The role of the state in health systems.

The object of this paper is to update the debate concerning the State's role in health systems services regarding the experience of the last decade. It is argued that it is impossible to give an account of the problem's complexity without bearing in mind the social science contribution concerning the crisis in Welfare States.

[The state, social class and health]. / Estado, clases sociales y salud.

This paper analyses the health policies implemented in Argentina during the last four decades, relating their application to concomitant development strategies that were underwritten by political projects advancing different 'societal models'. Our hypothesis is that, in Argentina over the last four decades, there have been three major attempts at adjusting the internal needs of capitalist development to the conditions imposed by the world capitalist system. Such strategies, globally termed 'populist', 'developmentalist' and 'authoritarian', imply a modification of the relationships between state and economy (mode of development) and between state and society (mode of hegemony). They also involve peculiar ways of approaching the contradiction between accumulation and distribution, and consequently, different methods for solving social problems and alternative paths to the consolidation of a hegemonic project. Within this context, both the rationale offered by the state for its proposed health and welfare policies, as well as the actual implementation of these policies conforms to the basic principles of each of the models in force. In the populist model, the political project involves a progressive expansion of the participation of the popular sectors, both in the labour and consumption markets and in the political system. Its health plan conforms with this model by recognizing the state's responsibility both to increase its participation in health services and to promote corporativist activities in the sector, in accordance with the global mobilization/incorporation policy controlled by the mass organizations. In the developmentalist model, emphasis falls on the need to privilege accumulation over distribution; investments in infrastructure are treated as a priority as they are considered indispensable to ensure the future generalization of public welfare. The argument is that the impact of medical assistance on labour productivity must go hand in hand with the creation of job opportunities from economic development. Finally, the authoritarian model excludes the promotion of concensus politics in an effort to radically transform the articulations between state and society. The disciplinary function of the market is used to concealing both a serious lack of interest in the population's living conditions and an iron decision to subject the totality of social life to the rationality of a system where social injustice stands as the society's bastion.

[The medical job market and the production of health services in Argentina]. / El mercado de trabajo médico y la producción de servicios de salud en la Argentina.

The article begins by considering the physician as a professional technically qualified to respond to a social need. First, the terms are defined: manpower equals the medical labor resource and the work of the physician in private practice, in the employ of a public or social security establishment, or in private firm. The article then examines the production system of medical care services in Argentina, where the functions of the State have been redefined since the depression of 1929 and have become more interventionist and care-oriented. This section describes three points: the organization and financing of medical care in three subsectors (public, social security, and private), advances in medical knowledge and technology, and the consequences for practice (specialization, subspecialization, and employment in large institutions). This part of the article stresses the effects on medical practice of introducing complex technology, and the special situation in Argentina where relatively highly qualified professionals are employed in auxiliary tasks. In the section specifically on the study of the labor market, relations between supply and demand care considered. This relationship depends on two interrelated social processes: medical education and medical practice. The possible relationships between these processes are examined, and the research is based on the assumption that there are many markets, each with its own supply of and demand for services and all differing in the sources of their financing. This section describes the characteristics of medical work in each subsector and their relationship to training. The section on the interconnection between the labor market and training describes the characteristics of undergraduate and graduate training and how they bear on the professional's placement on the labor market. Among the article's provisional conclusions, the authors emphasize the atypical character of this labor market, the social values involved, and the role of the State, which cannot be delegated, in the allocation of resources for health and in regulating the training and employment of medical human resources.