Sickness Insurance (Industry) Convention, 1927 (No. 24) - Peru (RATIFICATION: 1945)

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Previous comments: Direct request (2019), direct request (2019)

In order to provide a comprehensive view of the issues relating to the application of the ratified Conventions on social security, the Committee considers it appropriate to examine Conventions Nos 12 (workers’ compensation in agriculture), 19 (equality of treatment – accident compensation), 24 (sickness insurance – industry), 25 (sickness insurance – agriculture) and 102 (social security – minimum standards) together in a single same comment. With reference to Conventions Nos 24 and 25 (instruments considered to be outdated by the ILO Governing Body), the Committee refers to its comments on Convention No. 102, the most up-to-date Convention on social security ratified by Peru (including Parts II and III).

The Committee notes the observations of the Autonomous Workers’ Confederation of Peru (CATP), received on 1 September 2023. The Committee requests the Government to provide its comments in this regard.

Article 1 of Convention No. 12. Extension of coverage to agricultural workers. The Committee notes the information provided by the Government in its report that on 3 June 2022 Presidential Decree No. 008-2022-SA2 updated Schedule 5 of Presidential Decree No. 009-97-SA, extending the list of activities considered to be high risk which are covered by the Supplementary Scheme for High-risk Work (SCTR). The Committee notes in particular the inclusion of the cultivation of vegetables and melons, root and tuber crops, as well as the cultivation of plants for the preparation of drinks. The Committee also notes the observations of the CATP indicating that when updating Schedule 5, agricultural activities that are fundamental for the national economy were left out, with the result that only 2 per cent of the agricultural workers who should be covered are actually protected. In this context, the Committee requests the Government to provide information on the number of workers protected by the SCTR in relation to the total number of agricultural workers.

Article 1(2) of Convention No. 19 and application in practice of the Convention. The Committee notes the information provided by the Government concerning the implementation in practice, as from June 2022, of the improved version of the Electronic System for the Notification of Employment Accidents, Hazardous Incidents and Occupational Diseases (SAT), following the adoption of Presidential Decree No. 006-2022-TR. The Committee also notes that, according to the information available in the SAT for the period from June 2022 to March 2023, there were a total of 1,162 accidents involving foreign workers, of which 1,151 were not fatal. The Committee notes the CATP’s observations, according to which the SAT only reflects notifications relating to formal workers, resulting in a clear under-reporting of cases involving foreign workers, for whom the informality rate is around 70 per cent. Finally, the Committee observes that the Government has not provided information on matters that were raised in its previous comment. In this context, the Committee once again requests the Government to provide information, if the existing statistics allow, on the approximate number of non-national workers on the national territory, as well as on their occupation and nationality. It also once again requests the Government to provide information on the compensation for employment accidents provided to workers who are nationals of other Member States that have ratified the Convention and to their dependants, within and outside the national territory, in the case of occupational accidents that occurred in Peru.

Part I (General provisions), Article 3 of Convention No. 102. Declaration appended to the ratification. The Committee notes the information provided by the Government on the Bill to reform the social insurance system in Peru, drawn up within the context of the Multisectoral Commission established by Presidential Decree No. 081-2022-PCM. The Committee also notes that the proposed reform is under discussion in a public consultation with the social partners on its implementation. The Committee requests the Government to provide information on whether the introduction of the reform of the social insurance system will result in the percentage of persons protected being achieved, which would mean that it could cease to avail itself of the exceptions under Article 3 of the Convention.

Part II (Medical care), Article 10(2). Cost-sharing by beneficiaries in the cost of medical care. The Committee notes that, according to the information provided by the Government, neither emergency care nor promotional preventive care are subject to cost sharing. The Committee further notes the CATP’s observations concerning the excessive share of the cost of health care and medicines borne by insured persons in health schemes. In this regard, the Committee once again requests the Government to provide detailed information on the application of the Convention in practice in relation to the cost sharing by beneficiaries for medical care, in both the public and private systems, such that it avoids hardship.

Part V (Old-age benefit), Article 27(d) in relation to Article 3. Persons protected. The Committee notes the information provided by the Government on progress in the implementation of the Pension 65 Programme, and the statistics on the number of protected employees working in industrial workplaces employing 20 persons or more. The Committee also notes that, according to the Government, the exception under Article 3 of the Convention in respect of the group of persons protected, as set out in Article 27(d) will have to be maintained until the implementation of the proposed reforms to the social insurance system in Peru. The Committee trusts that the implementation of the reform of the social insurance system will make it possible to renounce the use of the exception under Article 3 of the Convention, and requests the Government to provide information on this subject.

Article 28, in relation to Article 65. The rate of the benefit. The Committee notes the information provided by the Government in relation to the provisions indicated in its previous comment. The Committee also notes the observations of the CATP, according to which the contributory pensions of the National Pension System (SNP) do not ensure the minimum replacement rate of 40 per cent, due to a combination of increases in wages and the maximum ceiling of the pension, set at 893 soles, and that the Private Pension System (SPP) is not really designed as a pension system, as the rules allow almost the whole content of accounts to be withdrawn for non-pension-related reasons. Taking into account the context of the above reform of the social insurance system, the Committee trusts that measures will be adopted to ensure the minimum replacement rate of 40 per cent for the old-age benefits of the National Pension System and the Private Pension System, and requests the Government to provide information on this subject.

Articles 29(2) and 63(2). Reduced old-age benefit with a qualifying period of 15 years of contribution and reduced survivors’ benefit.The Committee requests the Government to provide its comments on the observations of the CATP in relation to these Articles.

Article 30. Provision of benefits throughout the contingency. The Committee notes the information provided by the Government concerning the publication in 2023 of Act No. 31670, which establishes minimum pensions and promotes alternative voluntary social insurance contributions, the purpose of which is to create a disincentive for registered persons to withdraw funds for reasons unrelated to social insurance and to ensure the receipt of a minimum retirement pension. The Committee notes the CATP’s observations which point to the defects of the Private Pension System by allowing the withdrawal of savings for reasons unrelated to social insurance, which occurred frequently following the adoption of the emergency decrees during the COVID-19 pandemic. Taking into consideration the context of the reform of the social insurance system, the Committee trusts that the implementation of the new social insurance system will make it possible to ensure that the Private Pension System complies with the obligation set out in this Article of the Convention, and requests the Government to provide information on this subject.

Part IX (Invalidity benefit), Article 56, in relation to Article 65. Rate of the benefit. The Committee notes the information provided by the Government on the guaranteed replacement rate in the pensions schemes of the National Pension System and the Private Pension System. The Committee also notes the CATP’s observations indicating that the existence of a low maximum pension ceiling makes it difficult in practice to comply with the replacement rate guaranteed by the Convention. With reference to the Private Pension System, the CATP indicates that in a country with a high rate of labour instability, the requirement to have paid contributions in four of the past eight months to be entitled to the benefit makes it difficult in practice to be in compliance with the Convention, as only active insured persons are protected. Considering the impact on the National Pension System and the Private Pension System of the current reform of the social insurance system, the Committee trusts that the implementation of the new system will make it possible to guarantee in practice compliance with this Article of the Convention, and requests the Government to provide information on this subject.

Part XIII (Common provisions), Article 70(1). Right of appeal of claimants of social security benefits. The Committee requests the Government to provide information on the average time that elapses for the resolution of procedures before the Administrative Social Insurance Tribunal.

Article 71(1) and (2). Collective financing of social security. The Committee trusts that the implementation of the new social insurance system will ensure compliance with this Article of the Convention, and requests the Government to provide information on this subject.

Articles 71(3) and 72(2). General responsibility of the State for the due provision of benefits and the proper administration of institutions and services. Health system. The Committee notes the information provided by the Government on the proposal by the social security health system (EsSALUD) to standardize social security health contributions, approved by the Executive Board of EsSALUD by Executive Board Decision No. 9-5-ESSALUD-2023, which will be referred to the Ministry of Labour. The Committee also notes the recommendations made in the EsSALUD Financial Actuarial Study 2018 prepared by the ILO. The Committee requests the Government to provide information on the effect given to the recommendations contained in the EsSALUD Financial Actuarial Study 2018, and on the impact of the proposal to standardize social security contributions in this context.

Articles 71(3) and 72(2). General responsibility of the State for the due provision of benefits and the proper administration of institutions and services. Social security. The Committee notes the statistical data provided by the Government. The Committee also notes the observations of the CATP concerning: (i) the number of reports of violations in compliance with contributions for compensation for periods of service; (ii) the different role played by the National Superintendence of Customs and Tax Authorities (SUNAT) in relation to contributions to the Social Insurance Standardization Office (ONP), with reference to the operation of the Private Pension System; and (iii) the debt with penalty interest of 28,550.32 million soles of the Private Pension System, according to the figures of the Superintendence of Banks and Insurers (SBS). The Committee requests the Government to provide its comments on these observations.

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In order to provide a comprehensive view of the issues relating to the application of the ratified Conventions on social security, the Committee considers it appropriate to examine Conventions Nos 12 (workers’ compensation in agriculture), 24 (sickness insurance – industry), 25 (sickness insurance – agriculture) and 102 (social security – minimum standards) together. With regard to Conventions Nos 24 and 25 (instruments considered to be outdated by the ILO Governing Body), the Committee refers to its comments on Convention No. 102, the most up-to-date Convention on social security ratified by Peru (including Parts II and III).

The Committee notes the observations of the Autonomous Workers’ Confederation of Peru (CATP) on the application of Conventions Nos 12, 24, 25 and 102, received in 2016.

Article 1 of Convention No. 12. Extension of coverage to agricultural workers. In its previous comment, the Committee requested the Government to indicate whether the proposed amendment to extend the list of activities covered by the Supplementary Insurance Scheme for Hazardous Work (SCTR) with a view to including a certain number of agricultural activities in Annex V of the Regulations issued under Act No. 26790 on the modernization of social security for health care, as approved by Presidential Decree No. 009-97-SA of 1997, had been adopted, and whether there were plans to continue extending protection against employment injury to other categories of agricultural and industrial workers with a view to progressively achieving full coverage. The Committee notes the Government’s indication in its report that the Ministry of Agriculture has reported that Presidential Decree No. 009-97-SA still does not include in Annex V categories of agricultural workers, and only includes work relating to the extraction of wood and veterinary work. The Committee also notes the Government’s indication that Presidential Decree No. 008-2010-SA, issuing the Regulations under Act No. 29344, the Framework Act on universal health insurance, provides in section 105 that the coverage of the SCTR shall be granted to all persons who work, in accordance with section 19 of Act No. 26790 of 1997 on the modernization of social security for healthcare, and that the Ministry of Health shall approve the progressive implementation of the list set out in Annex V with a view to its universal application. The Committee also notes the observations of the CATP which refers to the difficult conditions faced by workers in the agro-industrial sector, “which not only give rise to diseases and health problems that do not enable them to work properly, but are a threat to their personal safety and survival”. The Committee notes this information and requests the Government to report any developments relating to the inclusion of categories of agricultural workers in Annex V of Presidential Decree No. 009-97-SA of 1997.

Part I (General provisions). Article 3 of Convention No. 102. Declaration appended to the ratification. In its previous comments, the Committee requested the Government to provide information, in accordance with Article 3 of the Convention, on the measures adopted to progressively extend the scope of the persons covered, with an indication of whether the reasons for maintaining reduced coverage subsist (50 per cent of the workers in enterprises with more than 20 employees, as declared by the Government at the time of ratification), or whether it renounces the right to avail itself of this exception in future. The Committee notes the Government’s indication that, by means of: Act No. 28015 of 2003 to promote and formalize micro and small enterprises; Legislative Decree No. 1086 of 2008 approving the Act to promote the competitiveness, formalization and development of micro and small enterprises and access to decent work; Presidential Decree No. 008-2008-TR; and Presidential Decree No. 013-2013-PRODUCE, it is intended to extend coverage by social protection for workers in micro and small enterprises, setting registration with the comprehensive health insurance scheme (SIS) as the minimum floor for microenterprises, the social security health system (EsSALUD) for micro and small enterprises and, in relation to social insurance, the possibility to register with either the national pensions system (SNP) or the private pensions system (SPP), or also with the social pensions system (SPS). However, the Committee notes the Government’s indication that the SPS, governed by Legislative Decree No. 1086 of 2008, has not yet been established as regulations have not yet been issued. In light of the legislative developments in relation to micro and small enterprises through Presidential Decree No. 013 2013-PRODUCE, the Committee requests the Government to provide information on the measures adopted or envisaged to give effect to this legislation. The Committee requests the Government to indicate whether the implementation of the legislation will result in an increase in the percentage of persons protected which will mean that it can renounce the exceptions of which it is availing itself under Article 3 of the Convention in relation to Articles 9(d), 12(2), 15(d), 18(2), 27(d), 48(c) and 55(d). The Committee also once again requests the Government to indicate whether it intends to avail itself in future of the exception envisaged in Article 3, in accordance with the Convention.

