Tienes Aseguranza?

Do you have health insurance? A question that is as important here as it is in the US. Sta. Clotilde is unique because patients are seen regardless of their insurance status or their ability to pay. Father Jack says that everyone who doesn't have insurance gets a bill, and they can pay that bill in whatever way they see fit...chickens, bananas, working at the clinic, or with cash. You will see many of the family members of our hospitalized patients that come from far away doing odd jobs around the health center.

Peru has several parallel health care systems...there is the public system (MINSA) which serves the vast majority the population, there is also the social security system (ES SALUD) this is for all those who are formally employed, there is a military health care system for those serving in any branch of the armed forces, and then there is a whole slew of private providers (hospitals and clinics). The Sta. Clotilde health center is part of the MINSA network. The vast majority of patients that come here are covered by the Seguro Integral de Salud (SIS). SIS is a program that covers clinic visits and hospitalizations for the poorest families in the country.

SIS is good because it gives people access to health care, but it comes with many limitations. One major one is that it is primarily focused on acute/reactive medicine. It does not cover some chronic diseases. I haven't figured out which ones it does and doesn't cover, b/c here they take care of everything regardless of your diagnosis. The SIS formulary is also pretty limited. And probably it's biggest weakness is how much they reimburse the center for the work they do. The center gets paid 12 soles (US $4) for each patient visit...but the patient cannot come to the clinic for the same thing twice in one month, so the doctors twist their diagnoses to meet this limitation. That 12 soles covers the doctor visit, the medications, and any procedures that are done. Ultimately the center ends up losing money...b/c these things all cost more than 12 soles. Here they don't charge patients for supplies when they do procedures, but at other health centers patients are often asked to buy their own gloves, needles, IV bags. For patients that are hospitalized the center gets 80 soles (US $26)...regardless of the diagnosis, how long they stay, or what supplies are used. It's impossible to fully fund everything that needs to get done this way. Because Sta. Clotilde is partially funded by the Catholic church they do not charge patients for anything except for an occasional medicine that's not on the formulary and even these prices are symbolic. The Peruvian government has just made a pledge to provide universal healthcare by 2011, but it will not be able to do this well without making a significant financial committment...keeping my fingers crossed.