Institute of Analysis and Management , Lima , Peru.
Health Syst Reform. 2019;5(3):244-249. doi: 10.1080/23288604.2019.1635415.
Peru is now on a path toward achieving universal health coverage (UHC), with 87% of its population covered by health insurance. This paper describes the politics surrounding the agenda setting and policy formulation process that led up to the adoption of Peru's Universal Health Coverage Act in 2009, which has been instrumental in expanding coverage. This reform established a mandatory health insurance system, which includes an Essential Health Benefit Package (Plan Esencial de Aseguramiento en Salud-PEAS) that is financed by three health insurance schemes (subsidized, contributory and semi-contributory). Collectively these schemes are intended to cover the entire population of Peru. In exploring the politics of the health reform process, the commentary applies the Political Economy of Health Financing Framework, presented in this special issue. It does so from the point of view of a participant in the reform process. Some broader lessons emerge that extend beyond Peru regarding the changing nature of the leadership roles in each phase of the policy cycle. In particular, the analysis highlights the importance of a consensus building process across a range of political stakeholders to set the health reform on the policy agenda and as well as to preemptively identify and resolve disagreements that might arise in the legislative phase.
秘鲁现已走上实现全民健康覆盖（UHC）的道路，其 87%的人口已获得医疗保险覆盖。本文描述了围绕 2009 年秘鲁《全民健康覆盖法》的议程设置和政策制定过程的政治情况，该法在扩大覆盖范围方面发挥了重要作用。这项改革建立了强制性医疗保险制度，其中包括由三个医疗保险计划（补贴、缴费和半缴费）供资的基本健康保险计划（Plan Esencial de Aseguramiento en Salud-PEAS）。这些计划旨在涵盖秘鲁的全体人口。在探讨卫生改革过程的政治情况时，述评从改革参与者的角度应用了本特刊中提出的卫生筹资政治经济学框架。述评超越了秘鲁，提出了关于政策周期各阶段领导角色不断变化的一些更广泛的经验教训。特别是，分析强调了在一系列政治利益攸关方之间建立共识的过程的重要性，以便将卫生改革纳入政策议程，并预先确定和解决立法阶段可能出现的分歧。
