Observation (CEACR) - adoptée 1998, publiée 87ème session CIT (1999)

See under Convention No. 24, as follows:

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).