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Upper-middle-income countries

Achieving universal health coverage in Peru

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Janice Seinfeld and Nicolas Besich, of Videnza Consultores in Peru, wrote an assessment of their country’s progress towards universal health coverage for GNHE.

You can read the full assessment here.

The authors’ concluding points are:

  • The health sector in Peru is fragmented, consisting of a non-integrated set of sub-systems aimed at serving different segments of the population.
  • Over a third of the population remains uncovered and out-of-pocket payments account for over a third of health care financing.
  • More than 75,000 households are impoverished annually as a result of health care payments.
  • One of the most neglected segments of the population in terms of health insurance is the one including lower-middle and low-income individuals. This segment is not classified as poor and thus cannot access subsidized insurance through the publicly financed SIS. At the same time, they mostly work in the informal sector and therefore are not able to access the mandatory insurance scheme for formal sector workers, EsSalud.
  • There are several problems that account for this state of affairs:
    • the large informal labour market
    • the fragmentation of the health system
    • fragmented and inadequate funding for the public sector
    • the poor responsiveness of health services (especially in the public sector)
    • bottlenecks associated with the integration of the purchasing and provision functions of EsSalud
    • difficulties in implementing strategic purchasing
    • the absence of a risk-pooling mechanism for different insurance plans
    • the inefficient and inequitable distribution of human resources
  • In response to these problems, in 2013 the Ministry of Health announced a comprehensive reform of the public health sector:
    • reorganisation of the sector and public agencies
    • strengthening the funding of SIS and EsSalud
    • the modernisation of the management of public investments in the sector
    • the modernisation of the national health system (e.g. to shift the focus to promotion, prevention and early detection)
    • a comprehensive reimbursement policy
  • The impact of these reforms is not yet known.
  • Some important areas that need attention with respect to promoting financial protection are:
    • the definition of an explicit benefit package and actuarial projections about its costs
    • improving the efficiency of available resource use
  • Any budgetary increase must be justified by the increased ability of the government to attain its health objectives.


Read more in: Seinfeld J, Besich N. 2014. Universal health coverage assessment: Peru. Global Network for Health Equity (GNHE). Available at: