Some Keys Aspects of the Hospital System in The Province of Córdoba, Argentina

Abstract

Objective: to describe the Hospital System of the Córdoba Province, as regards availability of human resources, output of services, and role of the provincial system of reference. A qualitative approach was selected, using participant observation of official secondary document sources for the description of personnel structure, service output and interhospital transfer flow, plus depth interviews and key informants. The study is of the descriptive type, with a transversal retrospective design. The conceptual framework Healthcare Management, with an emphasis on Clinical Government, including process management of pathologies and non-clinical channels, and networking between hospitals and between hospitals and primary care centers, two current problem areas in the provincial hospital system. There is a fragmentation of the system outside Córdoba city. In the capital city, activity concentrates in a smaller number of establishments, with more rational bed occupation, higher density of specialized profiles and better allocation of human resources to those with higher demand and service output, a contrast with the rest of the province. However, a deficient articulation of the institutional hospital network hampers coordination of the system, despite individual efforts by institutions. Availability of human resources matches healthcare demands. By restrictive criteria measuring only external consultation, releases, treatments and operations, hospitals are working at two-thirds of their capacity, with marked disparities between regions and establishments. Main deficiencies in human resources are related to profesionalization, exhaustion, dating of operative skills, and disparities in specialized professional training. This state of affairs is made worse by faulty network coordination, lack of organization in pathology management, disparities between formal and functional organization of establishments and restrictions arising from the system public regulatory framework.