The looting of public health: the ASSE audit that uncovers the rotten pot

The Uruguay of solid institutions seems to have taken a break in the Administration of State Health Services. The recent ASSE audit, promoted by the management of Álvaro Danza, has put on the table a panorama that oscillates between gross negligence and blatant benefit to private companies. Under the magnifying glass of the auditors, the SAME 105 service and the contracting of medical transfers have been exposed as a black hole where the traceability of public money is conspicuous by its absence. It is, quite simply, a slap in the face to the taxpayer who waits for an ambulance while the system pays private individuals for trips that were not even made.

One of the most irritating findings of this ASSE financial audit is the relationship with the company ITHG (today UTAM). This provider, which was born in the heat of the pandemic, managed to concentrate 96.5% of SAME 105 spending between 2022 and 2024. What is worse: payments were detected for transfers that appeared as "cancelled" in the system, but that the State paid religiously without asking for explanations. The lack of control reached such a point that deviations of 672% of the corresponding guideline were recorded in 2024, a figure that defies any minimum accounting logic and puts the honesty of resource management in check.

The waste does not stop at mobile phones. The expense accrued on medical studies jumped 4,160% between 2021 and 2022, an increase that is not explained solely by the end of the pandemic. The ASSE management control indicates that this explosion of spending is due, to a large extent, to the inclusion of transfer services within the category of "studies", an administrative sloppiness that smacks of a maneuver to hide the true cost of outsourcing. Meanwhile, in Beautiful Union, the public provider pays a whopping 280,000 pesos for each specialized transfer to Montevideo, a price that seems more like a private jet than an ambulance.

The feast of outsourcing under the magnifying glass of the ASSE audit

The investigation delves into the agreements signed in 2022 with Casmu and the Catholic Circle for the purchase of CTI beds and studios. According to the audit of public resources, these agreements were made without prior price calls and systematically violating Tocaf, that regulatory bible that should govern State purchases. There was no competition or transparency; it was simply chosen by hand where to put the silver of all Uruguayans. In places like the Paysandú Hospital, the situation is similar: direct purchases, without bidding and with a total absence of controls over the evolution of patients admitted to private sanatoriums.

At the Maldonado Hospital, the apathy is historic. The ASSE budget evaluation tracked observations dating back to 2020 and found that 65% of the recommendations were never implemented. Tomography scans continue to be contracted different prices according to the mutualist and, most unusual, the authorizations are given "verbally", without a rubric that supports the expense. It is the management of the "bowling" applied to the health of the population, where money flows through informal channels while the shortages in public centers they remain the norm.

A management model that suffocates the public provider

The report of almost a hundred pages describes how the use of outsourced doctors was encouraged to the detriment of own resources. At the Hospital of Thirty ThreeFor example, while interventions with ASSE staff decreased, the hiring of external services under the agreement with Casmu shot up by 237%. The ASSE audit makes it clear that the strategy was not to strengthen the public, but to feed private providers, concentrating 29% of total spending on providers in just three institutions.

This “adequate control environment” that the audit says “does not exist” is, in reality, a system ripe for waste. It is difficult to believe that such levels of overbilling and lack of planning have gone unnoticed by the previous hierarchies of the Frente Amplio or the ruling coalition at the time. The ASSE audit Now it is in the hands of the board, and judicial referrals seem to be the only logical path if we want to rescue some dignity in the management of public health.