👉 El director médico del hospital de Orán, en Salta, el Dr. Fabián Valenzuela, discute las medidas implementadas para priorizar a los ciudadanos salteños en la atención médica. La medida ha permitido aumentar la cirugía en un 300% para los locales. A pesar de las críticas y preocupaciones de Bolivia sobre la pérdida de servicios gratuitos para sus ciudadanos, el Dr. Valenzuela sostiene que es responsabilidad de las autoridades bolivianas proporcionar atención médica a sus ciudadanos.
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00:00Dr. Fabian Valenzuela, who is the director of the Oran Hospital in Salta, how are you, doctor? Thank you for attending us.
00:06Good morning, good morning to you and your team, a pleasure to be in contact.
00:09Likewise, doctor, in light of the decision that was taken in Salta, also in Jujuy, I mean, have the results been satisfactory?
00:19Yes, yes, we have been implementing this measure for almost 10 months, and on the one hand, at least as far as I am concerned,
00:27when it comes to this hospital, the evaluation we did was highly positive.
00:31Not only does it have its economic value, the impact it has, but I also value it in the value of the benefits that the hospital has,
00:41which today is honestly prioritizing the citizens of Salta.
00:46For example, with this measure, we have been able to increase surgery by 300% of citizens of Salta,
00:53where before, for a surgery, for example, of vesicles, it took up to one or two years, people had to wait,
01:01because other people were also enjoying the services, because they were legally protected,
01:09but we have a law, law 8421, that these services for citizens with precarious transitory residence in the province have to be canceled,
01:19and well, so for us it is highly positive.
01:23Doctor, they told me that before this resolution, the hospitals were attested, the corridors, all of them, of foreigners,
01:32many of them Bolivians, who could not even walk, and that today there is space in hospitals, is this true?
01:39Yes, really, the demand of the citizens was important.
01:44In the year 2020-2023, they used up 10% of the total budget for the public health of the province.
01:51Today, we still have the demand, but those resources are for the citizens of Salta,
01:59because we also increased the demand, not only for people who do not have coverage,
02:04but we also have a high demand for people who have social work or pre-payment,
02:10because of the economic situation and because of the implementation of the COPPA or the famous PLUS,
02:15public health is being overturned because they cannot face these costs,
02:19but we are also giving answers to those people who are Argentine and Salton citizens,
02:24so that's why, more than the economic impact, I see that the resources of the hospitals are fully intended for the citizens of Salta.
02:33Doctor, you just said that you can operate more Salton people compared to what happened before.
02:38Now, since you took the measure, how many foreigners have arrived? Do you have that statistic?
02:43In the last registration, in the month of November, we assisted 10 foreign citizens,
02:53of which 6 were in an ambulatory form and 4 required hospitalization,
02:57and 10 paid the corresponding fees.
03:02And here we have a list, let's see, tell me doctor, 100,000 pesos are charged per day for hospitalization,
03:07now for foreigners, is this right?
03:09Yes, that is approximately what happens, you have to add the supplies,
03:16and as health is very dynamic, a hospitalization can be and depends on the costs,
03:22for example, a surgery, you have to see how the postoperative course is,
03:25everything that goes on, so the final costs are made at the time of the patient's hospitalization,
03:32and we manage with the nominator of the Provincial Institute of Health, which is the Social Work.
03:38We have 245,000 pesos per birth.
03:41Let's see, before they told me that it was full of foreign midwives, how is the situation now?
03:48No, now it decreased, because before there was also a double reason,
03:55first the gratuity and then the nationality.
04:01Now they have to face the costs, it really went down.
04:06We have had hospitalizations this month in Toco Gineco,
04:11but they were hospitalizations due to emergency situations, high-risk pregnancies,
04:16which were necessary at the discretion of the patients and professionals in Bolivia,
04:22but they faced all the costs and here they gave assistance.