Part II (Medical care). Article 10(2). Cost-sharing by beneficiaries for medical care. The Committee requests the Government to provide detailed information on the application of the Convention in practice in relation to the cost-sharing by beneficiaries for medical care, such that it avoids hardship, both for the public health system (Essential Health Insurance Plan – PEAS – and the comprehensive health insurance scheme – SIS), and for private health insurance schemes.

Part V (Old-age benefit). Article 27(d) in relation to Article 3. Persons protected. With reference to its previous comments relating to the principle of guaranteed minimum benefits, the Committee requested the Government to provide information on the measures taken to extend the Pension 65 Programme to all regions of the country, together with details of its implementation and the progress made in this regard. The Committee notes the Government’s indication that the Pension 65 Programme began by being introduced progressively in the poorest areas of Peru and that, in accordance with the single final supplementary provision of Presidential Decree No. 006-2012-MIDIS of 2012, the coverage provided by the programme was extended to persons living in the departments in which the “Gratitud” Pilot Solidarity Assistance Programme was operating, until it covers the whole of the country, and that according to 2016 data, a total of 196 provinces and 500,000 people are covered. The Committee welcomes the positive information provided and requests the Government to continue providing information on any progress achieved in the implementation of the Pension 65 Programme, and particularly on the extension of the number of persons protected. In this regard, the Committee requests the Government to indicate whether the possibility of renouncing the exceptions declared under Article 3 of the Convention has been examined. The Committee also requests the Government to provide statistical data on the number of protected employees who work in industrial enterprises with at least 20 workers, in relation to each pension scheme, with a view to assessing the application of Article 27(d) of the Convention in relation to the exception declared under Article 3 of the Convention.

Article 28, in relation to Article 65. Rate of the benefit. In its previous comment, the Committee requested the Government to provide information on the minimum amount of each type of pension referred to in comparison with the minimum replacement rates set out in the Convention, and to indicate how such amounts are adjusted. The Committee notes the Government’s indications that the provisions which over time have been regulating the manner in which the reference wage is calculated are: Legislative Decree No. 19990 of 1973, which created the National Social Security Pensions System, section 73; Legislative Decree No. 25967 of 1992; and Presidential Decree No. 099-2002-EF in relation to the SNP. The Committee observes that these texts also regulate the rate of the benefit. In relation to the SPP, the Committee noted previously the Government’s confirmation that a replacement rate is not guaranteed in the SPP. The Committee recalls that Article 65 of the Convention provides that the rate of the benefit, or the replacement rate of the benefit, increased by the amount of any family allowances payable during the contingency, shall be such as to attain, for the standard beneficiary indicated in the Schedule appended to Part XI of the Convention, at least 40 per cent of the total of the previous earnings of the beneficiary and of the amount of any family allowances payable to a person protected with the same family responsibilities as the standard beneficiary. The Committee therefore requests the Government to provide statistical data so that it can fully assess the extent to which the old-age benefits of the SNP attain the level prescribed by the Convention. More specifically, the Committee requests the Government to indicate: (i) the amount of the wage of the skilled manual male employee selected; and (ii) the amount of benefit granted during the time basis and the amount of family allowances, if any, payable during employment and during the contingency, for the spouse, for a period equivalent to the time basis.

Finally, the Committee requests the Government to provide information on any measures that it has been considered appropriate to adopt in relation to the SPP to give effect to these Articles of the Convention.

Articles 29(2) and 63(2). Reduced old-age benefit with a qualifying period of 15 years of contribution and reduced survivors’ benefit. The Committee notes the allegation by the CATP that the Insurance Standardization Office (ONP) denied old-age pensions in 2013 to 21,560 people who could not demonstrate at least 20 years of contribution. The Committee notes the Government’s indication that, starting with the entry into force in 1992 of Legislative Decree No. 25967, the minimum period of contribution required for entitlement to the pension was set at 20 years for both men and women for the general scheme. The Committee also observes that section 51 of Legislation Decree No. 19990 of 1973 provides that, for entitlement to a survivors’ benefit, the deceased insured person must have been entitled to an old-age or invalidity pension. The Committee requests the Government to report on the manner in which effect is given to Article 29(2) of the Convention, which provides that where the benefit is conditional upon a minimum period of contribution or employment, a reduced old-age benefit shall be secured after a qualifying period of 15 years, as well as Article 63(2)(a) respecting the provision of a reduced benefit to a person protected whose breadwinner has completed, in accordance with prescribed rules, a qualifying period of five years of contribution.

Article 30. Provision of benefits throughout the contingency. In its previous comment, the Committee noted that the old-age benefits managed within the private administration system are calculated on the basis of the capital accrued in the individual accounts of each insured person. Once the capital is exhausted, the entitlement to a pension may cease to exist and insured persons who exceed the average life expectancy could be deprived of their sole source of income (see section 45, programmed retirement, of the single harmonized text of the Act on the private system of administration of pension funds, approved by Presidential Decree No. 054-97-EF). The Committee concluded that such a situation is not consistent with the principle laid down in international Conventions whereby benefits are to be paid throughout the contingency at a guaranteed minimum rate. The Committee also notes the Government’s reference to Act No. 30425 of 2016, amending the single harmonized text of the Act on the SPP, and the 24th final and transitional provision of the single harmonized text of the Act on the SPP, under the terms of which an insured person as from 65 years of age is entitled to “choose between the provision of the pension to which she/he is entitled under any retirement system”, or apply to the pension fund administrator (AFP) to “provide up to 95.5 per cent of the total funds available in her/his individual capital account (CIO)”. An insured person who adopts this option shall not be entitled to any guaranteed state benefit, and this includes insured persons covered by the special early retirement scheme (REJA). The Committee recalls that Article 30 of the Convention requires that old-age benefits shall be granted throughout the contingency. The Committee requests the Government to provide information on any measure that it is considered appropriate to adopt in relation to the SPP to ensure that it complies with the requirement set out in this Article of the Convention.

