Health Services Financing: Effects of the Mechanism of Payment of the Integral Insurance of Health in the Primary Health Service in Peru

Presenter: Martin Valdivia, GRADE

Abstract

The Integrated Health Insurance (Seguro Integral de Salud – SIS) is a free health insurance for children and mothers in extreme poverty condition. A main issue of SIS operation is the implementaton of tariffs and payment mechanisms and how contracts are determined with public establishments. Tariffs include the whole cost of the service, except wages and case attention payed to establishments depending on different levels of complexity, but SIS is a mixed subsidy system that has introduced serious distortions to the public health system because it has generated problems in competition among establishments due to its payment mechanisms. It has become a monopoly in the delievery of health services because it is the only buyer of services and it has established tariffs without negotiations or technical studies backing up this process according to the complexities of the establishments. Some fundamental changes on the implementation of SIS regarding the evaluation of how it has affected establishments at the primary level of attention, especially its organization and supply of services, are suggested in order to address SIS main purpose of providing access to health services to the extremely poor population in Peru.

This presentation presents: a) the historical development path, b) the institutional consequences it has had on the way the SIS is managed, c) it looks at some successful Latin American cases that help reforming SIS and d) it examines the health services pricing mechnism.