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Protecting the Peruvians that need it most !

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

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Protecting the Peruvians that need it most !

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  1. Protecting the Peruvians that need it most ! Comprehensive Health Insurance (SIS)

  2. a) Unresolved problems I. REASON FOR BEING OF THE SIS • Limited access to health services due to the existence of barriers: • Economic • Cultural • Geographic • The existence of barriers requires the development of strategies.

  3. b) Maternal Mortality (international context) LOW Under 20 AVERAGE 20 - 49 HIGH 50 - 149 VERY HIGH 150 or more Canada USA Uruguay Chile Argentina Mexico Costa Rica Cuba Brazil Colombia Jamaica Panama Dominican Rep. Trinidad & Tobago Venezuela PERU (163)* (Years 2000,2001) Bolivia Guatemala Haiti Honduras Ecuador El Salvador Nicaragua Paraguay * Per every 100,000 live births Source: Análisis de la situación de Salud del Perú 2001 – MINSA, Basic National Indicators

  4. c) Concern of the health authorities Other health indicators • Perinatal mortality 23.1 x 1,000 l.b. • Infant mortality 47.0 x 1,000 l.b. • Under-five child mortality 60.4 x 1,000 l.b. • Chronic malnutrition 25.4% in children under 5 • Prevalent diseases: (ARI, ADD) Source: Análisis de la situación de Salud del Perú 2001 – MINSA, Basic National Indicators

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

  6. TOWARD THE UNIVERSALIZATION OF SOCIAL SECURITY IN HEALTH 2005 PUBLIC INSURANCE 2012 UNIVERSAL PUBLIC INSURANCE 2001 FRAGMENTATION ESSALUD AAFF & NP facil 62.47% ESSALUD AAFF & NP 50.33% ESSALUD AAFF & NP SIS 49.67% SIS SEG (34.62%) MCH (2.91%) Population 26,346 Population 27,148 Population 30,766 Affiliates (46.5%) 12,259 Affiliates (55.9%) 15,171 Affiliates(100%)

  7. SIS COVERAGE WITHIN UNIVERSAL HEALTH CARE Population of Peru 2005: 27,219 27.04% Non-poor Peruvians without Social Security SIS Goal 2006 Contributory Insurance 23.98% Peruvians with Social Security 7,059 6,527 100 ESSALUD, HSP, AAFF & NP facilities 13,633 50.6% Poor Peruvians without Social Security 11,026,607 SIS Affiliations as of Dec – 2005

  8. MINSA – Ministry of Health STEWARDSHIP ROLE PROVIDER ROLE INSURER ROLE Contract and pay the health service provider Provide health services and charge insurance provider

  9. COMPREHENSIVE HEALTH INSURANCE What is SIS? Decentralized Public Institution Law Nº 27657 – Law of the Ministry of Health 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. Vision Administer the funds allocated to financing individual health services according to the National Health Policy. Mission Contribute to the protection of uninsured Peruvians, through non-contributory comprehensive health insurance. Purpose Guarantee health services to the vulnerable population in a situation of extreme poverty or poverty, under the Universal Insurance Policy. Priority

  10. SOURCES OF SIS FINANCING PUBLIC TREASURY COOPERATING INSTITUTIONS WB, IDB, PASA and Others Comprehensive Health Insurance SELF-FINANCING SiSalud, Labor shares, Municipality, Markets, Others FISSAL Intangible Health Solidarity Fund

  11. COMPREHENSIVE HEALTH INSURANCE NON-CONTRIBUTORY SEMI-CONTRIBUTORY PLAN A PLAN B PLAN G G1 INDIVIDUAL AND FAMILY PLAN C PLAN D G2 WORK-RELATED ACCIDENTS PLAN E PLAN F G3 MUNICIPALITIES AND OTHERS

  12. SIS Target Population Plan B 5 - 17 years Plan A 0 - 4 years Plan C Pregnant Women Plan E Targeted Adults Plan D Adults in Emergency Situations

  13. BENEFIT PLANS 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 Plan B: Children and adolescents from 5 to 17 years old Recovery care for children and adolescents with pathologies Emergency transfers Burials