Part IX (Invalidity benefit). Article 56 (in relation to Article 65). Rate of the benefit. The Committee requests the Government to indicate whether the rate of invalidity benefit attains, irrespective of the type of pension selected (in the SPP or SNP), the percentage set out in the Convention for a standard beneficiary.

Part XIII (Common provisions). Article 70(1). Right of appeal of claimants of social security benefits. In its previous comments, the Committee requested the Government to provide information on the repercussions in practice of the ruling in Case No. 05561 2007 PA/TC of 24 March 2010, in which the Constitutional Court (TC) found that the participation of the Insurance Standardization Office (ONP) in court proceedings pertaining to the payment of statutory or accrued interest on pensions to be an “unconstitutional state of affairs”. The Committee also urged the Government to speed up the process of the assessment and payment of benefits due to workers by simplifying complaint and appeal procedures. The Committee notes the Government’s indication that all processes relating to the payment of statutory and accrued interest have been settled in accordance with the ruling of the Constitutional Court and notes a list of cases attached. The Committee also notes with interest the information provided by the Government on the creation of the Administrative Tribunal on Social Security with a view to making appeal processes more flexible, and hopes that this development will make it possible to give effect to the right of persons protected to lodge complaints and appeals, as envisaged in the Convention. The Committee requests the Government to provide information on the time limits for dealing with cases, the rules applicable in the event of appeal and the merits of complaints and appeals to the Administrative Tribunal on Social Security.

Article 71(1) and (2). Collective financing of social security. In its previous comments, the Committee requested the Government to explain the extent to which the principle of the collective financing of social security is given effect in the national pensions system. The Committee notes the confirmation by the Government that in the SNP, which forms part of the public pensions system, contributions are entirely borne by insured persons, in accordance with section 2 of the Second Transitional Provision of Act No. 26504 of 1995 adopting modifications, among others, to the SNP and the private pension fund system. The Government indicates that the employer only acts as an agent for the deduction of contributions. The Committee recalls that it noted previously that, also in the private pensions system, contributions are only made by insured persons to individual capital accounts and for the financing of premiums for old-age, invalidity and survivors’ insurance, and that the administrative costs are solely borne by workers registered with the AFP. The Committee wishes to recall once again that Article 71 of the Convention provides that the cost of social security benefits and the cost of the administration of such benefits shall be borne collectively by way of insurance contributions or taxation in a manner which avoids hardship to persons of small means (paragraph 1) and such that the cost of the total of the insurance contributions borne by the employees protected shall not exceed 50 per cent of the total of the financial resources allocated to the protection of employees and their wives and children (paragraph 2). The Committee requests the Government to indicate the origin of the resources for each system examined for each of the Parts of the Convention that have been accepted, with an indication in particular of the rate or the amount of the deductions made from earnings to finance the system, either through contributions or taxation, and the insurance contributions borne by the employees protected.

Articles 71(3) and 72(2). General responsibility of the State for the due provision of benefits and the proper administration of institutions and services. Health system. In its previous comments, the Committee observed that Act No. 29344 of 2009 provided for at least nine alternatives for insurance in the health branch, administered by public, private and mixed bodies, and it suggested that the Government examine the possibility of a simplification of the system to achieve the harmonization and rationalization of health services. The Committee notes the allegation by the CATP concerning the high level of fragmentation of health schemes, with the coexistence of various systems which suffer from a lack of communication between them and that this situation is an obstacle to the achievement of economies of scale and is a source of inequality. The CATP also alleges that there are inefficiencies in the comprehensive health insurance scheme (SIS) intended for persons living in poverty and extreme poverty and that important weaknesses have been identified in the framework of the EsSALUD insurance scheme, such as the approval of special contribution schemes for specific groups who are not vulnerable, which has a negative impact on the income of EsSALUD. The Committee requests the Government to provide information on the measures adopted with a view to improving the administration of health services. It also requests the Government to indicate the measures adopted to improve effective access to health services, and more specifically to explain how the provision of medical care and sickness benefit is guaranteed in the manner and at the levels required by the Conventions for all persons protected.

Articles 71(3) and 72(2). General responsibility of the State for the due provision of benefits and for the proper administration of institutions and services. Social security. In its previous comment, the Committee observed that the obligation to improve the collection of social security contributions falls within the State’s general responsibility for the proper administration of social security institutions and services under the terms of Article 72 of the Convention and it requested the Government to intensify its efforts on the issues of the payment of contributions by employers, to reinforce collaboration between social security institutions and the tax authorities, and to provide information on the legislative progress achieved with regard to the bills proposing that the National Supervisory Authority for Tax Administration (SUNAT) takes over the functions of the collection of contributions and inspection for the SNP and the SPP. The Committee notes with interest the Government’s indication concerning the creation of the National Supervisory Authority for Labour Taxes (SUNAFIL), through which it has been possible to increase efforts to ensure compliance in the areas referred to above. The Committee notes that the SUNAFIL has concluded two agreements for inter-institutional cooperation with the EsSALUD and the SUNAT for the purposes, among others, of developing mechanisms and procedures of inter-institutional cooperation, the exchange of information on the processes developed by the various institutions and the establishment of joint supervisory and/or inspection of compliance with social security obligations. The Committee also notes the information provided by the Government that, according to the reports of the Labour Inspection Information System (SIIT), the Labour Inspection System (SIT) has issued a number of inspection orders and guidance on the registration of workers with the social security system. The Committee requests the Government to continue providing statistical data on the results achieved by the SUNAFIL and the action of the SIT in combating evasion of the requirement for registration with the social security system and in improving the collection of contributions in practice, and to provide information on any other measures adopted or envisaged to attain these objectives.

Article 72(1). Participation of insured persons in management. Health system. In its previous comment, the Committee requested the Government to examine the possibility of the establishment in private health providers (EPS), institutional providers of health services (IPRESS) or private health insurance companies of a mechanism through which representatives of insured persons could participate in their management or be associated with them in an consultative capacity, without prejudice to the public oversight mechanisms that may be established in due course by regional or local governments, with a view to bringing the legislation into accordance with Article 72(1) of the Convention. The Committee notes the allegation by the CATP that, in the health sector, the participation of insured persons is not envisaged in health insurance fund administrators (IAFAS), EPS, IPRESS, or private health insurance companies. The Committee once again requests the Government to indicate the measures adopted or envisaged in the private health insurance sector in relation to the right of the representatives of the persons protected to participate in their management or to be associated with them, in a consultative capacity, in accordance with the required conditions.

