protecting the peruvians that need it most !

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Protecting the Peruvians that need it most !

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Protecting the Peruvians that need it most !. Comprehensive Health Insurance (SIS). a) Unresolved problems. I. REASON FOR BEING OF THE SIS. Limited access to health services due to the existence of barriers: Economic Cultural Geographic - PowerPoint PPT Presentation

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Page 1: Protecting the Peruvians that need it most !

Protecting the Peruvians that need it most !

Page 2: Protecting the Peruvians that need it most !

a) Unresolved problems

Limited access to health services due to the existence of barriers:

Economic

Cultural

Geographic The existence of barriers

requires the development of strategies.

I. REASON FOR BEING OF THE SIS

Page 3: Protecting the Peruvians that need it most !

CanadaUSA

Uruguay

ChileArgentina

MexicoCosta Rica

Cuba

Brazil ColombiaJamaicaPanama

Dominican Rep.Trinidad & Tobago

Venezuela

EcuadorEl SalvadorNicaraguaParaguay

PERU (163)*(Years 2000,2001)

BoliviaGuatemala

HaitiHonduras

LOWUnder 20

AVERAGE20 - 49

HIGH50 - 149

VERY HIGH150 or more

b) Maternal Mortality (international context )

* Per every 100,000 live births

Source: Análisis de la situación de Salud del Perú 2001 – MINSA, Basic National Indicators

Page 4: Protecting the Peruvians that need it most !

Perinatal mortality23.1 x 1,000 l.b.

Infant mortality47.0 x 1,000 l.b.

Under-five child mortality 60.4 x 1,000 l.b.

Chronic malnutrition25.4% in children under 5

Prevalent diseases: (ARI, ADD)

c) Concern of the health authorities

Other health indicators

Source: Análisis de la situación de Salud del Perú 2001 – MINSA, Basic National Indicators

Page 5: Protecting the Peruvians that need it most !

HEALTH SYSTEM IN PERU

HEALTH SECTOR

EsSALUD*

AAFF & POLICE**

PUBLICSUB-SECTOR

NON-PUBLICSUB-SECTOR

MINISTRY OF HEALTH

PRIV. CLINICS & OFFICES

NGO

OTHERS

EsSALUD: Social Security Health Insurance; AAFF: Armed Forces; NP: National Police

Page 6: Protecting the Peruvians that need it most !

TOWARD THE UNIVERSALIZATION OF SOCIAL SECURITY IN HEALTH

TOWARD THE UNIVERSALIZATION OF SOCIAL SECURITY IN HEALTH

SEG (34.62%)

ESSALUDAAFF & NP facil

62.47%

2001FRAGMENTATION

2005PUBLIC INSURANCE

2012UNIVERSAL PUBLIC

INSURANCE

MCH (2.91%)

ESSALUDAAFF & NP

50.33%

SIS49.67%

Population26,346

Population27,148

Population30,766

Affiliates (46.5%)12,259

Affiliates (55.9%)15,171

Affiliates(100%)

ESSALUDAAFF & NP

SIS

Page 7: Protecting the Peruvians that need it most !

27.04% Non-poor Peruvians

without Social SecuritySIS Goal 2006

Contributory Insurance

Population of Peru 2005: 27,219

23.98% Peruvians with Social Security

11,026,607 SIS Affiliations as of Dec – 2005

ESSALUD, HSP,AAFF & NP facilities

6,527

7,059

100

SIS COVERAGE WITHIN UNIVERSAL HEALTH CARE

50.6% Poor Peruvians without Social

Security

13,633

Page 8: Protecting the Peruvians that need it most !

Contract and pay the health service

provider

Provide health services and

charge insurance provider

STEWARDSHIP ROLE

MINSA – Ministry of Health

INSURER ROLEINSURER ROLE PROVIDER PROVIDER ROLEROLE

Page 9: Protecting the Peruvians that need it most !

