The Peruvian Health Care System
Health care in Peru is delivered in a markedly different manner than it is in the U.S. There are 5 groups from which to receive health care, depending on one's social status. The Ministry of Health (MINSA) provides health care for about 60% of the population; EsSalud, a quasi-privatized, quasi-bureaucratic branch of delivery serves 30%; and the final 10% is provided with health care through the private sector, the Armed Forces, and the National Police.
In Otuzco, MINSA was present in both the only hospital in the region, Hospital Materno e Infantil Elpidio Benvides Pérez, as well as Puesto de Salud Ramón Castilla, a "health post" that was situated in one of the poorest neighborhoods in Otuzco. Health posts were scattered throughout the surrounding towns and villages, but were not fully staffed every day, as were the clinics and hospitals in the city of Otuzco. Both of these sites provided medical care to people who only had government-issued health insurance called Seguro Integral de Salud (SIS), which was established for the unemployed and/or poorest members of Peruvian society as a measure of universal health care. The EsSalud clinic is second form of national health care delivery and insurance that serves working families and individuals. Certain hospitals mandated by MINSA also provide services to the uninsured for varying fees, as was the hospital in Otuzco.
In Otuzco, MINSA was present in both the only hospital in the region, Hospital Materno e Infantil Elpidio Benvides Pérez, as well as Puesto de Salud Ramón Castilla, a "health post" that was situated in one of the poorest neighborhoods in Otuzco. Health posts were scattered throughout the surrounding towns and villages, but were not fully staffed every day, as were the clinics and hospitals in the city of Otuzco. Both of these sites provided medical care to people who only had government-issued health insurance called Seguro Integral de Salud (SIS), which was established for the unemployed and/or poorest members of Peruvian society as a measure of universal health care. The EsSalud clinic is second form of national health care delivery and insurance that serves working families and individuals. Certain hospitals mandated by MINSA also provide services to the uninsured for varying fees, as was the hospital in Otuzco.
About 18% of the population benefits from SIS, especially pregnant women over the age of 17, for whom special maternal programs are designated to support. SIS is funded by the national budget, whereas EsSalud is financed by employers who account for the health insurance as a portion of the wages that workers receive. About 20% of the population is covered under this form of insurance. The third method of health care delivery, through the private sector and services provided for the Armed Forces and National Police, was not available in my small mountain village, and serves only 2% of the population. The most significant consequence of the Peruvian health care system is that while basic health care is provided by the national government, between 10-20% of the population do not have access to health care services, even if they are covered. Although the current system appears to cover a wide demographic of the Peruvian population, accessibility is the new challenge to overcome.
NGOS and development organizations like VivePerú attempt to bridge the gap between health care provision and accessibility by providing medical campaigns in rural and urban areas of extreme poverty. Traditional medical campaigns run by American and other foreign missionary doctors are often criticized for their absence of longevity in communities in need of health care services. However, organizations that partner with existing Peruvian health care services and professionals can create self-sustaining models that address the needs of impoverished Peruvians more regularly than a one-time event. This is precisely the mission of VivePerú's medical outreach program, as it asks local doctors to spend a day working for free in communities where a doctor's presence is unheard of.
It has proven to be challenging for policymakers and health sector professionals alike to combat the drawbacks of Peru’s healthcare system, which historically has been described as a “patchwork of systems created to serve various sectors of the population according to their individual labor market status” (Rousseau 2007:99). The division of services based on one’s class status made it inherently difficult to overcome the greater structural issue of class and health, especially when placed in a rural geographic context.