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Please refer to the comment made under the Social Security (Minimum Standards) Convention, 1952 (No. 102).

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Article 2 of the Convention. With reference to its pervious comments, the Committee notes the detailed statistical information provided by the Government on the number of wage earners covered by health insurance under the general scheme and special schemes. With regard to the other information requested, that is on the total number of wage earners and the number of wage earners protected as a percentage of total wage earners, the Committee notes the Government’s statement that it undertakes to provide these data when they become available.

In this respect, the Committee notes, from the information contained in the report on the application of the Social Security (Minimum Standards) Convention, 1952 (No. 102), that the proportion of insured persons covered by the social health insurance scheme (ESSALUD) in relation to the active population at the national level was 18.3 per cent in 2001. It observes that since 1994 there has been a stagnation in absolute terms of the number of insured persons which, combined with the increase in the rate of the active population since that date, has resulted in a significant decline in the rate of insured persons among the active population. In these circumstances, the Committee hopes that the Government will provide with its next report all the information requested so that the Committee has at its disposal all the necessary data to assess the application of the Convention in Peru.

With regard to the geographical coverage of the health scheme, the Committee notes the statistical data provided by the Government under Convention No. 102 on the number of wage earners covered by ESSALUD in the departments of Amazonia, Apurimac, Huancavelica, Huanuco, Madre de Dios, Moquegua et Pasco, and the distribution by type of the ESSALUD health-care establishments in these departments. It requests the Government to keep it informed of the measures adopted or envisaged to supplement the existing supply of health-care establishments in departments such as those of Huancavelica, Madre de Dios and Moquegua, where it is relatively lower for a comparable number of insured persons than in the other departments referred to above.

Article 6, paragraph 2. In its previous comments, the Committee requested the Government to indicate the measures that it plans to adopt to allow the participation by the persons protected in the administration of the health-care providers (EPS) and health-care services at the enterprise level. In its report on the application of Convention No. 102, the Government indicates that, although the legislation in force does not provide for such participation, there exist supervisory and control mechanisms in the two systems. It adds, as it has indicated previously, that the regulation and supervision of the EPS is the responsibility of the EPS Supervisory Authority (SEPS), a public institution established for this purpose. It adds, with regard to enterprise health-care services, that they have to be accredited with the Ministry of Health and submit their health plans to ESSALUD to be authorized to operate. The Committee notes this information. It agrees with the Government that the procedures of accreditation and supervision offer certain guarantees that the rights of insured persons are respected. However, it recalls that the participation envisaged by this provision of the Convention is intended to associate insured persons in the management of these institutions and services, and not only to enable them to exercise a posteriori control over such management. It is in this spirit that the report form requests information on the proportion of seats or of votes assigned to the representatives of insured persons in the organs of these institutions. The Committee therefore trusts that the Government will re-examine the issue of the participation of insured persons in the management of self-governing insurance institutions and that it will provide information in the very near future on the measures adopted or envisaged with a view to bringing the national legislation into conformity with this provision of the Convention.

[The Committee is asked to reply in detail to the present comments in 2005.]

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With reference to its previous comments, the Committee notes the detailed information sent by the Government in its report. It notes in particular the information on the application of Article 6, paragraph 1, of the Convention, and the copies of the resolutions issuing authorization to operate whereby the health-care providers (EPS) obtain recognition, the copies of the reports of the EPS supervising authority, and the samples of contracts concluded with EPS.

Article 2 of the Convention. The Committee notes the Annual Report 2000 of the Social Health Insurance Scheme (ESSALUD) and the statistical tables of the monthly reports of affiliation to the EPS covering the period from April 2001 to April 2002. It also notes the information on the strength of the work force in Peru and the number of persons insured and covered by ESSALUD and by EPS. It notes in this connection that according to the Annual Report 2000, 32.6 per cent of the population of Peru (i.e. 8,361,425 out of a total of 25,661,690) has health coverage. The Committee also notes that in November 2001, the EPS system had 333,058 insured persons in all on register, which amounts to growth of 2.73 per cent as compared to November 2000. The Committee asks the Government to provide the following information: (a) the number of wage earners covered by health insurance: (i) under the general scheme; (ii) under special schemes; (b) total number of wage earners; (c) the number of wage earners protected as a percentage of total wage earners.

As to geographic coverage under the new health scheme, the Committee notes that the EPS system has nationwide coverage, there being no statutory restrictions or exclusions. The Committee observes that in four departments (Amazonas, Huancavelica, Madre de Dios, Moquegua) there is no coverage of any type of service and that in three others (Apurímac, Huanuco, Pasco) there is coverage only for outpatient services. The Committee would be grateful if the Government would supply information on the number of wage earners protected by ESSALUD, and on the types of services that the latter provides in these regions.

Article 6, paragraph 2. In reply the Committee’s comments, the Government again states in its report on Convention No. 102 that participation by the persons concerned in the administration of the health system is not compulsory, the SEPS being a public body established by law for the purpose of authorizing, regulating and supervising the operation of the EPS and monitoring proper use of the funds administered by EPS. The SEPS’ policy is to publicize the rights of the regular affiliates and to consider the views of the various players. The Committee takes note of this information. It agrees with the Government that, in the case of SEPS, participation by the persons concerned is not compulsory. It nevertheless observes that the EPS are independent of SEPS and that, as the Government itself points out, the legislation does not provide for participation by the persons concerned in the administration of the EPS. This was borne out by the Peruvian worker delegate in June 2002, at the Conference Committee on the Application of Standards. In view of the fact that, according to the legislation (sections 15 and 16 of Act No. 26790), enterprises providing health care, either through the EPS or their own care services, are entitled to credit on workers’ contributions amounting, in principle, to 25 per cent of the contributions, the Committee asks the Government to indicate the measures it plans to adopt to allow participation by the persons protected in the administration of the EPS and the enterprises’ own care services, which, according to 2001 Report evaluating institutional management, amounted at 31 December 2001 to 529 enterprises and bodies providing health services.

[The Government is asked to reply in detail to the present comments in 2003.]

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With reference to its previous comments, the Committee notes the information supplied by the Government in its report. In particular, it notes the information on the application of Article 7, paragraph 2, of the Convention.