04:26As I say, reciprocity, I heard a little bit of the introduction,
04:30I take away reciprocity a little bit, beyond the fact that we have unfortunate background
04:37with Argentine citizens in the Republic of Bolivia,
04:40and I do not want to stigmatize only the Republic of Bolivia,
04:43what touches us closest, only for that.
04:46But because we attend the emergency, we provide everything, we prioritize life,
04:54and then the income, the economic part, goes to other sources.
04:59If we do it, we are bad, but we prioritize life.
05:02And in reciprocity, we, the Argentines, are not going to look for public health in Bolivia.
05:08Generally they come here.
05:10What happened historically was 100 to 1,
05:12now, I said at the beginning that the law is cheating,
05:17that there was already a mafia that gave you the Argentine ID,
05:20that's why I asked you, are you also asking for an official residence certificate in Argentina,
05:25so as not to be deceived?
05:27The law does not say that they have to have a precarious or transitory residence.
05:33If it does not provide that, for us it is an illegal residence,
05:36because they have to go through migrations and they have to have that residence,
05:39which is how the law marks it.
05:41What we do, honestly, is to comply with the law.
05:44Precisely in the month of August, we had,
05:47the Consul of the Republic of Bolivia was present here,
05:51also expressing his concern that his fellow citizens
05:56were protesting for not accessing the hospital.
05:59Concern or anger, doctor?
06:01Because one gets used to this inexplicable gratuity for decades,
06:07and when they take it out and say, how are you going to get something that was wrong,
06:13let's tell the truth, doctor.
06:15Yes, that's right.
06:17And here the firmness of the measure was shown to you,
06:21I am not a hospital manager,
06:24you do not have to allow a flexibility of a law,
06:27and what I have said is that this approach should be done,
06:30personal appreciation, please, I do not want to mention anything.
06:33I would have to do it in their authorities,
06:36which are the ones who have to answer the citizens of that republic,
06:39the health authorities, not this hospital.
06:42Doctor, and those foreigners who go and attend and know they have to pay,
06:46how is the mechanism?
06:48How is the development?
06:50They, first of all, like all citizens,
06:52anyone who requires the hospital's care service,
06:55is identified in an office called admission,
06:58and it depends on what the hospital services require,
07:03and there it is identified first of all.
07:06And then, if it is within the framework of the law,
07:09it depends on the attention it wants,
07:11it is already arranged, a budget is passed,
07:15it is told how much the costs would be,
07:17and then it depends on the medical professionals,
07:21the complementary studies that can be required,
07:25or in the case of hospitalization, if it is urgent, it is attended to,
07:28and all that is saved.
07:30And if it is ambulatory, the budget is passed,
07:33and if it is not, it will be withdrawn as it entered the hospital,
07:36because they walk in and can walk out.
07:38Do you have a budget, doctor, from the time this measure was taken?
07:42We depend on our box,
07:45we have a regular account,
07:47yes, in a bank here,
07:49but it depends directly on the Ministry of Public Health,
07:52which is audited by the people at the central level,
07:55because we depend 100% on the Ministry of Public Health of the province.
07:58We are not a self-management hospital.
07:59But I understand that the government of Salta,
08:03in terms of attention now for Argentine citizens,
08:07has saved several million pesos, right?
08:10Yes, the Minister tells us that this money,
08:14we immediately have to acquire the resources that were spent,
08:19and return it, because if a citizen requires it,
08:23Argentines have to have these resources available,
08:26then immediately, with the corresponding tickets,
08:30pertinent returns are made.
08:32It is a very strict control that is taken.
08:34Doctor, another situation that had occurred was the vaccination,
08:37and the dengue case was punctual and had generated a lot of controversy
08:41at one point with what happened with the vaccine against foreigners.
08:45How are you handling that situation too?
08:47We, especially the dengue vaccine,
08:50we have had a lot of requirements,
08:52and in the issue of vaccination,
08:55we know that it is a preventive measure,
08:59and what we want is to prioritize the citizen.