What is SIS?What is SIS? Decentralized Public InstitutionLaw Nº 27657 – Law of the Ministry of Health

COMPREHENSIVE HEALTH INSURANCE

Administer the funds allocated to financing individual health services according to the National Health Policy.

Guarantee health services to the vulnerable population in a situation of extreme poverty or poverty, under the Universal Insurance Policy.

Contribute to the protection of uninsured Peruvians, through non-contributory comprehensive health insurance.

Integrate and contribute to the universal insurance system that guarantees the full exercise of the right to health, motivating a comprehensive model of care with social and cultural adaptation.

Page 10: Protecting the Peruvians that need it most !

Comprehensive Health Insurance

SOURCES OF SIS FINANCING

FISSALIntangible HealthSolidarity Fund

SELF-FINANCINGSiSalud, Labor shares, Municipality, Markets,

Others

COOPERATING INSTITUTIONS

WB, IDB, PASA and Others

PUBLICTREASURY

Page 11: Protecting the Peruvians that need it most !

NON-CONTRIBUTORY

PLAN A PLAN B

SEMI-CONTRIBUTORY

PLAN E

PLAN C PLAN D

PLAN F

PLAN G

G1INDIVIDUALAND FAMILY

G2

G3

WORK-RELATED ACCIDENTS

MUNICIPALITIESAND OTHERS

Page 12: Protecting the Peruvians that need it most !

Plan A0 - 4 years

Plan CPregnant Women

Plan DAdults in Emergency Situations

Plan B5 - 17 years

Plan ETargeted Adults

Page 13: Protecting the Peruvians that need it most !

Plan A: Children from 0 to 4 years old

Preventive-promotional care for the healthy newborn and by age groups

Recovery care for the sick newborn and for other age groups

Emergency transfers

Burials

Preventive-promotional care for the healthy newborn and by age groups

Recovery care for the sick newborn and for other age groups

Emergency transfers

Burials

BENEFIT PLANS

Plan B: Children and adolescents from 5 to 17 years old

Recovery care for children and adolescents with pathologies

Emergency transfers

Burials

Recovery care for children and adolescents with pathologies

Emergency transfers

Burials

Page 14: Protecting the Peruvians that need it most !

Plan D: Adults in Emergency Situations

• Recovery care for adult emergencies

• Emergency transfers

• Burials

• Recovery care for adult emergencies

• Emergency transfers

• Burials

Plan C: Pregnant women

Preventive-promotional care for pregnant women

Recovery care from pregnancy, including intercurrent pathologies

Emergency transfers

Burials

Preventive-promotional care for pregnant women

Recovery care from pregnancy, including intercurrent pathologies

Emergency transfers

Burials

BENEFIT PLANS

Page 15: Protecting the Peruvians that need it most !

Plan E: Targeted Adults

• Recovery care for adults with pathologies

• Emergency transfers

• Mental care according to Group

•Burials

• Recovery care for adults with pathologies

• Emergency transfers

• Mental care according to Group

•Burials

E1: Social grassroots organizations, (Leaders of the Glass of Milk – Vaso de Leche, Mother’s Club – Club de Madres, Communal Kitchen – Comedor Popular, and Children’s Homes - Wawa Wasi - programs), Shoe Shiners, Wrongly Accused, Victims of Human Rights violations (considered in the Truth Commission recommendations).E2: Dispersed and excluded Amazon populations, dispersed and excluded high Andean populations, community health agents, and victims of social violence (including those affected by the voluntary surgical contraception (AQV) interventions and their direct relatives, and the victims of violence that took place during the May 1980 to November 2000 period.

BENEFIT PLANS

Page 16: Protecting the Peruvians that need it most !

BENEFICIARIES OF HEALTH REPARATIONS

Innocent people who were wrongly accused of

terrorism-related crimes

Women who are Victims of

Forced Sterilizations

Victims and/or Families of Victims of Human Rights

Violations

Page 17: Protecting the Peruvians that need it most !