Article 2 of the Convention. In its previous comments, the Committee asked the Government to indicate whether in practice all the workers covered by the Convention and, in particular, apprentices, are affiliated to the social security scheme provided in Act No. 26790 of 1997. It also requested information on the geographical coverage of the new health-care system, with an indication of the regions which are not yet covered. In its report, the Government indicates that all employed workers, including apprentices, are covered by the Act in question and by Legislative Decree No. 20151. The Government also indicates that this new health insurance scheme is nationwide in scope but it does not supply statistics on either the real cover or the geographical cover of the new health scheme. The Committee observes however that, according to the report of the Peruvian Social Security Institute (IPSS) for 1999, the population insured numbers 6,574,534 persons, of whom 47.9 per cent are in Lima and Callao and the remaining 52.1 per cent from towns in the interior of the country. With regard to geographical cover, the Government indicates in its report on the Social Security (Minimum Standards) Convention, 1952 (No. 102), that the EPS (health-care providers) have regional scope and that there is no regulatory limitation or restriction on any region in the country; hence, 20 departments in the country are beneficiaries under this system; geographical cover of the new health scheme ESSALUD comprises care centres consisting of 112 hospitals, 42 medical centres, 193 health stations and 31 outpatient clinics. The Committee notes this information. It asks the Government to provide in its next report an example of the latest IPSS report, as well as the monthly reports of affiliation to the EPS. It also asks it to supply disaggregated statistical information on the number of persons who belong to the workforce in Peru and of persons who are insured and covered either by ESSALUD or by the EPS. In regard to geographical cover, the Committee requests that the Government specify the regions which are not yet covered, the zones where establishments providing care are located, along with information on the insured persons and beneficiaries given treatment in these establishments.

Article 6, paragraph 1. In its previous comments, the Committee asked the Government to indicate the manner in which it gave effect to this provision of the Convention under which health-care insurance must be administered by self governing institutions, under the administrative and financial supervision of the public authorities and shall not be carried out with a view to profit. Institutions funded by private initiative must be recognized by the public authorities. The Government’s report refers, inter alia, to section 13 of the regulations of Act No. 26790 (DS No. 009 97 SA) under which the sole purpose of the health-care providers is to provide health-care services with their own or with third parties’ infrastructure. The Committee notes this information. It requests that the Government supply copies of the decisions authorizing operation by which the EPS obtain recognition, of EPS superintendence reports and examples of agreements concluded with EPS.

Article 6, paragraph 2. In reply to previous comments of the Committee regarding participation of insured persons in the management of the health care scheme, in particular as regards the EPS and health-care services provided by the employer, the Government indicates that insured persons participate in the management of the health scheme through representation of the most representative organizations of the group of the workers in the public, private and pensioners’ labour system. The Committee notes this information. It observes, however, that the legislative provisions which the Government cites, under which participation of insured persons is provided, relate to the Social Security Health System (ESSALUD). Finally, it requests that the Government indicate the legislative provisions under which participation of insured persons in EPS and in health services provided by employers is envisaged.

[The Government is asked to report in detail in 2002.]

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In its previous comments, the Committee had requested the Government to provide detailed information concerning the legislation and the practice which give effect to the Convention, taking account of the implementation of a new health-care system as a consequence of the adoption in 1997 of Act No. 26790, respecting the modernization of the social security system in the health field, and of Supreme Decree No. 009-97-SA regulating the above Act, which came into force in 1997. The Committee notes the general information provided by the Government in its report as well as the observations communicated by the Unitary Trade Union of Technicians and Auxiliary Specialists of the Peruvian Institute of Social Security alleging in particular that Act No. 26790 and its Regulation are designed to dismantle the social security system and the Peruvian Institute of Social Security (IPSS) by placing them at the service of private individuals and foreign capital. In its response, the Government refutes these allegations and indicates that it has no intention of privatizing the social security system and that the IPSS should be considered as the administrator of the general social security system and the enterprises providing health care which workers may choose if they so wish.

The Committee recalls that the Act modernizing the social security system in the health field and its implementing Decree are designed to regulate the introduction of the private sector into the field of health care. The health-care services provided by the IPSS are complemented by the health-care plans and programmes of the Health Care Providers (EPS). These may be enterprises or public or private institutions which are independent of the IPSS. Nevertheless, under the new system the IPSS alone continues to be responsible for disbursing cash benefits and providing complex health care for illnesses such as chronic illnesses. With regard to other health-care services, these may be provided either by the IPSS or employers themselves through their own health-care services or health-care plans, which have been contracted out to the EPS. Consequently, under the new system workers who subscribe to private health-care programmes may receive cash benefits and complex health care (capa compleja) from the IPSS and normal health care (capa simple) from the EPS (or the health-care service provided by the employer).

The Committee notes that fundamental changes have been made to the health-care service by the new legislation. Consequently, it requests the Government to provide additional information in its next report, as required by the report form, in respect of the impact of the legislation and national practices with regard to the application of the Convention. The Committee in particular draws the Government's attention to the following points.

Article 2 of the Convention. In its previous comments, the Committee had referred to the need to take practical measures to ensure that health-care services are made available throughout the whole of the national territory to enable all workers who are covered by the Convention to be protected. The Committee notes in this regard that under section 3 of the Act respecting the modernization of the social security system in the health field the regular insured persons as well as voluntary insured persons and their beneficiaries are covered by the health-care insurance system. The regular subscribers, whose membership of the system is compulsory, include in particular active dependent workers as well as members of workers' cooperatives. The Committee would be grateful if the Government would indicate whether in practice all workers covered by the Convention and, in particular, apprentices, are now covered by the health-care insurance system provided for under Act No. 26790 of 1997. The Committee also requests the Government to provide detailed information relative to the geographic coverage of this new health-care system in specifying the regions which are not yet covered by the system.

Article 6, paragraph 1. The Committee notes that under sections 13 and 14 of the Act respecting the modernization of the social security system in the health field, the EPS are enterprises or public or private institutions independent of the IPSS, placed under the supervision of the EPS inspectorate and whose sole purpose is to offer health-care services through its own infrastructure or those of a third party. The Committee recalls that under Article 6, paragraph 1, of the Convention, health-care insurance must be administered by self-governing institutions, under the administrative and financial supervision of the competent public authority and shall not be carried out with a view to profit. Institutions founded by private initiative must be specially approved by the competent public authority. Under these conditions, the Committee would be grateful if the Government would indicate the manner in which it gives effect to this provision of the Convention.

