2014年-世界发展银行全球_Universal_Health_Coverage_for_Inclusive_and_Sustainable_Development___Country_Summary_Report_for_Peru_40页_996kb

Summary of the Japan-World Bank Partnership Program for Universal Health Coverage: Peru Country Summary Report

Core Content

This report provides an overview of Peru's progress toward achieving Universal Health Coverage (UHC) as part of the Japan-World Bank Partnership Program. It highlights the legal, institutional, and financial frameworks that have shaped UHC in Peru, as well as the challenges and opportunities that remain.

Main Points

1. Peru's Economic and Health Context

• Peru is an upper middle-income country with rapid economic growth (6.9% annually from 2004 to 2013) and significant reductions in poverty and inequality.
• The Gini index dropped from 0.503 in 2004 to 0.481 in 2010, reflecting improved income distribution.
• Life expectancy at birth increased to 74.52 years in 2012.
• Total health expenditure (THE) as a share of GDP was 5.07% in 2012, which is below the regional average of 7.7% in Latin America.

2. Progress Toward UHC

• Health insurance coverage increased significantly, from 53% in 2008 to 65% in 2013.
• EsSalud covers about 25.3% of the population, while SIS covers 35.3%.
• Private insurance covers a small portion (less than 4%).
• The informal sector and the poor are prioritized in SIS, which is designed to provide subsidized and semi-contributory health insurance.
• Despite progress, coverage for adults and the elderly is still lower, with only about 59% of those aged 18–49 insured.
• Regional disparities persist, with the poorest regions having higher insurance coverage.

3. Health Services and Coverage

• The Essential Plan of Health Insurance (PEAS) defines the range of services covered, including 1,100 diagnoses under ICD-10.
• SIS has expanded its coverage to include a wide range of services, but access remains a challenge, especially in rural areas.
• EsSalud provides comprehensive coverage but suffers from supply limitations, including long waiting times and inadequate infrastructure.
• Maternal and child health services have improved significantly, with high immunization rates, prenatal care access, and skilled birth attendance.

4. Financial Protection and Out-of-Pocket Payments

• Out-of-pocket (OOP) health spending accounts for 35.72% of THE in 2012, remaining the main source of health financing.
• OOP can lead to impoverishment and catastrophic health expenditures (CHE), defined as health costs exceeding 40% of a household's capacity to pay.
• 2.6% of the population became impoverished due to OOP in 2013, with SIS beneficiaries experiencing a higher increase in OOP spending (from 39% to 57% of the poverty line between 2008 and 2013).
• CHE incidence decreased slightly for the general population, but no clear downward trend was observed for the poorest quintile or SIS beneficiaries.

5. Governance and Institutional Arrangements

• The Ministry of Health (MINSA) leads the health sector reform and is responsible for regulation, planning, and monitoring.
• The National Superintendence of Health (SUSALUD) oversees both public and private health providers.
• Decentralization began in 2002 and was completed in 2009, transferring health management functions to regional governments.
• The SISOL (a public-private partnership in Lima) plays a key role in service delivery within the Lima Metropolitan Area.
• Health Reform Guidelines aim to shift the focus from processes and inputs to results and outcomes, emphasizing results-based management and financing.

Key Information

• UHC Goals: Ensure access to quality health services, protect from public health risks, and prevent impoverishment due to illness.
• Legal Milestones:
  • 1999: Creation of EsSalud.
  • 2002: Creation of SIS and decentralization of health services.
  • 2007: Introduction of semi-contributory health insurance.
  • 2009: Legislation for universal health insurance.
• Health Insurance Types:
  • EsSalud: Formal sector workers and their families.
  • SIS: Informal workers and the poor.
  • Private Insurance: Limited coverage.
  • FFAA and FFPP: Health funds for military and police personnel.
• Challenges:
  • Supply constraints: Limited infrastructure, equipment, and human resources.
  • Financial burden: High OOP payments and lack of adequate financial protection.
  • Coverage gaps: Particularly among adults and the elderly.
  • Regional disparities: Poorer regions have higher insurance coverage, but access remains uneven.

Conclusion

Peru has made substantial progress in expanding health insurance coverage and improving health outcomes, especially in maternal and child health. However, the country still faces significant challenges in achieving true UHC, including financial protection, service availability, and equitable access. The report emphasizes the need for further investment, policy coordination, and system-wide reforms to address these issues and ensure that UHC is both inclusive and sustainable.