Public healthcare (EsSalud) is government-run at the top, but devolved across the Peruvian regions. In addition it is regulated by a number of bodies, including the Ministry of Health (Ministerio de Salud, or MINSA), the Social Security Service, the police, and the Armed Forces Hospital. Much of the Peruvian population is below the poverty line, and government efforts are focused on bringing as much primary care to people in poor rural and urban areas as possible.

Initiatives similar to those elsewhere in South America have been brought in recently, such as medical graduates being obliged to spend a year in an area which lacks health provision. Treatment outcomes and patient use of the system have increased substantially. However, public healthcare is under strain despite this level of state investment in recent years, with shortages in personnel, equipment, medication and other resources. Waiting times can be lengthy, with over a month to see a GP in some areas, and two months’ wait for surgical procedures. Many of Peru’s poorer citizens still rely on traditional indigenous medicine.

There is also a role played by NGOs such as UNICEF and USAID, working with MINSA in the poorer regions of the country. Unlike some of Peru’s neighbours, where non-communicable diseases have become the main cause of death, mortality in Peru still results from infectious illnesses such as malaria, yellow fever, and TB. However, the population is ageing due to recent healthcare reforms and there is an increasing demand for care for the elderly.

The country also has a universal health insurance scheme, Integral Health Insurance (Seguro Integral de Salud, SIS also known as Aseguramiento Universal En Salud, AUS), introduced in 2009. This is slightly different from EsSalud and covers anyone who is not insured with the latter, and is completely free.

EsSalud is currently the country’s largest health insurance provider, covering around 60% of the population. From 2018, the Peruvian government will be working with the International Labour Organization (ILO) and the Pan American Health Organization (PAHO) to reform EsSalud.

As an expat working for a company in Peru, you will be covered if your employer is making contributions for you into EsSalud.

Your employer will register you, but you have a choice of being affiliated either with EsSalud, or with the Private Health System (Entidades Promotoras de Salud/EPS)

The state system covers primary and hospital care, including midwifery and maternity care, with an emphasis on primary care and disease prevention.

Most retirees in Peru take out private medical insurance to cover their stay in the country. Public provision is very limited even if you are eligible, although you should be covered under EsSalud.

International students will need to take out private cover for their time in the country, but some universities have medical facilities attached: consult your educational provider to see if they can provide cover for you as well.

Your dependents will be covered by EsSalud if you are registered with public healthcare.

The state schemes cover basic dental care, but as with the medical system, the public sector tends to be underfunded and overcrowded. Peru has four public dental schools.

Your employer must make monthly health contribution payments equal to 9% of your salary. You do not have to make contributions.

You can choose to be affiliated either with EsSalud, or with or EPS. 25% of the amount paid to the EPS can be used as a credit against EsSalud contributions.

Public healthcare in Peru faces significant challenges and is not yet of the standard that you might have been accustomed to in your home nation. Limited provision and long waiting times mean that the majority of expats in Peru take out private cover.

You may also wish to check with your employer to find out if you are covered under a private group health insurance package.

Primary and hospitalization costs, plus elective procedures such as cosmetic surgery and dental implants, are covered. You may want to personalise your health insurance policy, perhaps with a specific dental plan or medical evacuation cover.

This will depend on factors such as your age and any pre-existing conditions, and the kind of package you opt for (obviously, a more expensive insurance package will give you more a extensive range of treatment and facilities). As so many variables have an effect on the cost of international private medical insurance it becomes very difficult to give accurate estimates without knowing the full details of the coverage required.

However, as a very rough guide, using a standard profile of a 40 year old British male with no deductibles, no co-insurance, a middle tier plan/product, all modules included and worldwide coverage excluding the US, a ballpark price of around £4,000/$5,000 might be expected. Were coverage to be expanded to include the US then the premium could increase to almost double that amount.

Many of the big international providers offer cover, including:

• AETNA
• Allianz
• Cigna
• Foyer Global Health
• Pacific Prime

Entidades Promotoras de Salud/EPS - Private Health System

Federacion Medica Peruana/FMP - Peruvian Medical Federation

Ministerio de Salud, or MINSA - Ministry of Health

Seguro Integral de Salud(SIS), also known as Aseguramitnto Universal En Salud, AUS - Integral Health Insurance

Seguro Social de Salud del Perú/EsSalud - Social Health Insurance of Peru