Article 6, paragraph 2. The Committee would be grateful if the Government would provide detailed information in respect of the participation of insured persons in the management of the health-care system, in particular as regards the EPS and health-care services provided by the employer. The Committee would be grateful if the Government would indicate whether the insured persons are represented in the decision-making bodies of the EPS inspectorate.

Article 7, paragraph 2. The Committee would be grateful if the Government would indicate the manner in which effect is given to this provision of the Convention and the manner in which the national legislation provides for a financial contribution by the public authority to the health-care system.

Moreover, the Committee refers to its comments in respect of the Social Security (Minimum Standards) Convention, 1952 (No. 102).

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The Committee notes the Government's report received in September 1997. It also notes the adoption of new legislative texts: Act No. 26842 relating to general health; Act No. 26790 relating to the modernization of social security in the health field; and Supreme Decree No. 009-97-SA to regulate the Act relating to the modernization of social security in the health field. The new legislation establishes a social security system for health purposes -- under the Peruvian Institute of Social Security (IPSS) -- and provides for the participation of health service companies. In its report, in addition to other general remarks, the Government states that the health services provided by the social security system are supplemented by the plans and programmes of the health service companies, which are enterprises or public or private institutions distinct from the IPSS, whose only purpose is to provide a health care service with its own infrastructure or with that of a third party under the supervision of a Health Service Company Inspectorate. According to the Government, the aim sought is not to privatize the social security system but only to enable the private sector to enter into this field. Taking into account the important changes made by the new legislation, the Committee requests the Government to provide a detailed report containing information on the legislation and practice, including statistics, as requested in the report form for each of the provisions of the Convention.

[The Government is invited to report in detail in 1998.]

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The Committee notes the Government's statement in its report that the regulations for implementing Decree No. 718 of 8 November 1991 are still under development. It hopes that when these regulations are adopted they will not fail to take into account the points raised by the Committee in its observation formulated in March 1995.

[The Government is requested to report in detail in 1997.]

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I. With reference to its previous observations and the comments transmitted by the Central Union of Workers of the Peruvian Social Security Institute, the Committee notes the information supplied by the Government in its report, particularly as regards the new private health system introduced by Legislative Decree No. 718 of 8 November 1991.

The Committee notes in particular that the private health system (SPS), which will come into force on the date of enactment of the regulations issued under Legislative Decree No. 718, supplements the system administered by the Peruvian Social Security Institute (IPSS). Every worker has the right to select the system which suits him or her best and persons who are insured under the system administered by the IPSS may remain with that system or join the private system (section 3 of Legislative Decree No. 718). The new private health system will be administered by health service organizations (OSS), which shall be set up as legal entities and are obliged to register with the Superintendency of health service organizations (sections 4 and 5 of the above Decree). Furthermore, health service organizations provide health benefits and assistance in exchange for the amount of the statutory health contribution or a higher agreed amount (section 7 of the above Decree). While noting that the private health system established by Legislative Decree No. 718 of 1991 is established within the context of article 14 of the Constitution of Peru, which authorizes the existence of other public or private bodies in addition to the Peruvian Social Security Institute, provided that these entities provide supplementary or better benefits than those provided by the IPSS, with the agreement of the insured persons, the Committee considers that the new private health system raises certain issues relating to the application of the following provisions of the Convention.

Article 3, paragraph 1, and Article 4, paragraph 1, of the Convention. The Committee notes that Legislative Decree No. 718 of 1991 only contains provisions of a general nature in Chapter IV, regarding sickness benefit and medical assistance. In particular, in the contract concluded between a health service organization and the persons covered, the parties shall agree freely to the manner and conditions under which benefits are provided, although a number of matters must be determined, such as: (a) the benefits and other forms of compensation covered by the contract, including the percentages of coverage, the basic amounts and any ceiling to cash benefits; (b) the waiting periods; and (c) any exclusions from the above benefits.

In this respect, the Committee recalls that, in accordance with Article 3, paragraphs 1 and 2, of the Convention, an insured person who is rendered incapable of work by reason of the abnormal state of his bodily or mental health shall be entitled to a cash benefit for at least the first 26 weeks of incapacity from and including the first day for which benefit is payable. Furthermore, in accordance with Article 4, paragraph 1, the insured person shall be entitled free of charge, as from the commencement of his illness and at least until the period prescribed for the grant of sickness benefit expires, to medical treatment by a fully qualified medical practitioner and to the supply of proper and sufficient medicines and appliances. Moreover, the Committee draws attention to the fact that the Convention, in Article 3, paragraph 2, authorizes, but only for cash benefit for sickness, the imposition of a qualifying period and a waiting period which cannot be more than three days.

Article 6, paragraph 1. The Committee notes that health service organizations are established as legal entities subject to the supervision of the Superintendency of health service organizations, but they nevertheless operate in a competitive market, as recognized in the Preamble to Legislative Decree No. 718. The Committee recalls that, in accordance with Article 6, paragraph 1, of the Convention, sickness insurance shall be administered by institutions which are not carried on with a view to profit.

Article 6, paragraph 2. Legislative Decree No. 718 of 1991 contains no provision ensuring the participation of insured persons in the management of health service organizations.

Article 7, paragraph 1. The Committee notes that by virtue of sections 14 and 15 of Legislative Decree No. 718 of 1991, contributions to the private health system are payable exclusively by workers covered by the system. Indeed, while the workers participate in the provision of the financial resources of health service organizations at the rate of 8 per cent of the wage that is subject to contributions, with the deduction of the percentage established by regulation to be paid to the Peruvian Social Security Institute as a solidarity contribution, the whole of the employers' contribution, which amounts to only 1 per cent of the wage that is subject to contributions, is paid to the IPSS. The Committee recalls in this respect that, in accordance with Article 7, paragraph 1, the insured persons and their employers shall share in providing the financial resources of the sickness insurance scheme.

Article 9. Legislative Decree No. 718 of 1991 does not contain provisions on the right of appeal which has to be granted to insured persons in case of dispute concerning their right to benefit, in accordance with this provision of the Convention.