09:02We know that the dengue vaccine is very inaccessible,
09:07because there is practically no,
09:09Brazil occupied almost all of the production,
09:12so it is very difficult,
09:14so the small amount of vaccine,
09:17we are prioritizing the Salton citizen.
09:19This is really inflexible,
09:23because we want the preventive health policy
09:27to correspond to the states,
09:29and the state has to do that.
09:31In this case, I'm going to talk about the proximity,
09:35that's why I don't want much,
09:37because if not, they will say,
09:39everything with Bolivia, with Bolivia,
09:41but that's what I have close, you know?
09:43And the majority of the cases,
09:45objectively, the majority of the cases came from Bolivia.
09:47We, almost more than 90%
09:50of the attention of Bolivian citizens.
09:52Yes, now the paradigm has changed,
09:54I mean, the number of operations that were done,
09:56when this measure arrived,
09:58no longer free,
10:00supposedly they came for very expensive issues,
10:03everything was free,
10:05now what are the most representative
10:07attentions,
10:09the ones that are done with more recurrence,
10:11by no longer serving foreigners for free?
10:14Generally, the guard, the urgency,
10:17because they are situations that are given,
10:20and as I said,
10:22they still require some specialties,
10:24such as gynecology, or high complexity,
10:26but they have decreased,
10:28and there are other specialties
10:30that have decreased by 100%,
10:32ophthalmology we practically don't have,
10:34dentistry neither,
10:36everything was free,
10:38everything, everything was free.
10:44And public health really has its cost,
10:46I don't want to say that it is a waste,
10:48but it has its cost.
10:50So, you had told me that in Colombia,
10:52from the street,
10:54the organization was put to come and attend to Argentina.
10:56Yes, yes, yes, it was obvious.
10:58There is, to go out to any part of the world,
11:00what is the traveler insurance,
11:02the one that goes out to travel,
11:04you have to hire it,
11:06most countries,
11:08and that is also going to be discussed now
11:10with reforms to the immigration law,
11:12surely in Argentina,
11:14that there are citizens from neighboring countries
11:16who opt for public health
11:18and who come with these insurances.
11:20We had a case,
11:22not from neighboring countries,
11:24but from a country from North America,
11:26which required the services of the hospital,
11:28and the health insurance was taken care of,
11:30as it should be.
11:32Of course, that doesn't happen in Argentina, practically.
11:34No.
11:36There is also the reality,
11:38the one who has social work,
11:40who goes to the hospital,
11:42no, no, no,
11:44he has to recover through this type of insurance
11:46what would be the attention of foreigners.
11:48Yes.
11:50And they provide,
11:52they have a coverage
11:54where we can recover the costs,
11:56there is no problem.
11:58Of course, of course.
12:00Besides, this citizen told us
12:02the low costs he had,
12:04that is, the cost that had happened with that,
12:06the tensions,
12:08because the costs are very low
12:10to what is paid abroad.
12:12Of course.
12:14We know, doctor,
12:16that there is a Hippocratic Oath,
12:18that people are all the same
12:20when it comes to attending,
12:22but hey, here they were taking advantage.
12:24Did you ever have an experience
12:26of attending a foreigner
12:28knowing that there was a more suffered case,
12:30that he had a major condition,
12:32an Argentine citizen,
12:34and you were giving priority to a foreigner?
12:36No, no, no, no.
12:38What is prioritized here,
12:40in that case,
12:41when it was still free, doctor?
12:43Of course, when it was free, no,
12:45because everything was the same.
12:47Of course.
12:49Here, for example,
12:51in an emergency case,
12:53the triage is done,
12:55priorities are valued,
12:57who are the patients
12:59who have more priority in the attention
13:01and who do not.
13:03Independently,
13:05the same is happening today,
13:07as I told you,
13:09with social work.
13:11With social work.
13:13We have it.
13:15Does the neighbor show conformity,
13:17is he happy with this measure,
13:19when the patient is spoken to,
13:21who is seen in the most empty hospital,
13:23with more possibility of attention for them,
13:25do the neighbors manifest it,
13:27are they satisfied and happy with the decision?