Labor-related Accidents: “To Work in Urban Areas” program (ATU), Municipalities, Regional Governments and Others*

Recovery care as a result of labor-related accidents

Emergency transfers

Rehabilitation

(*) In some cases, includes outside visits for labor-related accidents

Recovery care as a result of labor-related accidents

Emergency transfers

Rehabilitation

(*) In some cases, includes outside visits for labor-related accidents

Individual and Family: for beneficiaries that don’t have insurance and are not poor, with limited purchasing power (includes Mototaxi drivers)

Preventive care for the individual and the family

Recovery care for the individual and the family

Odontological care for the individual

Emergency transfers (Urban/Rural/National)

Burials

Preventive care for the individual and the family

Recovery care for the individual and the family

Odontological care for the individual

Emergency transfers (Urban/Rural/National)

Burials

SEMI-CONTRIBUTORY INSURANCESEMI-CONTRIBUTORY INSURANCE

Page 18: Protecting the Peruvians that need it most !

COMPONENT OF SERVICE-RELATED SPENDING

MEDICINES

LAB. ANALYSIS

RADIOGRAPHS

PROCEDURE

LODGING

FOOD

LAUNDRY

GENL. SERVICES

SALARIES

VARIABLECOSTS

FIXED COSTS

SIS

MINSA

Page 19: Protecting the Peruvians that need it most !
Page 20: Protecting the Peruvians that need it most !

TYPES OF AFFILIATION

Indirect: Apply using FESE*

PLAN A PLAN B

PLAN E

PLAN C PLAN D

Women inOSB**

Shoe Shiners

Direct: Apply without FESE

People in Shelters

Beneficiaries ofHealth Reparat.

Wrongly Accused

Indigent People

Victims of HHRR Viol.Women Victims

of Forced Ster.

Excluded and dispersedpopulations

* FESE: Socio-Economic Evaluation Sheet

** OSB: Social grassroots organizations

Page 21: Protecting the Peruvians that need it most !

Requirements for Affiliation to Plan A, B and C:

• Sign the Affiliation Contract

• Not have any type of health insurance

• Apply with Socio-Economic Evaluation Sheet

• Identification document

• Affiliate with Health Estab. in their jurisdiction

• Pay the premium of S/. 1.00

Page 22: Protecting the Peruvians that need it most !

Population in state of poverty

Application of targeting instruments.

Children from PRONOEIS andWawa Wasis*

Coordination with Ministry of Education - MINEDU and

National Wawa Wasi Program.

Coordination with Social Organizations and Ministry of Women & Social

Development - MIMDES.

Shoe Shiners and partners

Coordination with FENTRALUC** to guarantee their affiliation.

Grassroots: Mother’s Club, Communal

Kitchen, Glass of Milk

AFFILIATION STRATEGIES FOR POPULATION GROUPS

*PRONOEIS: Non-formal early education programs; Wawa Wasis: Children’s Homes

** FENTRALUC: National Federation of Shoe Shine Workers

Page 23: Protecting the Peruvians that need it most !

Disabled Children and Adolescents

Preferential Affiliation Campaigns with special schools in Lima and Callao.

Excluded and Dispersed Pop. High Andes, Amazon

Coordination with DISAs – DGSP, AISPED –

ODSIS teams.*

Extension of MAMIS at the national level, central coordination by DGSP, DGP, UNICEF.**

Older Adults (*) Coordination with public institutions for inscription enrollment and future affiliation.

Law Num. 2858.

Children that suffer from violence and abuse

Adolescents, Pregnant and Puerperal Women

Coordination with the National Sexual and Reproductive Health Strategy

AFFILIATION STRATEGIES FOR POPULATION GROUPS

*DISA: Health Directorate; DGSP: General Public Health Directorate; AISPED: Integral Health Care for Excluded and Dispersed Populations; ODSIS: Decentralized Office of the Comprehensive Health Insurance ** MAMI: Child Abuse Care Module; DGP – General Police Directorate

Page 24: Protecting the Peruvians that need it most !
Page 25: Protecting the Peruvians that need it most !

