Abstract
BackgroundLike many other Latin America- and Caribbean countries, Peru has introduced a tax-financed health insurance scheme called “Sistema Integral de Salud (SIS)” to foster progress towards Universal Health Coverage. The scheme explicitly targets the poorest sections of the population. Our study explores levels of health insurance coverage and their determinants among Peruvian women following the introduction of SIS. We wish to determine the extent to which the introduction of SIS has effectively closed gaps in insurance coverage and for whom.MethodsRelying on the 2017 round of ENDES (Encuesta Nacional Demográfica y de Salud Familiar) survey, we analyzed data for 33,168 women aged 15–49. We used multinomial logistic regression to explore the association between health insurance coverage (defined as No Insurance, SIS, Standard Insurance) and women’s socio-demographic and economic characteristics.ResultsOut of the 33,168 women, 25.3% did not have any insurance coverage, 45.5% were covered by SIS and 29.2% were covered by a Standard Insurance scheme. Women in the SIS group were found to have lower educational levels, live in rural areas and more likely to be poorer. Women in the Standard insurance group were found to be more educated, more likely to be “Spanish”, and to be wealthier. Most uninsured women appeared to belong to a middle class, not poor enough to be eligible for SIS, but also not eligible for standard insurance.ConclusionsOur study confirms that SIS has been effective in increasing coverage among vulnerable women, with coverage rates comparable with those observed among men. Nevertheless, on its own, it has proven to be insufficient to ensure universal coverage among women. Further reforms are needed to ensure that coverage is extended to all population groups.
Highlights
Like many other Latin America- and Caribbean countries, Peru has introduced a tax-financed health insurance scheme called “Sistema Integral de Salud (SIS)” to foster progress towards Universal Health Coverage
To test if the model meets the assumption of independence of irrelevant alternatives (IIA), meaning that the addition or deletion of variables should not affect the results showed in the regression, we performed a SmallHsiao test [37], which confirmed the IIA assumption was not violated
Out of a total of 33,168 women included in our sample, 25.3% reported no insurance coverage, 45.5% were affiliated to SIS and 29.2% had Standard Insurance
Summary
Like many other Latin America- and Caribbean countries, Peru has introduced a tax-financed health insurance scheme called “Sistema Integral de Salud (SIS)” to foster progress towards Universal Health Coverage. Over the last few decades, many countries in Latin America and the Caribbean (LAC) have been implementing health financing reforms aimed at fostering progress towards UHC. These reforms have largely aimed at increasing the number of people included in formal social health protection mechanisms (i.e. insurance schemes and tax-based health systems), mainly by expanding the range of health services covered by existing schemes [2]. Many LAC countries introduced health insurance schemes targeting the poor and informal workers previously not covered by the existing social insurance schemes offered to formally employed workers [3]. Benefit packages and accessibility to provider networks are often more limited compared to the social insurance schemes offered to formally employed, leading to a some system segmentation, which in turn gives rise to important inequalities in terms of access and quality of care [4]
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