Peru Healthcare System vs US: A Comparative Analysis

The Peru healthcare system vs US comparison comes down to money, structure and reach. The U.S. spent about $15,474 per person on health in 2024, mostly through private insurance plus Medicare and Medicaid. Peru spends far less per person, runs care mainly through public insurers (SIS and EsSalud) and still struggles to reach rural and Indigenous communities.

This guide compares the two systems side by side: how each is built, who pays, who gets care and how well people do. It keeps the case studies from our original analysis, updates the numbers to the latest official data, and ends with what pre-health students can learn by seeing Peruvian hospitals firsthand through healthcare internships in Peru.

Introduction

Healthcare systems are fundamental pillars of any society. They represent a collective effort to promote, restore and maintain the health of a population. A health system is an interconnected web of organizations, people and actions. It provides immediate care, and it also shapes the broader determinants of health. Health systems influence public policy and environmental conditions, help individuals take control of their own health and play an essential role in social well-being and economic progress.

What Is a Healthcare System?

The U.S. Agency for Healthcare Research and Quality has long used a broad definition: a health system consists of all the organizations, people and actions whose primary intent is to promote, restore or maintain health, including efforts to influence the determinants of health as well as more direct health-improving activities. The World Health Organization uses nearly the same wording. Health systems are integral to society because they protect the health and well-being of individuals, which makes them critical to overall social and economic development.

The healthcare systems in Peru and the U.S. show this clearly. Both aim to keep people healthy, yet each has distinct characteristics and challenges, and those differences are what this analysis explores.

Our Analysis and Purpose

This analysis looks closely at two very different healthcare systems: the United States and Peru. The two systems share the goal of preserving and improving health, but they have distinct characteristics, face different challenges and have developed along different paths shaped by their political history, social structure and economic circumstances.

We start with the U.S. healthcare system: its historical development, its current structure across private and public sectors, and its administration at the federal, state and local levels. As one of the most privatized and most expensive systems in the world, the U.S. is a compelling case for studying how cost, access and quality interact.

Then we move south to Peru. Peru’s effort to expand healthcare access across a country of coastal deserts, Andean highlands and Amazon rainforest offers useful lessons about how healthcare works in a middle-income economy. We cover how Peru’s system evolved, how it is organized and how it is administered. It is financed mostly through public sources, and a private sector serves people who can pay.

From there we compare the systems across five dimensions: access to care, quality of care, financing, health outcomes, and health policies and reforms. We look at differences and common ground, and at how geography, income, race, ethnicity and other factors shape access in both countries. We examine how quality is measured and why patient experience matters, explain how each country pays for care and compare key health outcomes. We also compare the major policies and recent reforms that have shaped both systems.

Real case studies support the analysis. They show how each system works for patients and providers day to day, which helps connect the theory to practice.

Finally, we summarize the key findings, explain what the differences mean, and offer recommendations for improving both systems. The goal is a clear understanding of how each country delivers care: its strengths, its challenges and what each could learn from the other on the way to better health outcomes. For pre-health students, that understanding is also practical preparation. If you plan to train in Cusco, knowing how the system works before you arrive makes every day on the wards more useful.

Peru vs US Healthcare at a Glance

The table below puts the most recent official figures side by side. Spending, insurance and outcome data come from the World Bank’s health indicators, which draw on the World Health Organization’s Global Health Expenditure Database, and from U.S. government sources.

Two things stand out. First, the U.S. spends roughly 30 times as much per person as Peru, yet life expectancy at birth in the two countries is only about one year apart, according to the World Bank’s life expectancy data. Second, Peruvians pay a much larger share of their health spending directly out of pocket, which the World Bank tracks in its out-of-pocket expenditure series. Both facts come up again throughout this comparison.

Overview of the U.S. Healthcare System

The U.S. healthcare system is complex and has many layers, shaped by a long history of political, social and economic forces. Its roots go back to 1798, when Congress created the Marine Hospital Service to care for sick and injured merchant seamen. Over the 20th century, private medical insurance spread, much of it through employers. Medicare and Medicaid were signed into law in 1965. The Affordable Care Act followed in 2010 and remains the largest reform of the 21st century so far.

Today, the U.S. system blends public and private sectors. The public sector includes federal programs such as Medicare, which covers people 65 and older and some people with disabilities, and Medicaid, which covers certain low-income adults, children, pregnant women, older adults and people with disabilities. The Children’s Health Insurance Program adds coverage for children in families who earn too much for Medicaid. The private sector is made up largely of private health insurance companies, and most working-age Americans get that insurance through an employer.

According to the Census Bureau’s Health Insurance Coverage in the United States: 2024, 92.0% of people, or about 310 million, had health insurance for some or all of 2024. Private coverage (66.1%) was more common than public coverage (35.5%), and some people had both. That left 8.0% of the population uninsured.