The Committee hopes that the Government will be able to take the necessary measures to supplement Legislative Decree No. 718 of 1991, before the coming into force of the private health system, for example on the occasion of the adoption of the regulations provided for under section 33 of the above Legislative Decree, so as to give full effect to the provisions of the Convention.

II. The Committee once again hopes that the Government's next report will contain detailed information on the measures taken in practice to extend the health service throughout the national territory and provide the necessary infrastructure to protect all the workers covered by the Convention.

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The Committee took note of the observations trasmitted by the Central Union of Workers of the Peruvian Social Security Institute and the Government's reply. The Central Union of Workers alleges, in particular, that the new measures introduced by the Government with the aim of privatizing the system have resulted in the commercialization of workers' health. For its part, the Government has referred in its report to a health organization project to be elaborated in the Democratic Constituent Congress which provides better possibilities for covering the entire national population by the extension of its geographic scope. The Government also mentioned that article 11 of the 1993 Constitution declares that "the State shall guarantee free access to health and pension benefits by means of public, private or mixed institutions. It also supervises their efficient functioning". The Committee takes note of this information. It recalls that, in its 1992 observation, it requested the Government to communicate detailed information on the measures taken in practice to ensure the extension of health services over the entire national territory and to provide them with the necessary infrastructure to protect all the workers covered by the Convention. The Committee therefore hopes that all new legislation adopted in the area of sickness insurance will take fully into account the provisions of the Convention. It trusts that the next report of the Government will contain the information requested in its previous observation, as well as detailed explanations, for each of the Articles of the Convention, on the provisions in laws and regulations which make it possible to ensure its full application in law and practice.

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Article 4, paragraph 1, of the Convention. By virtue of section 18 of Legislative Decree No. 22-482 of 27 March 1979, as amended by Act No. 24-620 of 24 December 1986, workers are no longer required by law to have made three consecutive monthly contributions or four non-consecutive monthly contributions to be entitled to the provision of medical care, as the new provision empowers the Peruvian Institute of Social Security (IPSS) to determine the qualifying periods for insured persons to be entitled to the provision of medical care, in accordance with the characteristics of their work. In this connection, the Committee notes Directive No. 005-PE-IPSS-87 whereby the Peruvian Institute of Social Security has fixed a four-week qualifying period for entitlement to medical care for casual workers, it being understood that no qualifying period is required in the event of accident. The Committee would be grateful if the Government would indicate in its future reports whether the Peruvian Institute of Social Security has issued other directives fixing a qualifying period for entitlement to medical care for categories of workers other than casual workers. If so, please provide a copy of them.

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Article 2, paragraph 1, of the Convention. The Committee again requests the Government to provide detailed information on the measures taken in practice - following the adoption of Presidential Decree No. 022-86-SA - to ensure that the health services are extended throughout the national territory and are provided with the necessary infrastructure, so as to protect all the workers covered by the Convention.

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The Committee notes that the Government's report has not been received. It must therefore repeat its previous observation which read as follows:

1. Article 2, paragraph 1, of the Convention. The Committee notes that the Government refers once again to the functional integration of the Ministry of Health and the Peruvian Institute of Social Security, in accordance with Presidential Decree No. 022-86-SA, which will make it possible to provide care for the whole population, whether it is insured or not, through the co-ordination and rational use of the resources of both organisations. The Committee once again expresses the hope that the above integration will make it possible to provide medical assistance throughout the national territory in order to protect all the workers covered by the Convention. It therefore requests the Government to continue supplying information on any progress achieved in this respect. 2. Article 4, paragraph 1 (medical care). In its previous comments, the Committee drew the Government's attention to the fact that the Convention does not authorise the provision of medical assistance to be subject to any qualifying conditions. In its reply, the Government points out that section 18 of Legislative Decree No. 22482 of 27 March 1979, under which the prerequisite of three consecutive monthly contributions or four non-consecutive monthly contributions, has been substituted by Act No. 24620 of 24 December 1986. It adds that, since this latter Act empowers the Peruvian Institute of Social Security to determine the qualifying periods for insured persons to be entitled to the provision of medical care, in accordance with the characteristics of their work, it is possible to provide for the participation of the insured in the costs of the care, in accordance with Article 4, paragraph 2. The Committee notes this information. It points out that, although Article 4, paragraph 2, of the Convention authorises the participation by the insured in paying the cost of medical care, it does not authorise any qualifying conditions. It therefore hopes that the Government will take the necessary measures in order to abolish, in accordance with the Convention, any qualifying condition with regard to medical care. It once again requests the Government to supply copies of any regulations, rulings or any other text adopted by the Peruvian Institute of Social Security under Act No. 24620 referred to above.

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The Committee hopes that the Government will make very effort to take the necessary action in the very near future.

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The Committee takes note of the information supplied by the Government in its report.

1. Article 2, paragraph 1, of the Convention. The Committee notes that the Government refers once again to the functional integration of the Ministry of Health and the Peruvian Institute of Social Security, in accordance with Presidential Decree No. 022-86-SA, which will make it possible to provide care for the whole population, whether it is insured or not, through the co-ordination and rational use of the resources of both organisations. The Committee once again expresses the hope that the above integration will make it possible to provide medical assistance throughout the national territory in order to protect all the workers covered by the Convention. It therefore requests the Government to continue supplying information on any progress achieved in this respect.

2. Article 4, paragraph 1 (medical care). In its previous comments, the Committee drew the Government's attention to the fact that the Convention does not authorise the provision of medical assistance to be subject to any qualifying conditions. In its reply, the Government points out that section 18 of Legislative Decree No. 22482 of 27 March 1979, under which the prerequisite of three consecutive monthly contributions or four non-consecutive monthly contributions, has been substituted by Act No. 24620 of 24 December 1986. It adds that, since this latter Act empowers the Peruvian Institute of Social Security to determine the qualifying periods for insured persons to be entitled to the provision of medical care, in accordance with the characteristics of their work, it is possible to provide for the participation of the insured in the costs of the care, in accordance with Article 4, paragraph 2.

The Committee notes this information. It points out that, although Article 4, paragraph 2, of the Convention authorises the participation by the insured in paying the cost of medical care, it does not authorise any qualifying conditions. It therefore hopes that the Government will take the necessary measures in order to abolish, in accordance with the Convention, any qualifying condition with regard to medical care. It once again requests the Government to supply copies of any regulations, rulings or any other text adopted by the Peruvian Institute of Social Security under Act No. 24620 referred to above.