Progressos e desafios para alcançar a cobertura universal de saúde no Peru, 2011-2019: um estudo de caso

Abstract

The Peruvian health system demonstrated significant fragility during the COVID-19 pandemic, evidenced by the enormous number of deaths associated with the disease, despite health coverage for approximately 90% of the population being reported in the years before the pandemic. In the second decade of the 21st century, Peru conceived and implemented a "new" health reform, led by a government that promised social changes. The reform is based on the Universal Health Insurance model, a mixed insurance model, built during two previous decades — years of hegemonic neoliberal discourse and practices in the health sector. This reform is also framed in the discourse of Universal Health Coverage, hegemonic on regional and global levels, with vague definitions, interpretations and diverse strategies, and involving a dispute between two opposing models of construction of the health system: the market or residual model and the universal or health-directed model. This dissertation describes the health reform process in Peru, from 2011 to 2019, from a historical-contextual perspective, analyzing its trajectory and context, as well as some of the results of its implementation. It uses theoretical references, such as historical institutionalism, to try to understand the changes or continuities in public policies. The research strategy is a case study, mainly employing documentary and bibliographic analysis. After analyzing the health reform package and the changes implemented during the study period, it is evident that the main measures aim to strengthen the mixed health insurance model; This includes things like the separation of functions and the specialization of entities, within a market governance structure. Furthermore, it is noted that there is a lack of emphasis on measures to improve the provision of services and to overcome the fragmentation and segmentation of the health system. Finally, we believe that the opportunity for health reform was brief, given the context, and stressed, among other reasons, by the opposition of professional and civil society associations. Furthermore, it is worth highlighting the significant number of policies that have not been implemented or are only partially implemented, or that may be related to institutional fragility.