Administration is shared among federal, state and local governments. The federal government sets broad policy, regulates quality and safety, funds medical research through agencies such as the National Institutes of Health and pays for Medicare. State governments run their Medicaid programs within federal rules, regulate private insurance and oversee public health. Local governments, usually through county and city health departments, run public health work such as disease surveillance, immunization clinics and restaurant inspections.

Overview of the Peru Healthcare System

Peru’s healthcare system, like the U.S. system, reflects its own history, politics and society. In the early 20th century, care in Peru came mostly from charitable institutions and the state. Over the second half of the century, the government tried several times to extend coverage, first through social security for formal workers and later through public insurance for poor families. Those efforts led to the Universal Health Insurance Framework Law (Law 29344) in 2009, which set the goal of covering every resident.

Today, Peru’s system has public and private sectors, and the public side is split into several subsystems:

• The Ministry of Health (MINSA) and regional governments run the public network of health posts, health centers and hospitals. Most people who use this network are covered by the Seguro Integral de Salud (SIS), Peru’s public health insurer.
• EsSalud, Peru’s social health insurance, covers workers in formal employment and their families through its own hospitals and clinics. It is financed mainly by employer contributions of 9% of a regular worker’s pay under Law 26790.
• The Armed Forces and the National Police run separate health services for their members and families.
• The private sector, including for-profit clinics and nonprofit providers, serves people who can pay directly or who have private insurance.

SIS is now open to anyone living in Peru who has no other health insurance. According to Peru’s government portal, the SIS plans cover medicines, procedures, surgeries, supplies and emergency transport, and cover more than 12,000 diagnoses, including several types of cancer. There are five plans: SIS Gratuito for people living in poverty or extreme poverty, pregnant women, children and other groups set by law; SIS Para Todos for anyone without insurance regardless of income; and three low-cost plans for independent workers, microbusiness owners and their employees, and self-employed people.

Administration happens at several levels. MINSA sets national policy, regulates quality and runs national programs. Since decentralization in the 2000s, regional governments manage most public health services through regional health directorates (often called DIRESA or GERESA), and local health networks deliver primary care through health posts and centers. For a student, this means a public hospital in Cusco answers to the regional government of Cusco as well as to national rules from MINSA.

Comparative Analysis: Access to Care

Access to healthcare is one of the most important measures of how well a system works, and it is a significant issue in both the U.S. and Peru. The U.S. has some of the most advanced medical care in the world, but access varies widely. Geographic location, income, insurance coverage and race all affect whether a person can get the care they need. The Census Bureau’s 2024 report shows how much state policy matters: uninsured rates differ widely from state to state, and adults ages 19 to 64 are far more likely to be uninsured than children or older adults.

Peru faces similar challenges in a different form. Peru has made major progress in extending insurance coverage, but disparities in access remain, especially in rural and Indigenous communities. Geography, income and ethnicity all affect access. Many rural areas have too few facilities and too few staff, and travel to the nearest hospital can take hours over mountain roads. The national averages also hide large regional gaps: Peru had about 1.7 physicians per 1,000 people in 2023, according to the World Bank’s physician density data, and doctors are concentrated in Lima and other cities.

Coverage and access are not the same thing. A person in Peru can be enrolled in SIS and still face long waits, a health post with no doctor that day or a referral to a hospital several hours away. A person in the U.S. can have insurance and still delay care because of a high deductible. Both countries continue working to close these gaps as they pursue universal health coverage.

What Shapes Access in Each Country?

• Geography. In the U.S., rural hospital closures and long distances to specialists limit access in parts of the country. In Peru, the Andes and the Amazon make some communities reachable only by long road trips, river travel or small planes.
• Insurance status. In the U.S., about 8% of people were uninsured in 2024. In Peru, most residents are now covered by SIS, EsSalud or another plan, but coverage does not guarantee a nearby provider.
• Income. Cost-sharing in the U.S. and out-of-pocket spending in Peru both keep lower-income families from using care they need.
• Language and culture. Many Peruvians speak Quechua, Aymara or Amazonian languages, and Spanish-only services can be a barrier. In the U.S., limited English proficiency creates similar problems for millions of patients.

Comparative Analysis: Quality of Care

Quality of care means providing health services that are effective, safe, patient-centered, timely, efficient and equitable. Those six aims come from the Institute of Medicine’s 2001 report Crossing the Quality Chasm and are still used by AHRQ and health systems around the world. Quality is an essential indicator of a healthcare system’s performance.

The U.S. is known for advanced medical technology and facilities and is a global leader in medical innovation. But quality varies widely from place to place, and the U.S. often underperforms other high-income countries on overall measures. In the Commonwealth Fund’s Mirror, Mirror 2024 comparison of 10 high-income countries, the U.S. ranked last overall, even though it ranked second in the care process domain thanks largely to preventive services such as mammograms and screenings.

