Demande directe (CEACR) - adoptée 2001, publiée 90ème session CIT (2002)

The Committee notes that the Government requested those responsible for the Social Health Insurance Scheme (ESSALUD), the Insurance Standards Office (ONP) and the Health Providers Superintendence (SEPS) to provide, in their fields of competence, the necessary information for the preparation of the report on the application of this Convention and that they would transmit this information as soon as it was available. Since the Government’s report contained no information on the points raised in its direct request, the Committee is bound to reiterate its previous comments which read as follows:

I. Health care system.  With reference to its observation, the Committee would like to receive detailed information on the following points.

  Part II (Medical care), Article 7 of the Convention. Act No. 26790 to modernize social security in the area of health, and Supreme Decree No. 009-97-SA provide that benefits for prevention and health promotion are a priority and their purpose is to maintain the health of the population. In addition, compulsory preventive benefits are provided under preventive promotional programmes run by the Peruvian Social Security Institute (IPSS) and private companies, on the basis of their own services or those provided by health care providers (EPS) (section 9 of the Act and sections 11 and 19 of the Supreme Decree). The Committee requests the Government to provide detailed information on the implementation of these provisions.

  Article 10, paragraph 2. Section 42(1) of the above Supreme Decree provides that participation of insured persons in the costs of medical care may not exceed 2 per cent of their monthly income in the case of outpatient treatment or 10 per cent in the case of hospitalization, unless the worker expressly consents to a higher charge when the vote is taken at the enterprise on the choice of health care provider and health care plan. In addition, under section 42(3) of the Supreme Decree, the worker’s contribution to the cost of treatment, whether outpatient or inpatient, may not exceed 10 per cent. The Committee requests the Government to indicate whether the maximum amount specified in section 42(3) can also be exceeded with the member’s consent.

  Article 12. The Committee hopes that the Government will indicate in its next report the period during which medical benefits must be provided and indicate the relevant provisions.

  Part XIII (Common provisions) (in conjunction with Parts II, III and VIII), Article 69. The Committee would be grateful if the Government would provide copies of any legal or regulatory texts providing for the possibility of suspending medical or cash sickness and maternity benefits. Please provide in particular a copy of the text governing the conditions and procedures which must be adopted by the IPSS to implement section 15 of Supreme Decree No. 009-97-SA.

  Article 70. Please provide a copy of the regulations adopted by the Supervisory Board of the health care providers to implement section 91 of Supreme Decree No. 009-97-SA which provides that the settlement of disputes through arbitration, the provisions which also apply to persons affiliated to health care providers (EPS) and to persons who receive health care benefits provided by the employer. The Committee also requests the Government to indicate whether decisions made by arbitration bodies can be challenged in court. Lastly the Committee would be grateful if the Government would indicate whether disputes between the beneficiaries of health care benefits and the IPSS are also subject to arbitration, given that this is not explicitly clear from section 91.

  Part XIV (Miscellaneous provisions) (in conjunction with Parts II, III and VIII). (a) Article 76. Please provide statistical data on the coverage of medical care and the sickness and maternity benefits required under Article 76, paragraph 1(b)(i), in the form required by the report form under this Article of the Convention.

(b) Please provide statistical data, as requested in Article 76, paragraph 1(b)(ii) in conjunction with Article 65, concerning the amount of cash benefits for sickness and maternity, in the form required by the report form under Article 65. Please also indicate whether a maximum amount is fixed, either for sickness and maternity benefits or for the wages on which the calculation of the benefits is based.

Lastly, the Committee requests the Government to indicate whether section 52(2) of Supreme Decree No. 009-97-SA, according to which workers may once per year decide individually to transfer from the IPSS to a health care provider (EPS) and vice versa, also applies to the case of new workers referred to in section 53 of the same Supreme Decree.

II. The Committee hopes that the Government’s next report will contain detailed information in reply to the points raised in its direct request of 1997 concerning the private pensions system.

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