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Peru

Expanding Access to Essential Health Services

A government-led reform of the health sector in Peru seeks to improve coverage of publicly-subsidized health services through the public institution, Seguro Integral de Salud (SIS). SIS currently serves 6.2 million people with 67% of participants from the two lowest income quintiles. SIS aims to expand access of the poor to maternal, child, and other essential health services.

A team of health economists from Health Systems 20/20 is assisting SIS develop a methodology to estimate the cost of health services covered by SIS. This costing methodology, jointly with a tariff adjustment methodology, will serve as the basis for fees SIS pays to health care providers. Health Systems 20/20 is also helping SIS establish an economic and financial analysis unit to institutionalize capacity to carry out this type of analytical work in the future.

SIS intends to expand the services covered to all its target population. SIS currently pays government health providers on a fee-for-service basis, and not by historical budget (allocation of budget based on previous expenditures), and it is considering improving its provider payment system in the near future. The growth of SIS may result in a progressive split between financing and provision in the government health sector, with SIS financing services and the Ministry of Health providing the services.

Improving Maternal and Child Health

Two programs currently underway to improve maternal and child health in Peru include:

  • Juntos, a cash transfer program oriented to poor families based on conditionality of education and health care services for their children (families are paid for health visits and school attendance)
  • Crecer, a national strategy to reduce malnutrition in 638 prioritized districts by which an integrated package of public service education, health, and nutrition programs will be provided to poor households

Both programs have increased the demand for health services by the poor. In fact, the number of people insured by SIS increased from 3.6 to 6.3 million between January and October 2007. Health Systems 20/20 is working with SIS to implement pilots focused on decentralized management of public health insurance at the regional level to expand access to essential health services. Issues being addressed in these pilots include resource allocation, reimbursement methods, and supervision processes. Lessons learned will help to replicate an improved strategy, contributing to the achievement of the national goal of increased access of the poor to improved health services, and in particular, maternal and child health services.