Analysis of the Fees and Payment Mechanisms in the Integral Health Insurance in Peru and Proposals for Their Adjustment
The Integral Health Insurance (SIS) is a decentralized entity under the Ministry of Health of Peru (MINSA) that finances a predefined set of services for its target population. SIS pays providers for insured services via retrospective, invoiced payments as established by MINSA, i.e., a fee-for-service system. SIS is currently expanding its target population through enrollment campaigns. It is also broadening coverage to include more complex services. As SIS grows in its financing role, it will need a new fee and provider payment system that better fits with its mission and objectives. The development of SIS is the main public policy expression of Peru’s universal insurance initiative.
This report provides conceptual and methodological background for recommending a new evaluation and fee system for SIS. Our recommendations are intended to support SIS’s provider payment system restructuring within the Peruvian public health system.
A Spanish language version of this document is available here.
