ON THE MEND

Peru 2015 | HEALTH & EDUCATION | FOCUS: EXPANDING HEALTHCARE

One of the major goals of Peru's current government is to achieve universal healthcare coverage for all Peruvians by 2021.

Over the past decade, the country has made great strides in improving healthcare coverage, particularly through the expansion of government insurance programs. According to SIS, in 2005, around 70% of Peruvians had no insurance coverage. As of 1H2015, according to the Ministry of Health, that number has now fallen to around 20% of Peruvians, and the government is confident that it can close the gap completely and reach 100% insurance coverage by 2021. For Peruvians in poverty, the change has been even more drastic. In 2002, 35% of Peruvians in extreme poverty and 7% of Peruvians in non-extreme poverty had access to insurance. Those figures have now risen to 78% and 70% as of 1H2015.

Aside from insurance affiliation, however, one of the major challenges to achieving universal healthcare coverage in Peru is improving public health infrastructure. According to the Ministry of Health, nearly 98% of Peruvians with health insurance are covered through one of the government-run public health insurance systems, which each rely on a network of public hospitals and clinics. As a number of representatives of Peru's public healthcare system explained in interviews with TBY, the system has suffered from a historical lack of investment, particularly in rural infrastructure. As Pedro Fidel Grillo, head of Peru's largest public health insurance program Seguro Integral de Salud (SIS), explained to TBY, “The first challenge is having access to remote populations. [...] We are working with public health infrastructure that has been around for over 50 years.” Minster of Health Aníbal Velásquez expressed a similar sentiment, telling TBY that “In the past, investment in the public sector was limited. Most of the main establishments were regional and national hospitals and health posts. Medical care was too primary.”

In order to overcome this challenge, the government has launched an ambitious multi-year investment plan to invest around $3 billion in hospitals and clinics in under-served areas. In total, according to the Minister of Health, Peru plans to build 11 new national-level hospitals, 23 new regional-level hospitals, and 170 new provincial-level hospitals. An important element of Peru's plans to expand health coverage and infrastructure has been a new willingness to work in partnership with the private sector. According to both Minister Velásquez and Mr. Grillo of SIS, public-private partnerships (PPPs), both through concessions and build-operate-transfer style projects, will play an important role in increasing coverage of health services in rural areas. In addition, SIS has become increasingly open to paying directly for private healthcare services when necessary to fill gaps in coverage. As Mr. Grillo explained to TBY “International experience shows that health needs always demand more than what the state can offer. Even the most developed countries have difficult in fulfilling the demand.”

On the private sector side, lack of infrastructure also presents a challenge for growth. Currently, only around 2% of Peruvians have private health insurance. As Guillermo Garrido Lecca of Pacifico Salud explained to TBY, only a small portion of Peruvians, around 5%, realistically have a possibility of purchasing private health insurance. Still, the majority of private hospitals are clustered in a few areas of Lima, making it impractical for many potential private health insurance clients to actually participate in the system. Grupo San Pablo is one example of a private healthcare provider that is moving into areas of the city without private coverage. The network of clinics has grown exponentially over the past 30 years by providing low-cost clinics targeted at lower-middle income Peruvians, a model that has a great deal of growth potential in coming years.