Health care in Peru

Located in South America, Peru is almost twice the size of Texas and has 31 million people.  About one third of these live along the coast, largely in Lima.  About half of the population–largely Amerinidan population–live in the Andean highlands, with the rest spread on the eastern slopes of the Andes and the adjoining rainforest.  About 45% of the population is aged 24 or younger.  Peru is a middle income country, with GDP per capita of $13,300, which ranks 118/224 countries in the world.

Life expectancy in Peru is 74 years, which ranks 126 out of 224 countries.  Health care spending is 5.5% of GDP (128/224 countries), far below the United States’ 17.1% of GDP.  There are 1.12 physicians per 1000 people and 1.5 hospital beds per 1,000 individuals.  The World Health Organization recommends 2.3 health workers per 1,000 people so this figure is far below that recommendation.  However, access to physicians and hospitals is highly variable depending on where you live, particularly across rural regions.

Before 2007, health care spending was largely financed by the government (54% of health expenditures) or patients paid out-of-pocket (40%).  Over 60% of the population had no health insurance coverage.  As stated in Neelsen and Donnell:

From 2002, poor children (<18 years) and poor pregnant women were exempted from paying user fees for basic healthcare at National Health Service (NHS) facilities.5  Providers were reimbursed through the tax-financed Seguro Integral de Salud (SIS), which covered 16% of the population in 2006. This programme also covered basic emergency care for poor uninsured adults with life-threatening or potentially permanently damaging conditions.

Despite the perceived generosity of the National Health Service at his time, the budget only allowed for spending of $18 per person. Further, often times claims exceeded Peru’s budget and in these cases regional governments simply refused to pay these bills.

In 2007, the Peruvian government passed the Seguro Integral de Salud (SIS), which provided 6 million Peruvian adults (21% of the population) access to free basic health care.  Previous user fees were eliminated and coverage was intended to be more comprehensive. Budget shortfalls, however, have made accessing some services difficult, especially inpatient treatment.

Both before and after the reform, workers in the formal economy were covered by El Seguro Social en Salud (EsSalud).  This program was financed by a 9% payroll tax.  Worker retain this benefit during retirement as well as for up to 1 year of unemployment.

Sources:

• Neelsen, Sven, and Owen O’donnell. “Progressive universalism? The impact of targeted coverage on health care access and expenditures in Peru.” Health economics (2017).
• World Health Organization. 2013. “A Universal Truth: No Health without a Workforce.” 2013-2-
  24].
• CIA World Factbook: Peru.

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