13:29Yes, yes, yes.
13:31The common citizen is always telling us
13:33that now they are seeing
13:35that the access they are having
13:37to the health system,
13:39that is, one always notices
13:41things and they see now
13:43what happens that foreigners do not come.
13:45Do you understand me?
13:47Because before this was really
13:49an important number of citizens
13:51who came to the hospital services.
13:53Sure.
13:55Well, doctor,
13:57thank you very much,
13:59because obviously this is giving results
14:01and has improved the health
14:03of the Argentine citizen.
14:05There is attention, there is space,
14:07they no longer have to wait for shifts.
14:09You said a two-year shift.
14:11A two-year shift,
14:13for whatever reason,
14:15one can die.
14:17For a surgery,
14:19as I read,
14:21we are talking about scheduled surgeries,
14:23which are theoretically.
14:25If these complications had gone up,
14:27the patient goes to the emergency room
14:29and gets operated.
14:31And now what is the average
14:33waiting time for a scheduled surgery?
14:35What is the average?
14:37Now the average is approximately
14:38we are within 45-60 days.
14:40Wow.
14:42It changed two years.
14:44What happens is that we are recovering
14:46all previous patients.
14:48Of course, of course, of course.
14:50Well, obviously something had to be done
14:52and luckily this is positive
14:54for the Salteño.
14:56Excuse me,
14:58I want to add a topic.
15:00Listen to the introduction.
15:02You are talking about
15:04university training.
15:06I also come from a public university.
15:08In which they come to do
15:10specialties in public hospitals.
15:12Let's see, tell us, doctor,
15:14because we are going to get into that topic.
15:16Because a resident,
15:18more or less I have estimated,
15:20because we have a residence here,
15:22completes the specialty of a resident
15:24who starts until he goes to the state,
15:26he gets more or less 500,000 dollars.
15:28500,000 dollars.
15:30Let's see, let's go with this.
15:32There is still in the education part.
15:34And many times, many times
15:36foreign residents come
15:38to the United States.
15:40That would also have to be imposed
15:42as a debate.
15:44That would be a nice debate
15:46of the Congress.
15:48Let's see, doctor,
15:50so that it is understood.
15:52They study the career in their country
15:54of origin, of birth,
15:56but they come to do the specialty here.
15:58Yes, that happens everywhere.
16:00Well, and only that specialty,
16:02depending on how long it lasts,
16:04you give an average of 500,000 dollars
16:06that the country pays a foreigner
16:08who ends up paying our schedule.
16:10And then he goes.
16:12Of course, of course.
16:14And then he goes to his country.
16:16Probably not.
16:18Most of them leave
16:20and most of them express it.
16:22He tells you when you meet him,
16:24I talk a lot with people on the street
16:26and he tells you no, no,
16:28I receive and I go.
16:30The raw material, all that knowledge
16:32that Argentina gave him,
16:34he takes it to his country.
16:36Yes, I don't want to say
16:38that you don't know what happens,
16:40that it is understood, it is logical.
16:42It's a lot of work,
16:44because they come, they do the residency,
16:46they cost half a million dollars
16:48and they come back.
16:50But who is wrong, the other or us?
16:52We are a poor country.
16:54And if you come to take advantage, of course.
16:56Because this is what Álvaro just said is true.
16:58Argentina for many years
17:00was a country with poverty.
17:02In the last three decades
17:04it became a poor country.
17:06Extreme.
17:08And you come to say, hey, stop,
17:10we have a country with a lot of poor people,
17:12we are giving to the one who did the career,
17:14to the one who comes to do the residency here,
17:16half a million dollars.
17:18To the one who comes to educate himself
17:20and to the one who comes to educate himself
17:22from another country,
17:24because in his country he cannot,
17:26because it is very expensive, it is not accessible.
17:28And the one who comes to attend his health here,
17:30because here it is free
17:32and in his country it is very expensive.