Protecting the Peruvians that need it most !
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Transcript of Protecting the Peruvians that need it most !
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
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
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
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
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
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
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
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.
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
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
Plan A0 - 4 years
Plan CPregnant Women
Plan DAdults in Emergency Situations
Plan B5 - 17 years
Plan ETargeted Adults
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
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
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
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
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
COMPONENT OF SERVICE-RELATED SPENDING
MEDICINES
LAB. ANALYSIS
RADIOGRAPHS
PROCEDURE
LODGING
FOOD
LAUNDRY
GENL. SERVICES
SALARIES
VARIABLECOSTS
FIXED COSTS
SIS
MINSA
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
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
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
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
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
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
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
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
Maternal Mortality
Maternal Mortality in the 10 departments with the highest level of deaths. Peru 2000-2004
Source: General Epidemiology Office - OGE - MINSA
HEMORRAGIA26758%
ABORTO378%
INFECCION327%
HIPERTENSION12327%
MATERNAL DEATHS BY SPECIFIC CAUSE. PERU 2004
Source: OGE - MINSA
HYPERTENSIONINFECTION ABORTION
HEMORRHAGE
NO ESPECIFICADO163%
ABORTO376%
EMBARAZO13622%
PUERPERIO25339%
PARTO18630%
MATERNAL DEATHS BY TIME OF DEATH. PERU 2004
Source: OGE - MINSA
ABORTION
PREGNANCYUNSPECIFIED
PUERPERIUM
DELIVERY
MATERNAL DEATHS BY PLACE OF DEATH. PERU 2004
ESTABLECIMIENT33553%
TRAYECTO488%
NO ESPECIFICADO163%
DOMICILIO22936%
Source: OGE - MINSA
AT HOME
UNSPECIFIEDIN TRANSIT
ESTABLISHMENT
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
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)