Modifications to the Healthcare System: Impact on Public and Private Healthcare Insurance

Decrees 170/2024, 171/2024, and 172/2024 of the Argentine Executive, published in the Official Gazette on February 21, 2024, deregulate public and private healthcare insurance systems established in Emergency Decree 70/2023

 

Among the most relevant modifications, users will now have the right to choose freely between public or private healthcare insurance providers, eliminating the obligation to remain one year in the public healthcare insurance provider of the employee’s labor activity when starting a new job position.

 

1.         Background and purpose

 

Until the issuance of Emergency Decree 70/2023, the healthcare system in Argentina had a different regulatory framework applicable to the Public Healthcare Insurance Regime—established through Law 23660—and the regulatory framework for private healthcare insurance, established in Law 26682. However, the recent Emergency Decree 70/2023 impacted on this distinction by incorporating all entities included in article 1 of Law 26682 (i.e., private healthcare insurance providers) under the scope of Law 23660.

 

In this sense, article 295 of Emergency Decree 70/2023 modified Law 23661, which regulated the “National Healthcare Insurance System,” to include private healthcare insurance providers as new insurance agents.

 

With these modifications, the Executive Branch sought “a better integration of the subsystems that make up the Health System” to favor users’ right to choose, and to promote competitiveness among healthcare insurance providers.

 

2.         Decree 170/2024 – Free choice and timeframes for the right to choose

 

Decree 170/2024 complemented the modifications in Emergency Decree 70/2023 by establishing that “the right to choose freely may be exercised by the beneficiaries of the Health Insurance Agents under article 1 of Law 23660, among any of the entities included in said Law.” In this way, beneficiaries of the National Healthcare Insurance System will be able to choose between public or private healthcare insurance providers for their coverage, since, as of Emergency Decree 70/2023, all of them are included in article 1 of Law 23660. The Decree also exempts retired persons and pensioners from the new regulation regarding the right of choice.

 

Regarding the timeframes for exercising the right to choose, there are two relevant deadlines that have been affected by Decrees 70/2023 and 170/2024:

 

• the one-year minimum stay period with the public healthcare insurance provider of the employee’s labor activity when entering a new employment relationship, before being granted the right to choose, 
• the one-year minimum stay-period with the chosen public healthcare insurance provider once the employee has exercised their right to choose.

 

The first of these time limits was repealed by Emergency Decree 70/2023, which established the right to choose freely between insurance agents included in Law 23661, eliminating the requirement of a minimum one-year stay period.

 

Regarding the minimum stay period once the right to choose has been exercised, Emergency Decree 70/2023 also introduced significant changes. Previously, based on Decree 504/1998, affiliates were required to stay with the chosen insurance agent for one year before being able to choose again. However, Emergency Decree 70/2023 established that the regulatory authority should determine the minimum time for which affiliates must stay with the chosen insurance agent, which cannot exceed one year.

 

In this sense, the Superintendence of Health Services, as the regulatory authority, has issued on February 29, 2024 Regulation 201/2024, by which a minimum 12- month stay period is established. That time limit is the maximum allowed according to Decree 504/1998.

 

The new Decree 170/2024 reinforces this idea but also establishes an exception: it states that the minimum stay-period will not apply to beneficiaries who, while affiliated to a healthcare insurance agent, have chosen a private healthcare insurance provider as their medical coverage provider, when this entity is duly registered. In this latter case, they can exercise the right to freely choose that same private healthcare insurance provider.

 

3.         Decree 171/2024 - Technical considerations

 

Decree 171/2024 introduces technical modifications to bring coherence to the system following the recent changes. It implements modifications to many articles of Annexes I and II of Decree 579/1993, which regulates Laws 23660 and 23661.

 

Among the technical aspects of the new regulation, “entities included in article 1 of Law No. 26682 (i.e., Private Healthcare Insurance Providers) intending to be eligible as Health Insurance Agents by cause of the right of choice established by Decree No. 504/98, must register before the Registry outlined in Article 6 of Law No. 23660."

 

In that sense, the rules for registration were set forth by Regulation 232/2024 of the Superintendence of Health Services, issued on March 4, 2024.

 

4.         Decree 172/2024 - Coordination with the public subsystem

 

Decree 172/2024 regulates the payment mechanism for providers within the public subsystem for the services covered by healthcare insurance agents: "Healthcare Insurance Agents included in Laws No. 23660 and 23661 and their respective amendments may enter into agreements with providers within the public subsystem to establish the mechanism for implementing payment for services, either through the applicable jurisdictional authority or individually."

 

Said agreements will be freely discussed between the parties and may establish, among other things, the practices covered, their codification, fees, billing rules and payment methods, and means for dispute resolution.

 

5.         Effective date

 

Decrees 170/2024 and 171/2024 become effective on March 1, 2024. Decree 172/2024 does not specify an effective date, so it will become effective the eighth day after its publication.