title: Comparing the performance of the public, social security and private health subsystems in Argentina by core dimensions of primary health care.
abstract: Most Latin American health systems are comprised of public (PubS), social security (SSS) and private (PrS) subsystems. These subsystems coexist, causing health care fragmentation and population segmentation.
  
  
  
  To estimate the extent of subsystem cross-coverage in a geographically bounded population (Rosario city) and to compare the subsystems' performance on primary health care (PHC) dimensions.
  
  
  
  Through a cross-sectional, interviewer-administered survey to a representative sample (n = 822) of the Rosario population, we measured the percentage of cross-coverage (people with usual source of care in one subsystem but also covered by another subsystem) and the health services' performance by core PHC dimensions, as reported by each subsystem's usual users. We compared the subsystems' performance using chi-square analysis and one-way analysis of variance testing. We analyzed whether the observed differences were coherent with the predominant institutional and organizational features of each subsystem.
  
  
  
  Overall, 39.3% of the population was affiliated with the PubS, 44.8% with the SSS and 15.9% with the PrS. Cross-coverage was reported by 40.6% of respondents. The performance of the PubS was weak on accessibility but strong on person-and-community-oriented care, the opposite of the PrS. The SSS combined the strengths of the other two subsystems.
  
  
  
  Rosario's health system has a high percentage of cross-coverage, contributing to issues of fragmentation, segmentation, financial inequity and inefficiency. The overall performance of the SSS was better than that of the PrS and PubS, though each subsystem had a particular performance pattern with areas of strength and weakness that were consistent with their institutional and organizational profiles.
authors.affiliation: National Scientific and Technical Research Council (Consejo Nacional de Investigaciones Científicas y Técnicas, CONICET), Center for Interdisciplinary Studies (Centro de Estudios Interdisciplinarios), National University of Rosario (Universidad Nacional de Rosario), Rosario, Argentina and nyavich@gmail.com.
authors.forename: Natalia
authors.initials: N
authors.lastname: Yavich
authors.affiliation: National Scientific and Technical Research Council (Consejo Nacional de Investigaciones Científicas y Técnicas, CONICET), Center for Interdisciplinary Studies (Centro de Estudios Interdisciplinarios), National University of Rosario (Universidad Nacional de Rosario), Rosario, Argentina and.
authors.forename: Ernesto Pablo
authors.initials: EP
authors.lastname: Báscolo
authors.affiliation: Department of Family Medicine, St. Mary's Hospital Research Centre, McGill University, Montréal, Quebec, Canada.
authors.forename: Jeannie
authors.initials: J
authors.lastname: Haggerty
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001118:Argentina / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006296:Health Services / Q000592:standards*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006779:Hospitals, Public; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D017149:Private Sector; D012943:Social Security; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Access; Health Care Quality; Latin America; and Evaluation; health services research; integrated health care systems; primary health care; public health.