Social security and medicines: coverage mechanisms of two health insurance organizations in the context of inflation, 2011-2019

Abstract

INTRODUCTION: Argentina’s high inflation can compromise access to medicines, even with social security coverage. The
objective was to describe the evolution between 2011 and 2019 of the coverage by the National Institute of Social Services for Retirees and Pensioners (INSSJyP, also known as PAMI) and the Institute of Medical Assistance (IOMA, for the Spanish acronym)  of a selection of medicines for outpatient use, with expired patent, frequently used in prevalent pathologies, and to  evaluate whether the evolution of the beneficiaries’ income accompanied the increase in out-of-pocket expenses for these  drugs. METHODS: The evolution of the retail Price (RP) and coverage by INSSJyP and IOMA was recorded for a selection of 10  drugs used in high-prevalence chronic diseases, in the periods 2011-2015 and 2015-2019. The out-of-pocket expense evolution  was calculated for the average, cheapest and most expensive presentations of each drug, and compared with the evolution of  the beneficiaries’ income. RESULTS: The average coverage of the INSSJyP for the studied drugs increased from 63% of de RP in  2011 to 73% in 2019. The coverage of the average RP by IOMA was 55% in 2011 and decreased to 36% in 2019, due to the delay  in updating the fixed amounts. For the beneficiaries of both institutions, out-of-pocket spending grew less than income in 2011- 2015 but greatly exceeded it in 2015-2019. DISCUSSION: The fixed amount coverage system has conceptual advantages, but  requires a timely update of the values accompanying inflation.