Peruvian Health System

Brand logo for one of the national insurances, "EsSalud"

The health system in Peru has two sectors, one public and one private.  Within the public sector, there are two types of national insurance.  The first, called Seguro Integral de Salud (SIS) is mandated by the Peruvian Ministry of Health (Ministerio de Salud, or MINSA).  SIS is what I would describe as the equivalent of Medicaid or Medical in the United States, and is further discussed below.

The second type of national insurance is called EsSalud, and is coverage given through employment for working families and individuals.  It is similar to most employment-based plans in the United States, but is on a national coverage scale, and offers full coverage of services within the health plan.  More information about EsSalud is described below.

In addition, MINSA (Ministry of Health) mandates certain public hospitals (e.g. Hospital Regional and Hospital Antonio Lorena, both in Cuzco) that offer healthcare services, regardless of insurance coverage.  At these public hospitals, the government provides health care to the uninsured population in exchange for a fee of variable amounts under the discretion of the individual hospitals/organizations or through the Seguro Integral de Salud (SIS).

Seguro Integral de Salud (SIS):  Translated as “Comprehensive Health Insurance,” SIS is under the Ministry of Health, and aims to protect the health of Peruvians who do not have health insurance, giving priority to those vulnerable populations who are at poverty and extreme poverty.   The beneficiaries of the SIS, about 18% of the population, are mostly in rural and urban areas, where poverty is greatest.  Additionally, SIS benefits pregnant women and men over the age of 17 who live in poverty and extreme poverty, both in rural and urban provinces, provided they do not have coverage of EsSalud or other social security schemes.  Qualification for coverage of SIS is based on an individual’s or family’s economic level.

SIS is funded almost entirely (94%) with regular resources from the general budget. The remaining 6% of its resources come from donations and contributions, international aid agencies, contributions from individuals, and public and private institutions.

Brand logo for SIS

Poster of SIS benefits

El Seguro Social de Salud del Perú (EsSalud):  EsSalud is a national insruance coverage that provides health services to the working population and their families within national EsSalud facilities and hospitals.

EsSalud benefits are financed by employer contributions, equivalent to 9% of the wages of active workers.  In the case of retirees, the contribution comes from the insured and is 4% of insurable earnings.

EsSalud covers approximately 20% of the population, which includes formal sector workers, retirees and their families.  Again, the health plan provides health services in its own health units that are located mainly in urban areas.

Sign for one of the EsSalud city clinics.

Promotional tent for EsSalud coverage at a local open market.

Example of a typical facility under the coverage of EsSalud.

While the two national plans have been successful in providing more coverage and access to health services in the community, one of the biggest disadvantages that I have heard from local Peruvians is that the waiting time to receive appointments or schedule an operation is generally very long.

Table showing the percentage of the population that has insurance coverage. Basically, in 2008 48% of the population has some kind of social health coverage, compared with 32% in 2000. In 2008 20% and 18% of the population had either EsSalud or SIS insurance coverage, respectively. In 2008 4% of the population had some other type of insurance and 58% of the population was not covered by any type of social insurance.

Other Plans:  Similar to the United States system, the military, police and their families have their own health subsystem composed of the Armed Forces Medical Services (Armed Forces) and the National Police of Peru (PNP).

Private insurance and prepaid services offer coverage to just under 2% of the population.

Between 10 and 20% of the population is totally excluded from the health care system despite the government has tried, through the MINSA and regional governments, to reach the poorest.  To clarify this statement, 20% of the population does not have access to to any health care services or facilities, regardless of their insurance coverage.

References:
1.  Alcalde-Rabanal JE,  Lazo-González O, Nigenda G.  Sistema de salud de Perú.  Salud Publica Mex 2011;53 supl 2:S243-S254.

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