On 2 April, nearly a year after the establishment of a framework law on universal health insurance (AUS), was published the rules of the standard features some aspects that need clarification or redirected. Before bringing these observations, it is necessary to know the AUS although that has been touted as automatic for all Peruvians, it applies only in pilot areas: Ayacucho, Huancavelica and Apurimac, and five geographical areas including Pachacutec in Window.
Less coverage in the SIS and EsSalud? Today
SIS members to receive care contained in the Prioritized List of Health Interventions (LPIS) in force since 2007, after the implementation of AUS members to receive the attention it via the SIS but are contained in Essential Plan Health Insurance (PEAS). The problem is that the PEAS covers a single layer of care in cases such as breast cancer and cervical cancer only comes to diagnosis LPIS while covering a single layer but also a complex care, including renal transplantation be the case.
What can explain this is you want to submit the AUS as progress in relation to health coverage, but this assumption is based on serving a single layer and leave aside the complex care are more expensive. The concern is evident, since in the pilot areas and regions AUS, citizens who were formerly members of the SIS, to move to AUS pederían the right acquired more complex, which is a setback.
The other disturbing aspect that could be given, refers to the rules of the law leaves open the possibility that EsSalud can choose from now but by affiliating with PEAS, pack quite limited compared to the comprehensive coverage EsSalud at least in the theory provides. The concern arises because given the logic that has been driving EsSalud, in which the priority is to have more income to showcase new hospitals without necessarily raising the quality of care, management may opt to apply the AUS and provide the Peas, as it costs much less than comprehensive care. This could deepen differences in health and set a harmful precedent EsSalud down.
Where is the problem
After a year of rule of law in AUS, it becomes clear that it does not address the substantive issues in achieving the right to health: Does not have sustainable funding, but depends on the will of the MEF, which as we see health as an expense and not as an investment, not promote the integration of healthcare providers to maintain the fragmentation in which the health bureaucracy and duplication of effort, does not aim to recover MISNA stewardship that should be on healthcare providers, maintaining a state of affairs in which each provider does what is best, as evidenced by the mafias of organ transplants that are involved in several clinics and the expansion of Hospitals of Solidarity with no possibility of control over them, does not contain a bid to improve conditions for health workers. It is therefore
becomes clear that more good will with MOH authorities to expand access to health, the problem is more complex and deals with two key aspects. One is the logic from which the State assumes its responsibility towards society: AUS SIS and reflect a logic of social welfare protection, remaining focused and in which the state is to provide a subsidy to the excludes market, and thus evade its responsibility to society as a whole. The other bit as visible aspect has to do with the interests that are behind the lack of progress towards a truly universal reform and integrity in health, as this would directly affect the pharmaceutical industry and insurance companies or foreign nationals who do not provide comprehensive care package in which the insured must always take a share of attention.
If not successful public health logic and continue giving priority to market interests, will be very little we can do to bring health to Peruvian society. The state should not be satisfied with a universal insurance in the paper and the advertising looks good and creates expectations among the population, governments should assume that any process of development is achieved on the basis of a health system that is incapable response to the real demands of health, health is not a market order as if it is a TV, watch, clothing. That is the theme and for this we must reverse a process that takes years to leave building.
Detail: Since the formation of SIS was created Intangible Solidarity Fund for Health (FISSAL) to refer to it the attention of high cost or very complex. The reality is that the FISSAL is bankrupt and has survived these years only with a grant from the SUNARP of unos3.5 million soles, so that their officials should be devoted to seeking support from corporations or other state institutions . This reflects that the State sees health as a matter of charity rather than rights. Alexandro
Saco
10 April 2010
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