This case study analyzes the progress of Peru's Comprehensive Health Insurance (SIS) and evaluates the challenges that remain to achieving universal health care coverage. Peru is an upper-middle-income country with a gross domestic product (GDP) per capita of just over US$10,000 (purchasing power parity). The country has grown rapidly in the last decade; the average growth rate was 6.5 percent. However, 28 percent of the population lives in poverty (2011), which is estimated with regionally differentiated poverty lines between US$1 and US$2 per capita per day. In addition, only one in four individuals has employment with social security coverage. The SIS aims to reduce economic barriers through the elimination of user fees for a package of services. Although its budget has been low, the SIS has played an important role in the reduction of maternal and child mortality. However, the improvements expected to the overall health system have not materialized. Meanwhile, when the decentralization process transferred funds and authority to the regions, it did so in a context of weak management capabilities, and it failed to clearly define the relationship between the national and regional governments. A major effort to strengthen the technical capacity of the Ministry of Health (MOH) should accompany the strategies outlined above. This effort should emphasize a review of health priorities, the design of effective interventions within a fiscally sustainable benefits package, and the introduction of incentives and new payment mechanisms at hospitals and other health facilities.
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