In Peru, the quality of healthcare can differ sharply between urban and rural areas. Cities generally offer better care with more advanced facilities and specialists, while rural areas often lack equipment, medicines and health professionals. Quality can also vary by insurer and by ability to pay. EsSalud hospitals, MINSA hospitals and private clinics can offer noticeably different experiences in the same city.

How Quality Is Measured

Both countries measure quality in similar ways: rates of avoidable deaths, infection rates, readmissions, waiting times and patient experience surveys. The U.S. publishes hospital quality data through Medicare’s Care Compare tools. Peru’s health authorities track waiting times, medicine availability and patient complaints, and Peru’s health insurance regulator, SUSALUD, handles patient complaints about insurers and providers. Patient satisfaction matters in both places because people who trust their providers are more likely to seek care early and follow treatment plans.

Comparative Analysis: Financing

Healthcare financing covers the ways a country pays for care: insurance premiums, taxes, payroll contributions and out-of-pocket payments. The mix of these sources affects how affordable and accessible care is, and it reflects a country’s policy priorities and economic conditions. The U.S. and Peru finance their systems in very different ways.

United States: Private-Public Mix with High Out-of-Pocket Costs

In the U.S., individuals, employers and government share the cost of healthcare, and private funding plays a large role.

According to the CMS National Health Expenditure fact sheet, U.S. health spending grew 7.2% to $5.3 trillion in 2024, or $15,474 per person, and accounted for 18.0% of GDP. Private health insurance spending reached $1,644.6 billion (31% of the total), Medicare $1,118.0 billion (21%), Medicaid $931.7 billion (18%) and out-of-pocket spending $556.6 billion (11%).

Private insurance, mostly employer-sponsored, is the most common form of coverage. These plans usually include cost-sharing, such as deductibles, copayments and coinsurance, which means individuals pay a substantial part of their healthcare costs directly. The idea behind cost-sharing is to encourage careful use of healthcare services. In practice, high out-of-pocket costs can be a serious financial burden for many Americans and can lead people to skip or delay care they need.

Government programs cover specific populations. Medicare covers people 65 and older and certain people with disabilities. It is funded by payroll taxes, premiums and general federal revenue. Medicaid is a joint federal and state program for certain low-income people, paid for by both levels of government.

Even with these public programs, the U.S. stands out for its spending. It has one of the highest levels of health spending per person in the world, far above other high-income countries, as the Commonwealth Fund showed in U.S. Health Care from a Global Perspective, 2022. That level of spending raises real concerns about affordability and about financial barriers to necessary care.

Peru: Public and Private Funding with a Focus on Universal Coverage

Peru finances healthcare very differently. It mixes public and private funding and puts strong emphasis on extending universal coverage.

The public sector carries most of the cost. About 64% of Peru’s health spending came from government sources in 2023, according to the World Bank’s government health expenditure data. MINSA facilities and SIS are funded mainly through general taxes. SIS pays for care for people who have no other insurance, with free coverage for the poorest and most vulnerable. EsSalud covers formally employed workers and their families and is financed through payroll contributions paid by employers.

The private sector is smaller than the public sector but still important, especially for middle- and higher-income families. Private financing comes mostly from out-of-pocket payments and private insurance premiums. Private clinics often offer shorter waits and more comfortable facilities, but at a higher cost, which limits access for people with lower incomes.

Peru’s overall healthcare costs are far lower than those of the U.S. Peru spent about 5.6% of GDP on health in 2023, compared with 16.7% in the U.S. by the same World Bank measure, as shown in the World Bank’s health expenditure data. But a large share of Peru’s spending is still paid directly by patients. Out-of-pocket payments made up about 27% of Peru’s health spending in 2023, compared with about 11% in the U.S. These direct costs are a real financial challenge for many Peruvian families, especially when public facilities run short of medicines and patients have to buy them at private pharmacies.

Financing Side by Side

In short, the U.S. and Peru take different approaches to healthcare financing, reflecting their different structures, policy choices and economic conditions. Those differences affect how affordable care is, who can access it and, ultimately, health outcomes in each country.

Comparative Analysis: Health Outcomes

Health outcomes, including life expectancy, infant mortality and the burden of disease, are key indicators of how well a healthcare system works.

Despite the highest health spending in the world, the U.S. lags behind many other high-income nations on several outcomes. It has lower life expectancy, higher infant and maternal mortality, and higher rates of avoidable deaths than most peer countries. The Commonwealth Fund’s 2024 comparison found that U.S. health outcomes were the worst of the 10 countries it studied. High spending does not automatically produce better health.

