Observation (CEACR) - adopted 2004, published 93rd ILC session (2005)

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.]