  14. BENEFIT PLANS Plan C: Pregnant women Preventive-promotional care for pregnant women Recovery care from pregnancy, including intercurrent pathologies Emergency transfers Burials Plan D: Adults in Emergency Situations • Recovery care for adult emergencies • Emergency transfers • Burials

  15. BENEFIT PLANS Plan E: Targeted Adults 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. • Recovery care for adults with pathologies • Emergency transfers • Mental care according to Group • Burials

  16. 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

  17. SEMI-CONTRIBUTORY INSURANCE 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 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

  18. COMPONENT OF SERVICE-RELATED SPENDING MEDICINES LAB. ANALYSIS VARIABLECOSTS SIS RADIOGRAPHS PROCEDURE LODGING FOOD LAUNDRY FIXED COSTS MINSA GENL. SERVICES SALARIES

  19. AFFILIATIONS

  20. TYPES OF AFFILIATION Indirect: Apply using FESE* Direct: Apply without FESE Indigent People PLAN B People in Shelters PLAN A Wrongly Accused PLAN C PLAN D Beneficiaries of Health Reparat. Victims of HHRR Viol. Women in OSB** Women Victims of Forced Ster. PLAN E Shoe Shiners Excluded and dispersed populations * FESE: Socio-Economic Evaluation Sheet ** OSB: Social grassroots organizations

  21. Requirements for Affiliation to Plan A, B and C: • Not have any type of health insurance • Apply with Socio-Economic Evaluation Sheet • Identification document • Affiliate with Health Estab. in their jurisdiction • Sign the Affiliation Contract • Pay the premium of S/. 1.00

  22. AFFILIATION STRATEGIES FOR POPULATION GROUPS Population in state of poverty Application of targeting instruments. Children from PRONOEIS and Wawa Wasis* Coordination with Ministry of Education - MINEDU and National Wawa Wasi Program. Grassroots: Mother’s Club, Communal Kitchen, Glass of Milk Coordination with Social Organizations and Ministry of Women & Social Development - MIMDES. Coordination with FENTRALUC** to guarantee their affiliation. Shoe Shiners and partners *PRONOEIS: Non-formal early education programs; Wawa Wasis: Children’s Homes ** FENTRALUC: National Federation of Shoe Shine Workers

  23. AFFILIATION STRATEGIES FOR POPULATION GROUPS 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.* Children that suffer from violence and abuse 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. Adolescents, Pregnant and Puerperal Women Coordination with the National Sexual and Reproductive Health Strategy *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

  24. SERVICES PROVIDED

  25. PERCENT VARIATION IN CARE, BY TYPE OF CARE 2002 - 2005 Source: Office of Information and Statistics

  26. VARIATION IN CONCENTRATION BY TYPE OF PLAN 2002 - 2005 Source: Office of Information and Statistics

  27. Maternal Mortality

  28. Maternal Mortality in the 10 departments with the highest level of deaths. Peru 2000-2004 Source: General Epidemiology Office - OGE - MINSA

  29. MATERNAL DEATHS BY SPECIFIC CAUSE. PERU 2004 ABORTION INFECTION HYPERTENSION HEMORRHAGE Source: OGE - MINSA

  30. MATERNAL DEATHS BY TIME OF DEATH. PERU 2004 UNSPECIFIED PREGNANCY PUERPERIUM ABORTION DELIVERY Source: OGE - MINSA

  31. MATERNAL DEATHS BY PLACE OF DEATH. PERU 2004 IN TRANSIT UNSPECIFIED AT HOME ESTABLISHMENT Source: OGE - MINSA

  32. MATERNAL DEATHS BY AGE GROUPS. PERU 2004 35-49 YEARS OLD UNSPECIFIED 14-19 YEARS OLD 20-34 YEARS OLD Source: OGE - MINSA

  33. Which is why… PROVIDING HEALTH IS NOT A PROBLEM OF FINANCING ALONE Finance services in a timely manner US (SIS) Provide quality services PROVIDERS THEM (beneficiarypopulation) Exercise their right as citizens

  34. PROMOTING THE EXERCISE OF THE RIGHT TO HEALTH THANK YOU

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