Francke, Pedro2013-05-062013-05-062013-01https://hdl.handle.net/10986/13294This case study analyzes the progress of Peru's Comprehensive Health Insurance (SIS) and evaluates the challenges that remain to achieving universal health care coverage. Peru is an upper-middle-income country with a gross domestic product (GDP) per capita of just over US$10,000 (purchasing power parity). The country has grown rapidly in the last decade; the average growth rate was 6.5 percent. However, 28 percent of the population lives in poverty (2011), which is estimated with regionally differentiated poverty lines between US$1 and US$2 per capita per day. In addition, only one in four individuals has employment with social security coverage. The SIS aims to reduce economic barriers through the elimination of user fees for a package of services. Although its budget has been low, the SIS has played an important role in the reduction of maternal and child mortality. However, the improvements expected to the overall health system have not materialized. Meanwhile, when the decentralization process transferred funds and authority to the regions, it did so in a context of weak management capabilities, and it failed to clearly define the relationship between the national and regional governments. A major effort to strengthen the technical capacity of the Ministry of Health (MOH) should accompany the strategies outlined above. This effort should emphasize a review of health priorities, the design of effective interventions within a fiscally sustainable benefits package, and the introduction of incentives and new payment mechanisms at hospitals and other health facilities.Perú tiene un sistema de salud segmentado, conformado por el Ministerio de Salud (MINSA) y la seguridad social, ambos con bajo financiamiento, y el sector privado. Establecido en el 2002, el SIS peruano fue diseñado para expandir la cobertura de salud al reducir las barreras económicas mediante la eliminación de los cobros a los usuarios por un paquete de atenciones. Implementó además políticas y sistemas de gestión con un mayor enfoque en resultados e incentivos.. Si bien el SIS ha desempeñado un papel importante en la reducción de la mortalidad infantil y materna, las reformas al sistema de salud todavía no han logrado los avances previstos en un inicio. Consecuentemente, en 2009 y 2010 se aprobó una nueva política (Aseguramiento Universal en Salud [AUS]) con el propósito de dar un enfoque más integral a la reforma del sistema sanitario. Hasta la fecha, ha habido poco progreso en la implementación de la nueva política. En el presente estudio se discutirá en detalle la interacción entre las reformas de descentralización de Perú y el SIS, con énfasis particular en el modo en que esta interacción ha alterado la capacidad de regulación del sistema de salud, y la compra y provisión de servicios.en-USCC BY 3.0 IGOaccess to contraceptionaccess to drugsaccess to servicesadolescentsAdult mortalityage groupsagedbasic infrastructurebedsbudget capsbudget ceilingbudget increasebudget processcancercancer patientscardiovascular diseasechild healthchild health carechild mortalitychildbirthchronic malnutritioncitiescitizenCitizensCommunicable diseasescomprehensive careContraceptive prevalencecontraceptive usecrowdingdeathsdemand for healthdemand for health servicesdemand for servicesdemocracyDependency ratiodeveloping countriesdiabetesDiscriminationDiscrimination against womendoctorsdrugsearly detectioneconomic growtheducation of womenemergenciesemergency careemploymentEpidemiological Transitionequilibriumequitable accessEssential Health Servicesexpendituresfamiliesfamily planningFee-for-servicefertilityfertility ratefinancial risksgeneral practicegross domestic productHealth Administrationhealth carehealth care coveragehealth care managementhealth centersHealth Coveragehealth educationHealth expenditurehealth facilitieshealth financingHealth for Allhealth inequitieshealth infrastructureHealth InsuranceHealth Interventionshealth outcomeshealth planhealth policieshealth policyhealth postshealth problemshealth professionalshealth promotershealth promotionhealth reformhealth sectorHealth servicehealth serviceshealth spendingHealth StrategiesHealth Systemhealth system reformhealth systemshealth workershealthcare servicesHIV/AIDSholistic approachhospitalHospital bedshospital carehospital serviceshospitalshuman developmenthuman resourcesHuman Rightsill healthillnessillnessesimmunizationimmunizationsincomeincome countriesincome householdsIncome inequalityindexesindigenous populationsinfantinfant mortalityInfant mortality rateinformal paymentsinsurance plansinsurersinternational economic crisisinterventionlarge citieslevels of infantlife expectancylive birthslocal governmentsmalariamanagement of healthmanagement systemsmaternal carematernal healthmaternal mortalityMaternal mortality ratematernal mortality ratiomaternity leaveMedical Caremedical schoolmedical specialistsmedicinesmental healthmidwivesMinistry of Healthmodernizationmorbiditymortalitymothernational levelnational policiesnational policyNeonatal mortalitynumber of peoplenursesOffice of Healthoutpatient careoutpatient servicespatientpatientsphysicianphysicianspractitionerspregnant womenprenatal careprimary careprimary health careprivate pharmaciesprivate sectorprivate spendingprogressprovision of carepublic expenditurepublic expenditure on healthPublic Healthpublic health carepublic health care servicesPublic health expenditurepublic health expenditurespublic health programspublic health servicespublic health systempublic hospitalspublic insurancepublic insurance schemepublic sectorPublic Spendingpurchasing powerpurchasing power parityquality controlquality of healthquality of lifereferral systemregional hospitalreimbursement ratesreproductive healthreproductive health programresource constraintsresource needsrespectrural areasrural populationssanitationsanitation facilitiesSkilled birth attendancesocial programssocial securitysocial security systemssurgeryTB controltechnical assistancetechnical capacitytransportationtuberculosisuniversal accessurban areasurban developmenturban populationsuser feesvulnerable populationswomanworkersworking-age populationWorld Bank10.1596/13293