Peru’s health outcomes have improved substantially over recent decades. Life expectancy has risen and infant and maternal deaths have fallen. By World Bank figures, Peru’s life expectancy at birth reached 77.9 years in 2024, close to the U.S. figure of 78.9 years. Gaps remain on other measures. Peru recorded 11 infant deaths per 1,000 live births in 2024, double the U.S. rate of 5.5, according to the World Bank’s infant mortality data. Peru’s maternal mortality ratio of 51 deaths per 100,000 live births in 2023 was three times the U.S. ratio of 17.

Outcomes in Peru also vary widely between urban and rural areas and among income groups. Many rural and underserved communities still face infectious diseases, anemia and child undernutrition, and maternal and child health problems. In the highlands, conditions linked to altitude and cold, such as respiratory infections in children, add to the burden. Tuberculosis also remains a significant public health problem in parts of the country.

What the Outcome Gap Tells Us

Comparing outcomes this way has limits. Life expectancy reflects diet, income, violence, road safety and many other factors outside the health system. Still, the comparison makes one point clearly: Peru reaches nearly the same life expectancy as the U.S. while spending a small fraction as much per person, and the U.S. gets less health per dollar than any comparable country. At the same time, Peru’s higher infant and maternal mortality shows where more investment in primary care, skilled birth attendance and rural services would make the biggest difference.

Comparative Analysis: Health Policies and Reforms

Health policies and reforms show how seriously a country is working to improve its system and what strategies it uses. Both the U.S. and Peru have passed major reforms in recent decades, with different approaches shaped by their health systems and economies.

United States: The Affordable Care Act

In the U.S., the Affordable Care Act (ACA), signed into law in March 2010 under President Obama, is one of the most significant health policy reforms in recent history. Its main goals were to:

• Extend health insurance coverage to millions of uninsured Americans,
• Control rising healthcare costs, and
• Improve healthcare quality and efficiency.

The ACA expanded Medicaid and created health insurance marketplaces with income-based subsidies, which opened coverage to many low- and middle-income people. It let young adults stay on a parent’s insurance plan until age 26 and required insurers to cover people with pre-existing conditions. After a 2012 Supreme Court decision, Medicaid expansion became optional for states. According to KFF’s tracker of state Medicaid expansion decisions, 41 states (including DC) have adopted the expansion and 10 have not.

To control costs, the ACA introduced value-based purchasing programs that reward providers for quality and efficiency rather than volume alone. It also created accountable care organizations, which encourage doctors, hospitals and other providers to coordinate care and share in the savings when they keep patients healthy at lower cost.

The ACA has faced political opposition, repeated legal challenges and ongoing debate about how well it works. It has clearly increased the number of insured Americans. Still, the U.S. system continues to struggle with high costs, and disparities in access and quality remain.

Peru: The Universal Health Insurance Law

Peru’s healthcare landscape has been shaped by the Universal Health Insurance Framework Law of 2009 (Law 29344). The law reflects a commitment to health as a fundamental right and aims to guarantee all Peruvians access to quality health services regardless of income or ability to pay.

To reach that goal, the law built on SIS, the public insurer that targets the poorest and most vulnerable people with subsidized or free coverage, and defined a basic package of guaranteed benefits that every insurer must cover. It also supported efforts to decentralize health services so that regions could manage care closer to the communities they serve. In 2019, an emergency decree (Decree of Urgency 017-2019) went further and allowed SIS to enroll every resident without health insurance, regardless of income, which is the origin of today’s SIS Para Todos plan.

Reaching universal health coverage in Peru remains difficult. The main obstacles are extending real access to rural and hard-to-reach areas, improving the quality of care and keeping the system financially sustainable. Even so, the Universal Health Insurance Law has moved the country firmly toward health equity.

In both the U.S. and Peru, these reforms show a shared commitment to improving access, affordability and quality. They also show the distinct challenges each country faces on the way to health equity and universal coverage. Future reforms will need to build on these foundations and adapt to new and continuing health challenges.

Case Studies

The case studies below come from our original analysis. We have kept each one and updated the details so they match the sources they come from.

Case Study 1: U.S. Healthcare System

The Commonwealth Fund’s Mirror, Mirror report compares the health systems of high-income countries, including the U.S. The 2014 edition compared 11 countries and found that the U.S. had the most expensive system but performed poorly on health outcomes and equity. The 2024 edition, which compared 10 countries, reached the same overall conclusion: the U.S. ranked last. Across both editions, the U.S. case shows how complex healthcare delivery is and why many experts call for systemic reform.

#### Context and Background

The U.S. healthcare system is one of the most expensive in the world, with per capita spending far higher than in other developed countries. Despite those costs, the country struggles with disparities in health outcomes, service quality and access to care.

#### U.S. Performance in a Global Context

The 2014 report ranked the U.S. last overall among 11 countries on quality, efficiency, access, equity and healthy lives. The 2024 update scored 70 measures across five areas (access to care, care process, administrative efficiency, equity and health outcomes) and again placed the U.S. last overall, even though the U.S. ranked second on care process, which covers prevention, safety and coordination. Access to primary care and equity across population groups drove much of the low ranking in both reports.

