Peru’s heath care system undergoes a period of transition
Reform to the public health care system in Peru is moving more slowly than anticipated, while competition is heating up among private care providers as the largest insurance companies enter the market.
President Ollanta Humala pledged to make the introduction of universal health care a priority when he took office in 2011. However, the initiative has fallen short of expectations, as many Peruvians working in the informal sector remain uninsured.
The Humala administration has also faced criticism from medical professionals employed by the Ministry of Health (MINSA), who say the government has failed to follow through with a promise made in October 2012 to increase salaries. In July, state-employed doctors and nurses went on strike, calling for new medical equipment and improvements in hospital facilities in addition to pay rises. The strike was suspended in August, as medical workers went into negotiation with MINSA.
The ministry’s medical facilities typically serve low-income Peruvians who cannot afford private health coverage and are enrolled in a state-run scheme known as Integral Health Insurance (Seguro Integral de Salud). The programme has around 11.5 people members, out of a population of about 30m.
EsSalud, the national social security system, is the next-largest provider of health insurance and services. The organisation is overseen by the government but operates independently, providing its own network of facilities and different benefit plans.
EsSalud covers around 25% of the population and is growing as more people move into the formal economy. Virginia Baffigo, president of EsSalud, told OBG that the number of its members is increasing each year by 7%. “By 2021, we estimate that 44% of the population will be insured by EsSalud,” she said.
Both EsSalud and MINSA are looking to expand their facilities, in part through agreements with the private sector. EsSalud has used the public-private partnership (PPP) model to build two new hospitals, Hospital Villa Maria del Triunfo and Hosptial del Calla, both of which are expected to be open by 2014.
According to Baffigo, PPPs are the “best option for increasing the supply of health care,” adding that Peru needs an addition 6000 hospital beds. The country has around 45,000 beds, according to the Pan American Health Organisation.
MINSA is moving in the same direction, having developed a series of concession projects to be tendered through ProInversión, the state’s private investment agency. Of these, the most significant is a 15-year concession to manage the new Children’s Hospital (Instituto Nacional de Salud del Niño) in Lima’s San Borja district. The contract is set to be awarded later this year.
Private sector doctors, clinics and hospitals are also a part of the medical landscape in Peru, particularly in Lima. However, this market has changed in recent years, as major insurance providers, including Rímac and El Pacífico Peruano Suiza, have moved to acquire their own facilities. This process of vertical integration, which was first witnessed around two years ago, forms a key component of a strategy that insurers hope will help contain health care costs.
Private clinics face a choice of either selling to the insurance giants or competing with them for patients, Sebastian Cespedes, general manager of the Ricardo Palma Clinic in Lima, told OBG.
In recent years, private clinics have increasingly turned to prepaid services, or “prepagos”, as a means of taking on larger firms. The schemes provide benefits similar to insurance coverage, offering comprehensive health care plans and allowing patients to establish prepaid accounts which can be drawn on during care. “With about 800,000 people covered in the country, prepaid services have become an effective way to compete against the larger insurance groups,” Cespedes said.
The private health care system is likely to remain highly competitive, although analysts also expect business to remain concentrated in Lima. “The private sector has very little coverage outside of Lima, as the public hospitals have saturated these markets and districts like San Isidro, within Lima, remain more attractive for the private hospitals,” Cespedes told OBG.
Outside the capital, it will be up to the government and lawmakers to resolve the challenges facing the public health care system. Addressing medical workers’ call for increased pay will be of most immediate concern, but going forward, making more substantial improvements to public healthcare facilities is a priority.