The document presents critical aspects of health care delivery and financing, proposing some improvements systematized in a roadmap for their implementation, without considering public procurement and human resources in health.
Between 2013 and 2019, health spending from the public sector, EsSalud and the private sector increased steadily. During 2020, healthcare spending increased significantly due to the crisis caused by COVID-19. The financing of the Seguro Integral de Salud, EsSalud, the Armed Forces and the Police, as well as the private sector, comes from different sources and is managed in a disjointed manner. Out-of-pocket spending by Peruvian households is high and increases the fragmentation problem, as it is a direct transaction between patient and provider, without being managed by an insurer. This out-of-pocket spending represents 29% of total health spending in Peru, which is above the 20% recommended by the World Health Organization. The existing fragmentation of the Peruvian health system increases the risk of coverage among insurers and prevents economies of scale and cross-subsidies to the population.