#### Challenges and Inequities

A central finding is that high spending has not bought high performance. High out-of-pocket costs and high insurance costs create significant financial barriers to care. Inequities are wide: lower-income people and people with health problems are more likely to skip needed care because of cost.

Efficiency is another weak point. The 2024 report found that the U.S. and Switzerland came in last on administrative efficiency, with patients and doctors spending more time on paperwork and billing disputes than in the top-performing countries. Earlier editions also pointed to avoidable emergency room use and duplicated medical tests.

Taken together, Mirror, Mirror gives a stark overview of the U.S. system’s challenges. Despite its high spending, the U.S. lags behind comparable countries, which underscores the urgency of improving access, efficiency and equity.

Case Study 2: U.S. Healthcare System

A second U.S. case comes from J. Michael McWilliams’s review Health Consequences of Uninsurance among Adults in the United States: Recent Evidence and Implications, published in The Milbank Quarterly in 2009. Our original article attributed it to “Williams” and described it as a Detroit study; it is in fact a systematic review of research published since 2002 on how insurance coverage affects adult health.

#### Context and Background

The review starts from an Institute of Medicine finding from 2002: uninsured adults in the U.S. have less access to recommended care, receive poorer quality of care and have worse health outcomes than insured adults. McWilliams asked whether newer, more rigorous studies supported that conclusion.

#### Impact

The answer was yes. Recent studies using stronger quasi-experimental designs found consistently positive and often significant effects of health insurance on health across a range of outcomes. The benefits were clearest for adults with acute or chronic conditions that have effective treatments, such as heart disease, diabetes and high blood pressure. Without insurance, many lower-income adults delay or skip care, which leads to worse health and deepens existing inequities.

#### Challenges

The review concluded that the health consequences of uninsurance are real and that they strengthen the case for universal coverage in the U.S. Its findings also raise questions that remain relevant after the ACA: whether coverage is adequate and fair for lower-income people, and what happens to people who remain uninsured, many of whom live in states that did not expand Medicaid.

The case adds to the policy discussion in the U.S. by showing that coverage alone is not the goal. Policies need to make sure coverage turns into real access to care for everyone, regardless of income. Addressing these disparities is essential to improving the health of the whole population and achieving health equity.

This case highlights the need for reforms that guarantee access for the most vulnerable people. It also points beyond insurance to the social determinants of health, such as housing, food security and income, that shape outcomes in low-income communities.

Case Study 3: An Extended Stay (U.S. Healthcare, Hilliard, 2010)

This teaching case from the Institute for Healthcare Improvement (IHI) Open School follows Mr. Londborg, a 64-year-old man with several health problems who was admitted to the hospital for shortness of breath. His care team treated a COPD exacerbation and sent him home. The next day he was readmitted with a blood clot in his leg. The team started blood thinners, but a medication he already took, levetiracetam, which prevents seizures, was not given. That night he had a seizure and fell out of bed. A nurse found him and he was taken for emergency evaluation. The seizure was traced to the missed levetiracetam, and his hospital stay was extended by several days.

The case identifies several system failures that led to Mr. Londborg’s extended stay:

• The care team did not communicate effectively about his medication needs.
• The automated medication dispensing system did not have all of his medications in stock.
• The nurses did not notify the physicians or the pharmacy when a medication was not available.

The case then discusses how to prevent these failures:

• The care team should use a standardized process for communicating about medication needs.
• The automated dispensing system should be stocked with all commonly used medications.
• Nurses should be trained to notify physicians and the pharmacy when a patient’s medication is not available.

An Extended Stay shows how much patient safety depends on communication and medication management. Each failure on its own might have been caught. Together, they turned a routine readmission into a seizure, a fall and several extra days in the hospital.

The first failure was a breakdown in communication within the care team about what Mr. Londborg needed. That gap led to the omission of a critical medication, levetiracetam, and ultimately to the seizure. The second was a dispensing system that was not stocked with everything he required, which slowed the team’s ability to treat him on time. The third was that no one alerted the physicians or the pharmacy when the medication was missing, so the problem went unnoticed until harm occurred.

The recommendations follow directly. A standardized process for communicating medication needs helps every provider know what a patient requires. Keeping the dispensing system stocked with commonly used medications reduces the risk of a dose being unavailable. Training nurses to escalate medication problems promptly gives physicians and pharmacists the chance to act before a patient is harmed.

In the broader discussion of health systems, this case shows that patient safety and quality depend on system design, not just individual skill. Strong communication channels, medication management protocols and training help prevent adverse events and improve outcomes. Fixing these system failures improves safety, reduces readmissions and makes better use of hospital resources.

