The reforms implemented during 2000-2009 affected directly or indirectly the functioning of the health financing system. However, there are no assessments as to whether such policies are aimed in the right direction; i.e., if they are contributing to achieving the health system’s objectives. With an aim to throw light on this matter, this study provides statistical information about the changes in the performance of the health financing system in 2000-2009 that can allow the health authorities to make policy decisions (on financing) based on evidence.

The study is important from several viewpoints. From and instrumental perspective, the study proposes a set of parameters and indicators that are relevant for assessing performance and that can be quantified, monitored, and evaluated over time. From an analytical perspective, the study uses a systemic approach to evaluate the changes in the performance of the health financing system, i.e., it assesses the interrelations between the financing system’s sub-functions and how these are linked to the health system’s general objectives. The study emphasizes the role of the financing system’s institutional design and organizational practices as a key performance determinant.

Finally, from a policy perspective, an exploratory analysis is performed for the critical areas affecting the performance of the system; i.e., institutional design problems (lack of rules, inadequate rules, conflicting rules or policies) or the organizational capacity to implement or enforce rules, among other factors. Along these lines, this analysis seeks to provide inputs to policymakers as guidance for potential changes in financing policy.

This study on the changes in the performance of the health financing system in Peru is organized as follows. Section 2 presents a brief summary of the analytical and methodological framework used to clarify the objective and criteria to assess performance, including a description (technical specifications) of the indicators and information sources used. Section 3 describes the evaluation context, i.e., the economic and fiscal environment in which the health sector operated in 2000-2009 and the health reforms introduced in that decade, and presents the statistical evidence for the performance of the financing system in line with the analytical dimensions established in the previous section. Finally, section 4 identifies some causal factors explaining the results and reflects on the challenges to advance the process towards universal coverage, mainly regarding public financing. The emphasis on this kind of financing responds to the government’s role in ensuring financial coverage for the more vulnerable segments of the population.


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