Villa Pueyrredón. Her mother fractured her hip, went from a hospital to a sanatorium and when she was discharged, the problems began to get home admission, rehabilitation and delivery of diapers. It took several days of paperwork and payment with their own money until the situation was unlocked.
The capitation system also applies to “social support” benefits that range from nursing homes to tourist activities. In the recreation segment, drawn numbers were detected on several occasions and in different procedures.
International parameters for social projects for the elderly population state that 15% of the budget for medicines is already a “high” value. The PAMI, according to unofficial sources, double that figure. In March 2020, President Fernández presented a list of 170 free medications, involving 3,600 brand-name benefits which PAMI affiliates without other coverage can access free of charge. This vademecum is financed with the COUNTRY tax and, according to the institution, users save, on average, $4,700 per month. At the same time, one part of the chronic medication that was previously covered at 80% is now at 50%.
The pharmaceutical industry also prefers silence Before the consultations and from the pharmacy chambers, they maintain that they are charging on time and insist with the claim that their contribution of 12% be reduced (44% put the laboratories and the rest, the social work). “We have 10% margin left; 300 PAMI prescriptions are needed to pay an employee”, they graph. On average, billing to the entity is around 40% of all pharmacies.
Marcelo Peretta, head of the Pharmacists and Biochemists Union, assesses that the free access formulary “helps” members, but warns that “no new pharmacies are enabled, which forces retirees to walk more or end up with ‘fallen recipes’: those that are made but not used”.
He assures that they warned Volnovich about the situation: “Not enabling is a political decision. There are many interested parties who did the paperwork. Not authorizing them is a way of not increasing spending.”
the PAMI does not apply the law of generic drugs, which is another way of saving. Semino points out that it should be used and that “it is not done because the industry does not want it.” He adds that in the same formulary there is a drug for hypertension for $500 and another for $1,500 and “the doctor is left free to prescribe, without guidance on what to consume.”
Semino also remarks that this year there were problems with flu vaccines and shortages of pneumonia. Regarding the participation of social work in immunization against Covid-19, he classified it as “more effective than effective”.
Of the total volume of drug spending, former directors estimate that a third are oncology products (mostly imported, which put pressure on spending) and another third are insulins. Million-dollar scams have already been detected several times in these groups, with deliveries to deceased patients or people with falsified diagnoses.
The tenders for purchases are carried out by the central PAMI, concentrating all the power (this was determined during the Luciano Di Césare, during the first government of Cristina Kirchner) although in cases of emergency, the UGL go out to buy on their own. In April 2020, Volnovich denied having paid overprices in a direct purchase of alcohol gel; assured that the comparison between different products was “malicious”.
“Even if you are a genius here, if you don’t have a political organization you can’t do anything. I, as a taquito, because in all places I have a partner who paints a flag just like mine. And it’s not that thing that La Cámpora drinks… But, yes, it’s my eyes throughout the country”, Volnovich said in an interview with elDiarioAR last April. The organization also controls Anses.
“It is an organism that is used to do politics. La Cámpora already did it in the last part of Cristina Kirchner’s government. it has the fourth largest budget in the country and is present everywhere”, Ocaña does not hesitate to say.
A week into the pandemic, layoffs began at PAMI and leaders of the UCR and Pro questioned the decisions “for ideological issues”. Throughout the months there were several batches of designated people in the management of Cambiemos who were left out. Even the unions spoke of “political persecution.” In Córdoba, for example, social work is defined as a “trench K”.