It is also a useful case for students heading abroad. Medication reconciliation, handoffs and escalation are universal problems. In Peru, as in the U.S., the questions are the same: who checks the medication list, what happens when a drug is out of stock, and who tells whom.

Case Study 4: On Being Transparent (Griner, 2005)

On Being Transparent is a reflection by Paul Griner, MD, a physician and former hospital leader, used in IHI Open School teaching materials. It describes how a hospital’s leaders responded after a patient died from a medical error: by disclosing the error openly, to the family and to the public, rather than keeping it quiet.

Choosing transparency was not easy. It exposed the hospital to criticism and legal risk. But the leaders believed it was the right thing to do. They wanted the family to know the full truth and to see that the hospital took responsibility. They also wanted to send a clear message to their own staff that errors would be reported, studied and fixed, not hidden.

The case discusses the benefits of transparency in healthcare. Transparency builds trust between patients and providers, and it helps hospitals find and fix the system problems that lead to errors.

In the context of health systems more broadly, the case shows why transparency is central to patient safety and quality improvement. By being open, hospital leaders can build trust between patients and clinicians, which supports patient-centered care and honest communication with families.

The case also shows how transparency helps uncover system problems. By acknowledging a mistake openly and explaining what the hospital is doing to prevent it from happening again, leaders create a culture of learning and continuous improvement. Modern patient safety work calls this a just culture: people are accountable, but the focus is on fixing systems rather than blaming individuals, so staff feel safe reporting errors and near misses.

For the comparison between Peru and the U.S., the case shows that transparency is a key element of good healthcare delivery in any country. The case focuses on one hospital, but its principles apply across very different systems.

Transparency is a common thread in our recommendations for both countries. In the U.S., efforts to improve access and affordability should come with clear communication about policies, coverage options and their limits, including price transparency so patients know what care will cost. In Peru, transparency can help address disparities and ensure fair access, especially in underserved and remote areas, for example by publishing waiting times, medicine stock levels and complaint outcomes.

By promoting transparency, both countries can strengthen relationships between patients and providers, improve patient safety and drive continuous quality improvement. On Being Transparent is a useful reminder of how much openness can improve patient outcomes and the overall functioning of a health system.

Case Study 5: Peru Healthcare System

For Peru, a relevant case comes from Social Exclusion and Universal Health Coverage: Health Care Rights and Citizen-Led Accountability in Guatemala and Peru by Jeannie Samuel, Walter Flores and Ariel Frisancho, published in 2020. Our original article gave it a different title. The study examines how socially excluded groups, especially Indigenous peoples, experience Peru’s push for universal coverage.

#### Context and Background

From the 2000s, Peru set out to achieve universal health coverage. At the center of that reform was SIS, the publicly funded insurer created to cover the poor and vulnerable, particularly people in rural areas who historically had little access to care. In 2009, the Universal Health Insurance Law expanded and deepened that coverage. The study notes that even with these expansions, Peru’s government health spending per person in 2015 was still lower than that of at least 18 other countries in the Americas.

#### The Impact of Universal Insurance

The study’s Peru case centers on Puno, a mountainous and predominantly Indigenous region in the south. In 2007, a citizen monitoring initiative began there, growing in part out of research on maternal deaths in the region. Trained community volunteers, mostly Indigenous women, took regular shifts at local health posts, health centers and hospitals. They documented problems and brought complaints to health officials in joint meetings. The regional SIS office and the local Human Rights Ombudsman’s office became partners and helped train the monitors.

Expanded insurance did make a difference. Enrollment in SIS grew quickly, and coverage reduced some financial barriers to care. The authors’ central finding, however, is that rights on paper did not always reach the people who needed them most.

#### Challenges in Implementation

The monitors in Puno documented illegal charges for services that SIS was supposed to cover, denials of service, missing medicines and equipment, cultural insensitivity, discrimination and abuse. The authors concluded that funding and coverage had expanded, but marginalized Indigenous populations still did not receive either the services or the financial protection the system promised. They argue that universal coverage efforts cannot stop at financing. They must also make public health institutions more accountable to the communities they serve.

The case gives a detailed picture of Peru’s universal insurance reform and its limits. It confirms that financial protection is essential to access, and it highlights the persistent challenges: extending real coverage to everyone, overcoming geographic and cultural barriers and improving the quality and respectfulness of care.

Case Study 6: Peru Healthcare System

The World Bank’s Universal Health Coverage Study Series includes Peru among the countries working toward universal health coverage. The Peru case shows how a middle-income country expanded access over time, with a strong focus on maternal and child health. It also points to persistent challenges, such as inequalities in health outcomes and access, especially in rural and Indigenous communities.

#### Context and Background

Peru has made considerable progress in expanding access to healthcare. It focused much of its effort on maternal and child health, on the principle that healthy mothers and children build a stronger, more productive society. Those efforts brought clear gains, including lower maternal and child mortality and higher immunization coverage.

