Observación (CEACR) - Adopción: 2002, Publicación: 91ª reunión CIT (2003)

Convenio sobre el seguro de enfermedad (industria), 1927 (núm. 24) - Perú (Ratificación : 1945)

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.]