Healthcare Peru

The public health system in Peru is split into four entities, although only two are likely to apply to expats. Seguro Integral de Salud (SIS) is for those without health insurance, on low incomes, living in poverty, retired, or unemployed. Funded through taxes, those eligible will receive free or heavily subsidised care. EsSalud is the public healthcare offering for those formally employed in Peru. With this coverage, some aspects of care are free, but co-pays and fees often apply.

Public healthcare in Peru offers many services.  General consultations, pediatric care, preventative care, and emergency care are all included, as well as surgeries, diagnostic testing and maternity care. However, long waits, limited resources, and extreme regional disparity mean that the level of service provided can vary significantly.

It is a system that does not match the standards found in Europe, North America or some parts of South America, leading many to choose a private health insurance plan to provide a more comprehensive healthcare service.

For expats working in Peru under a Peruvian contract, EsSalud is compulsory. The employer will take care of enrolling them in the system with a 9% salary deduction each month to fund the coverage. For expats not formally employed, but holding residency, SIS is the form of coverage available. Simply apply at the nearest public health centre or via the SIS website.

Private healthcare is an option chosen by many expats and natives. With faster access to a higher level of facilities, a broader range of services and less of a language barrier, the private option is often preferred. Private facilities are found in Lima and Cusco, among other areas, but it should be noted that the standards within them are not always comparable to those found in private facilities in Europe and the USA.

The costs of private healthcare in Peru are, naturally, more expensive than those found in the public sector, but when compared to the costs of private healthcare in other areas of South America, the USA and Europe, they are relatively low. However, with regional disparity so evident and standards not as high as elsewhere, costs can soon mount if relocation to other areas of the country, or abroad, is required. As a result, most expats look for an insurance plan that provides comprehensive coverage with repatriation included.

Whilst EsSalud is compulsory for expats working in Peru, and SIS is available to those not working, on low incomes, retired or living in poverty, private health insurance is seen as a valuable top-up to the existing public sector coverage. With it providing faster access to a broader range of services, a heightened level of care and a wider range of specialists, private health insurance is seen by many as the only way to source adequate care in Peru.

Private health insurance policies in Peru are generally more affordable than those found in the USA or Europe; however, the final cost of a policy will be determined by age, level of coverage, current health status, and provider.  With private insurance, access to premium facilities will be covered, but due to the varying levels of care available in Peru, it is advisable for expats to seek an international health insurance plan. That way, should repatriation be necessary, the extensive costs involved will be reduced.

Local plans that offer coverage in Peru only are also available, and will cost less than an international plan, but expats should review the coverage being offered before committing, due to the potentially more limited offering.

The quality of hospitals in Peru varies, with care in cities ranging from adequate to excellent, but in rural areas, it can rarely exceed poor at best. Lack of funding, staff shortages and long wait times make public facilities difficult for expats to adjust to. As a result, private facilities are preferred. Some are excellent, especially in Lima and Arequipa, but much like the public sector, the standards can be inconsistent throughout the country.

English is not a language widely spoken in Peru, and in the public sector, it’s rare to find English-speaking medical staff. Private hospitals and clinics provide a degree of bilingual support with some staff fluent in more than one language; however, this is not guaranteed. Some key Spanish phrases should be learnt in advance to assist with medical emergencies.

Peru is home to a wide range of hospitals, and whilst there are many deemed to be of insufficient quality, there are some within the private sector that hold the prestigious JCI accreditation. Hospital Guillermo Kaelin de la Fuente in Lima and Hospital Alberto Leonardo Barton Thomspon in Callao are just two of the facilities holding this honour. Expats can also benefit from using Clinica Anglo Americana in Lima and the San Pablo Group clinics for English-speaking medical assistance.

A broad range of services is offered in Peruvian hospitals, including emergency care, surgery, maternal care, paediatrics, and diagnostic testing; however, many facilities, especially in the public sector, are not suitably equipped to treat expatriates. Private facilities are more accommodating and provide a broader range of care with services such as optical care, dental care and cosmetic surgery also available.

Admission to a hospital in Peru depends on the type of insurance held and the care required. By law, emergency care is free of charge and can be accessed without an appointment or insurance. Patients are triaged and then treated based on the severity of the emergency. For non-emergency care, patients require a referral by a GP, but in the public sector, it can take months until they are seen. Within private care, a doctor will refer a patient, with the insurer or patient completing pre-admission paperwork, a room is then assigned within the same or the next day.

Healthcare costs in Peru can vary from being completely free to very expensive. Public facilities offer free or subsidised care to those on EsSalud or SIS. For those covered by EsSalud, care is mostly free at the point of service, but not always. Specialist care, for example, will incur out-of-pocket expenses. Private facilities charge for all services, except emergency care, although if specific medications or tests are required, costs will be incurred. The costs of healthcare in Peru are generally less than those in Europe, the USA and some areas of South America, but private health insurance is recommended to reduce any out-of-pocket costs that could arise.

Some private hospitals in Peru are excellent and are equal to what can be found elsewhere in the world.  Some lack the additional levels of comfort or personal service encountered in Europe or the USA, for example. Public facilities are generally good, at best, with many failing to deliver levels of care many expats would deem suitable.

Private hospitals in Peru accept health insurance and, in most cases, will expect payment upfront for their services. Some hospitals may have an agreement in place with insurance providers where payment can be made after treatment, but this should be checked before booking any appointments.

Before relocating to Peru, it is recommended that expats ensure all routine vaccinations are up to date. This would include MMR and DTP. Additionally, most travellers are also advised to obtain Hepatitis A and Typhoid vaccinations before travel. There is currently a warning for Yellow Fever in some areas of Peru, and for some travellers, the vaccine for this should also be considered alongside those for Rabies, Dengue, Chikungunya, and Tuberculosis.

Expats should contact their GP approximately 6-8 weeks before travel for the latest health advice and to organise vaccinations where relevant.

Common health risks in Peru include mosquito-borne illnesses, such as Dengue, Zika, Malaria and Chikungunya. To help minimise the risk, insect repellent, protective clothing, and mosquito nets should be used. There are also concerns over water and food-borne illnesses throughout the country. Hepatitis A, Typhoid and diarrhoea are also common, so expats should stick to bottled water and be wary of street food.

Due to the varying geography of Peru, respiratory illnesses such as high-altitude sickness are common in areas like Cusco, Huaraz and Arequipa. Gradual adjustment to changes in altitude, avoiding alcohol and frequent rest are advised to help combat the symptoms of soroche.