#### Universal Health Coverage Efforts

Central to Peru’s progress has been the creation and expansion of SIS, the publicly funded insurer for the poor and vulnerable. Together with other health sector reforms, SIS has extended access and provided financial protection to Peruvians who otherwise could not afford care.

Peru has also worked to fold vertical health programs, which focus on a single disease or population group, into a more coordinated system. That integrated approach makes more efficient use of resources and improves continuity of care for patients.

#### Challenges and Opportunities

Despite these gains, the World Bank’s case highlights continuing challenges. Inequalities in outcomes and access remain a major concern. Rural and Indigenous communities face significant barriers to care because of geography, culture and income.

And while SIS has expanded coverage, many Peruvians still face high out-of-pocket costs. Reducing those financial barriers is essential if Peru is to achieve true universal coverage.

The case points to several opportunities: strengthening care delivery in rural and underserved areas, continuing to expand insurance coverage and improving the quality of care. It also stresses the need for targeted programs that address health disparities and promote equity.

Case Study 7: Universal Health Coverage

The World Bank’s broader work on universal health coverage collects lessons from many countries, including Peru, and is useful for understanding both the effort required and the obstacles involved. Its country summary for Peru describes how Peru set out to close historical gaps in coverage and what it is doing now to improve access.

The World Bank’s Peru work looks at how the country has tried to extend care to everyone, particularly people who have historically been underserved.

#### Context and Background

Peru’s healthcare system has long been highly fragmented. Several separate entities provide care: MINSA and regional governments, EsSalud, the Armed Forces, the National Police and the private sector. Fragmentation, combined with the difficulty of delivering care across a varied and often remote landscape, has led to uneven access and very different health outcomes across regions and populations.

#### Universal Health Coverage Efforts

In response, Peru passed the Universal Health Insurance Law in 2009, a major policy shift toward universal coverage. The law calls for health coverage for all Peruvians regardless of income and relies on SIS to cover the poorest and most vulnerable groups.

Peru has also worked to coordinate its many providers, aiming to reduce fragmentation and improve efficiency and quality. In particular, the government has focused on strengthening primary care, which promotes health, prevents disease and serves as the entry point to the rest of the system.

#### Challenges and Opportunities

Peru’s path to universal coverage still has obstacles. The World Bank notes that coverage does not always translate into access, especially in remote areas without enough facilities or health workers. Quality also remains a major issue, with wide variation across providers and regions.

The World Bank also stresses financial protection. SIS has reduced the financial burden for the poorest groups, but out-of-pocket payments remain high for many others. Those payments are a barrier to care and a risk of financial hardship.

These challenges are also opportunities. Peru can keep investing in facilities and the health workforce, particularly in underserved areas. It can improve quality through health sector reforms and stronger health information systems that track quality and outcomes.

The World Bank’s work on Peru offers valuable insight into the country’s path toward universal health coverage. It shows that coverage alone is not enough: access, quality and financial protection all matter for health equity. It also illustrates a challenge many countries share. Delivering care to every citizen takes sustained commitment, investment and new policy ideas.

Taken together, these case studies show the strengths and weaknesses of each country’s system and the continuing efforts in both to improve health outcomes and equity.

What Students Can Learn by Seeing Peru’s System Firsthand

Reading about two health systems is useful. Watching one work is different. IMA’s healthcare internships in Peru place interns in major hospitals in Cusco, across multiple specialties, with departments that vary by cohort and by each intern’s level of training. Interns gain clinical and direct patient care hours through hospital rotations and outreach programs, including hygiene education and community medical clinics. Licensed clinicians supervise them throughout. The program also includes clinical simulation sessions and global health lectures on the Peruvian healthcare system and how it differs from the U.S. model of care delivery.

Under that supervision and within their training level, IMA interns take part in direct patient care: taking vital signs, helping with patient intake and triage, conducting basic patient interviews and assisting with noninvasive tasks. They do not diagnose, prescribe or perform invasive procedures. That combination of real responsibility and clear limits is exactly what makes the system comparison concrete. You see where patients wait, which medicines are in stock and how a referral moves from a health post to a regional hospital.

If you are weighing where to train, our guide to pre-med internships abroad compares IMA’s programs, and our analysis of public vs private hospitals in Peru explains what each setting offers a pre-med intern.

Questions to Ask While You Are There

• How is this patient insured: SIS, EsSalud, private insurance or none?
• What happens when a medicine on the prescription is out of stock?
• How are patients referred from rural health posts to this hospital, and how long does that take?
• Which conditions does this department see most often, and how does that compare with a U.S. hospital?
• How do clinicians communicate with patients who speak Quechua or another Indigenous language?
• How are medication errors and near misses reported here?

Write your answers down each day. Those notes become the specific, honest material that admissions readers look for later, and they help you avoid generalizations about a system you only saw for a few weeks.