Children on Plan A who received care, by year

Year Received care

2002 410,328

2003 844,136

2004 640,689

2005 695,791

2006 494,799

Source: SIS central database

Page 26: Protecting the Peruvians that need it most !

COMMON EMERGENCY REFERRAL

2002 88.0 5.9 6.1 100.0

2003 89.5 5.5 5.0 100.0

2004 90.5 5.1 4.4 100.0

2005 91.2 4.3 4.5 100.0

YEARTYPE OF CARE

TOTAL %

PERCENT VARIATION IN CARE, BY TYPE OF CARE 2002 - 2005

Source: Office of Information and Statistics

Page 27: Protecting the Peruvians that need it most !

2002 2003 2004 2005

A 3.92 4.19 2.69 3.86

B 2.52 2.46 1.83 2.42

C 5.03 5.08 4.02 4.97

D 1.42 1.28 1.26 1.38

E 2.46 2.81 1.89 2.57

TOTAL 3.41 3.59 2.58 3.47

YEARPLAN

VARIATION IN CONCENTRATION BY TYPE OF PLAN 2002 - 2005

Source: Office of Information and Statistics

Page 28: Protecting the Peruvians that need it most !

THOSE RECEIVING CARE BY BENEFIT PLAN, BY AGE

Years

PLANES DE BENEFICIO

TOTAL A: 0- 4 Years

B:5-17 Years

C: Pregnant

D: Adult

Emergencies

E: Targeted

Adults

2002 4,225,136 1,587,641 1,944,870 600,065 60,218 70,645

2003 5,177,555 2,095,641 2,194,743 790,828 40,803 124,698

2004 4,086,012 1,794,547 1,576,088 698,253 22,423 25,836

2005 4,293,420 1,823,644 1,751,622 714,538 23,763 17,016

Jan - June 2006

2,848,923 1,259,185 1.163,498 402,717 11,508 21,222

Source: SIS Database

Page 29: Protecting the Peruvians that need it most !

Maternal Mortality

Page 30: Protecting the Peruvians that need it most !

Maternal Mortality in the 10 departments with the highest level of deaths. Peru 2000-2004

Source: General Epidemiology Office - OGE - MINSA

Page 31: Protecting the Peruvians that need it most !

HEMORRAGIA26758%

ABORTO378%

INFECCION327%

HIPERTENSION12327%

MATERNAL DEATHS BY SPECIFIC CAUSE. PERU 2004

Source: OGE - MINSA

HYPERTENSIONINFECTION ABORTION

HEMORRHAGE

Page 32: Protecting the Peruvians that need it most !

NO ESPECIFICADO163%

ABORTO376%

EMBARAZO13622%

PUERPERIO25339%

PARTO18630%

MATERNAL DEATHS BY TIME OF DEATH. PERU 2004

Source: OGE - MINSA

ABORTION

PREGNANCYUNSPECIFIED

PUERPERIUM

DELIVERY

Page 33: Protecting the Peruvians that need it most !

MATERNAL DEATHS BY PLACE OF DEATH. PERU 2004

ESTABLECIMIENT33553%

TRAYECTO488%

NO ESPECIFICADO163%

DOMICILIO22936%

Source: OGE - MINSA

AT HOME

UNSPECIFIEDIN TRANSIT

ESTABLISHMENT

Page 34: Protecting the Peruvians that need it most !

20-34 AÑOS35957%

SIN ESPECIFICAR

122%

14-19 AÑOS79

13%

35-49 AÑOS17828%

MATERNAL DEATHS BY AGE GROUPS. PERU 2004

Source: OGE - MINSA

UNSPECIFIED35-49 YEARS OLD 14-19 YEARS OLD

20-34 YEARS OLD

Page 35: Protecting the Peruvians that need it most !

Exercise their right as citizens

Which is why…

PROVIDING HEALTH IS NOT A PROBLEM

OF FINANCING ALONE

US (SIS)Finance services in

a timely manner

PROVIDERSProvide quality

services

THEM(beneficiary population)

Page 36: Protecting the Peruvians that need it most !