Escenarios de la desregulación de las obras sociales sindicales: el desafío de los actores frente a la libre elección de los servicios de salud : Buenos Aires 1997-2004


Belmartino, Susana

Spatial Coverage

Temporal Coverage





375 p.


Atribución-NoComercial-SinDerivadas 2.0 Genérica (CC BY-NC-ND 2.0)




Ciudad Autónoma de Buenos Aires (autonomus city)


The impact of the reforms in medical care services and systems constitutes an issue in the political agenda of most Latin-American countries. Argentina couldn´t escape the complicated picture the region went through. The consecutive adjustment measures applied, drastically restructured the social policies within the framework of a transformation process in the presence of new requirements deriving from a globalized economy.

Far from being equitable, the structure of the Trade Union Health Institutions - Obras Sociales reproduces the income inequality present in the economy, and holds a high level of disparity and fragmentation in the access to medical care services.

Government reform projects posed restrictions and conditioning related to trade union presence at the administration and management of the Obras Sociales funds, with the absence of the State as financial backer, the weak State role in the system´s regulation and the presence of the private sector, which imposed its interests.

Deregulation was thought as a mechanism for putting the system in order which attempted to transform the entities organizational culture. One of the Reform Process focal points was the free choice of institutions, considering beneficiaries, making full use of its rights, would personally punish inefficient providers and obras sociales encouraging a process of natural selection, which would turn the system into a more rational one.

The Reform, which took more than four years to be implemented, was hindered by continuous negotiations among the main corporative actors, and reflected a highly fragmented internal logic with a total absence of influence at parliamentary level.

The overall aim of this thesis is focused on describing the process of reform of the trade union Obras Sociales during the period 1997-2004 in the metropolitan area of Buenos Aires, as well as analyzing, as a case study, the changes produced within two trade union entities during its reconversion process, having in mind the institutional orbit and the beneficiaries point of view.

The specific goals are: a) to outline the main axes of the Obras Sociales Reconversion Process, b) to analyze positioning assumed by the actors involved, and c) to describe the changes occurred within two trade union entities (Unión Obrera Metalúrgica and Obra Social del Personal Gráfico) during its reconversion process.

The methodology foresaw a descriptive qualitative-quantitative diachronic design, based on the analysis of secondary sources and gathering of primary data. Secondary data allowed the analysis of the main indicators of the system´s reform, the trade union entities reconversion process and the two obras sociales under study. In-depth interviews were thoroughly conducted with key informants involved in the Reform Process, with those responsible for the obras sociales selected, and with trade union institutions affiliates. Through the design of a non probabilistic sample by quotas of sex and age groups, semi-structured surveys were carried out to affiliates from both entities on medical care services in the metropolitan area of Buenos Aires. Field work was conducted in two stages: in the year 1999 and in 2004.

Analyzing this process of change, both from a macro and micro perspective, involves examining enlightening cases in action which provide a clear understanding on the development of the process from a narrower context.

Despite the change produced in the logic of social policies and the decay of social protection conditions (due to the decrease of employment rates in the formal sector and deregulation of the labor market), one could argue that the different mechanisms proposed in Medical Social Security didn't quite altered the structure of the Obras Sociales subsystem. The limited opening of free choice was lower than expected, and resulted in an adverse selection which deepened the existent inequity still further. Even though the Reform placed emphasize on improving the Obras Sociales effectiveness and efficiency, some of its core subjects were not conductive to a greater equity, for instance, the Benefits Basic Program, free choice of entities and a better allocation of the Solidary Redistribution Fund benefits. The group of Obras Sociales that received assistance from the World Bank Program, relatively improved their economic-financial indicators, but got into long term debts hard to pay back in a scenario of economic contraction.

The Reconversion analysis at a micro level (metallurgical trade union –UOM- and Graphics Trade Union –OSPG-) showed dissimilar logics related to organizational structures and political trajectories. The common thread was its solid ideological profile, which cuts across healthcare conception, planning its offer on the basis of its own service model with scarce private procurement. UOM failed in its survival strategies and had to resort to composition with creditors and handing over the management of its services. Graphics, in the meantime, benefited from the accession to the World Bank loan in order to consolidate its objectives. At both entities, high levels of satisfaction with attention were detected, regardless the quality of the prevailing health care services. Such evaluation is related to a strong sense of belonging, determined by an identity created by the relationship with their jobs. Nevertheless, the access to healthcare coverage was without a doubt, a highly appreciated asset among the beneficiaries, because it gave them a higher level of safety and assurance facing health needs.

Table Of Contents


Capítulo I - Introducción
1.1 Planteo del problema
1.3Principales interrogantes
1.4 Metodología

Capítulo II - Aspectos conceptuales
2.1 Sobre las políticas sociales
2.2 Sobre los actores
2.3 Sobre la inequidad y las desigualdades en salud
2.4 Sobre la evaluación de los servicios y la satisfacción con la atención de la salud

Capítulo III - El sistema de salud en Argentina: algunas dimensiones
3.1 Principales indicadores socio-demográficos y sanitarios
3.2 La estructura del sistema de salud en Argentina
3.3 Utilización del sistema de salud
3.4 El gasto en salud
3.5 Cobertura de salud
3.6 Indicadores laborales y pobreza

Capítulo IV - El sub-sistema de Obras Sociales
4.1 Aspectos generales
4.2 Recaudación del sub-sistema
4.3 Indicadores de población
4.4 Rama, tamaño e ingreso per cápita
4.5 Producción prestacional e indicadores de utilización

Capítulo V - Principales aspectos de la Reconversión durante el período
5.1 Antecedentes de la Reforma
5.2 Aspectos centrales de la Reconversión de Obras Sociales
5.2.1 Libre elección de afiliados
5.2.2. Programa Médico Obligatorio (PMO)
5.2.3 Reformas en el Fondo Solidario de Redistribución (FSR)
5.2.4 Programa de Reconversión de Obras Sociales
5.2.5 Eficiencia, regulación y supervisión del sub-sistema
5.3. A modo de cierre: el fin de la etapa menemista

Capítulo VI - Actores, tomas de posición, estrategias y conflictos
6.1 Los actores estatales
6.2 Los actores sindicales
6.3 Los actores privados
6.4 Los Organismos Internacionales
6.5 Otros actores con menos presencia

Capítulo VII - El proceso de Reconversión de la Obra Social de la Unión Obrera Metalúrgica de la República Argentina (OSUOMRA)
7.1 Surgimiento de la UOM
7.2 Estructura de la UOM
7.3 Situación financiera
7.4 El proceso de Reconversión
7.5 Los actores frente a la Reconversión
7.6 La visión de los beneficiarios
7.6.1 Etapa cualitativa
7.6.2 Etapa cuantitativa
7.7 A modo de resumen

Capítulo VIII - Estudio de caso: Obra Social del Personal Gráfico (OSPG)
8.1 Surgimiento del gremio
8.2 Estructura de la OSPG
8.3 El proceso de Reconversión
8.4 La visión de los actores involucrados
8.5 La opinión de los usuarios
8.5.1 Etapa cualitativa
8.5.2 Etapa cuantitativa
8.6 A modo de cierre

Capítulo IX - Consideraciones finales


Título obtenido

Doctora de la Universidad de Buenos Aires en Ciencias Sociales

Institución otorgante

Universidad de Buenos Aires. Facultad de Ciencias Sociales

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