How to Prepare Before You Go

• Learn the basics of medical Spanish. Even simple greetings and questions help you follow patient conversations. Our list of medical Spanish phrases for interning in Peru is a good place to start.
• Read up on the regional caseload. Our guide to conditions IMA interns see by region explains what is common in Peru compared with Kenya.
• Plan for altitude and travel health. Cusco sits high in the Andes. Check the CDC’s travel health guidance for Peru and talk to your doctor before you travel.
• Know the program’s safety support. IMA has maintained a 100% safety record for all high school and pre-health interns, and its program safety and security page explains the support in place on site.
• Prepare your mindset. Our guide to preparing for a pre-med program in Peru covers practical steps, and our overview of ethical global health internships explains how to learn from a host system respectfully.

Conclusion

Comparing the healthcare systems of the U.S. and Peru shows that both mix public and private sectors, and each faces distinct challenges rooted in its history, politics and economy.

The U.S. system has evolved over more than two centuries and remains complex and uneven. It offers some of the most advanced medical technology and facilities in the world, yet access and affordability are serious problems. High spending has not produced better outcomes: Americans have lower life expectancy, higher infant and maternal mortality and more avoidable deaths than people in comparable countries. Geography, income and race strongly influence who gets care and how well they do.

Peru’s system has fewer resources but has made considerable progress in extending coverage and improving outcomes. It now reaches nearly the same life expectancy as the U.S. at a small fraction of the cost. Still, disparities persist, especially among rural and Indigenous communities, and geography, income and ethnicity strongly affect access to care and health outcomes.

On financing, the U.S. relies heavily on private insurance alongside large public programs, and patients face significant out-of-pocket costs through deductibles and copays. Peru spends far less overall and relies on a blend of public funding, social insurance and out-of-pocket payments, which still make up more than a quarter of its health spending.

On policy, the U.S. Affordable Care Act set out to extend coverage and control costs, while Peru’s Universal Health Insurance Law set out to guarantee every resident access to quality health services.

The case studies add real-world detail to these patterns, from hospital medication errors and the value of transparency in the U.S. to citizen monitors in Puno holding Peru’s public system to its promises.

These differences matter for policy and reform. In the U.S., the infrastructure is strong, and the main challenge is making care accessible and affordable for every resident regardless of income. In Peru, the priority is strengthening facilities and the health workforce, especially in rural areas, and meeting the needs of the most vulnerable people.

Based on this comparison, we offer several recommendations. For the U.S., policy could focus on access and affordability through expanded public funding, stronger regulation of private insurance and programs that reduce health disparities. For Peru, priorities include continued progress toward universal coverage, investment in rural facilities and staff, and targeted programs to address health inequities.

In conclusion, each country can learn from the other’s successes and challenges. Those lessons can guide ongoing efforts to improve both systems and promote health equity. The goal is the same in Lima and in Los Angeles: every person, whatever their circumstances, should have access to high-quality, affordable healthcare.

Frequently Asked Questions

What Is the Main Difference Between the Peru and US Healthcare Systems?

Scale and structure. The U.S. spends about $15,474 per person and relies mostly on private insurance plus Medicare and Medicaid. Peru spends far less per person and covers most residents through public insurers, mainly SIS and EsSalud, though patients pay a larger share of costs out of pocket.

Does Peru Have Universal Healthcare?

Peru has a legal goal of universal coverage under the Universal Health Insurance Framework Law of 2009. Since 2019, SIS can enroll any resident who has no other health insurance. Access still varies widely, especially in rural and Indigenous communities.

What Is SIS in Peru?

SIS, the Seguro Integral de Salud, is Peru’s public health insurer. It covers people without other insurance, with free coverage for people living in poverty, pregnant women and children, and low-cost plans for independent workers and small businesses.

What Is EsSalud?

EsSalud is Peru’s social health insurance for workers in formal employment and their families. It runs its own hospitals and clinics and is financed mainly by employer contributions of 9% of a regular worker’s pay.

How Does Life Expectancy in Peru Compare With the US?

They are close. World Bank data put life expectancy at birth at 77.9 years in Peru and 78.9 years in the U.S. in 2024, even though the U.S. spends roughly 30 times as much per person on health.

Which Is Better, Public or Private Hospitals in Peru?

It depends on what you need. Public hospitals see a wide range of conditions and patients, while private clinics often have shorter waits and newer equipment. Our guide to public vs private hospitals in Peru compares them for pre-med interns.

What Do IMA Interns Do in Peru’s Hospitals?

Under the supervision of licensed clinicians and within their training level, IMA interns in Cusco rotate through hospital departments, take part in direct patient care such as vital signs, intake and patient interviews, and join outreach programs and community clinics. They do not diagnose, prescribe or perform invasive procedures.