Comprehensive health insurance (Seguro Integral de Salud - SIS)

SIS provides free or low-cost health insurance to Peruvians living in poverty and extreme poverty so that they can overcome barriers to accessing health care. Launched in 2002, the main objective of SIS is to increase utilization of health services by removing barriers to accessing care for poor people/vulnerable populations, especially women and children under five.

Literature Review

Existing literature shows that SIS improved access to health care for the poor and those living in rural areas. Quantitative data analysis also indicates SIS was associated with a small decrease in stunting during from 2000 to 2016, and qualitative data supports that this program was important to reducing stunting in Peru.¹

Quantitative Analysis

According to the linear mixed effects regression, SIS significantly influenced stunting prevalence in the expected direction for 2000-2016 period. SIS was statistically significant at the 10 percent level with a large effect size (1.64 Cohen’s F2) suggesting that it was highly predictive of stunting prevalence decline at the region level. Along with PAN and PSMN, SIS demonstrated the largest effect size of any input variable considered in the regression analysis. SIS was not found to be statistically significant during the 2000-2007 or 2008-2016 periods. However, the 2000-2016 results are likely to be the most reliable among the three periods of study.

It was also not found to be a significant predictor of HAZ-score based on the decomposition analysis.

Qualitative Analysis

SIS was identified as an important means of strengthening health services among impoverished states and people in Peru. As a part of PAN, the budget for SIS was increased, with the aim of increasing utilization of health services by the poorest segments of society.

Conclusion

Launched in 2002, the main objective of SIS is to increase utilization of health services by removing barriers to accessing care for poor people/vulnerable populations, especially women and children. Given its contribution to improving access to health care for poor and rural populations, as well as support from both our regression analysis and other sources, it was likely a very important contributor to the decline in stunting. Our ecological quantitative models suggest statistically significant positive relationships between SIS and stunting during from 2000 to 2016 (after adjusting for confounders), and experts corroborated SIS’s importance during our key informant consultations. Evidence from published literature also supports SIS’s positive role in improving access to health care for the poor and those living in rural areas, and consequently, its downstream role in improving child growth.

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