ArticleGlobal health, science and practice2024
Budget Process and Execution: A Case Study on the Underperformance of the Peruvian Health System, 2000-2021.
Article in Global health, science and practice, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- Global Asthma Burden due to Attributable Risk Factors, 1990-2021, and Forecast to 2050: A Systematic Analysis of the Global Burden of Disease Study 2021.NPJ primary care respiratory medicine · 2026Article
- Public and Private Healthcare Service Quality in Trujillo, Peru: Evidence from a SERVQUAL Survey.Healthcare (Basel, Switzerland) · 2026Article
- Trends and Factors Associated with the Non-Use of Formal Health Services in Peru, 2015-2024.International journal of environmental research and public health · 2026Article
- Temporal costs of access to formal health care among adult users in Peru: a national analysis of inequalities in travel and waiting times, 2016-2024.Frontiers in health services · 2026Article
- Barriers to surveillance and control of re-emergence of the Chagas disease vector Triatoma infestans in Arequipa, Peru.PLoS neglected tropical diseases · 2025Article
- Impact of COVID-19 on the utilisation of maternal and child health services in Peru at national and subnational levels: An interrupted time series analysis.Journal of global health · 2024Article
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2 authors.
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Abstract
introductionHealth system financing for emerging economies with aging populations and changing epidemiological profiles is an increasing challenge. Peru, as one of the countries with the highest economic growth in this century, provides a good example for analyzing the impact of the budgeting process and the budget execution on the performance of a health system. This article aims to answer how policies and processes are the root causes of the performance gap of the Peruvian health system.
methodsWe used a case study methodology composed of 17 semistructured interviews with senior national and regional actors conducted between the end of 2021 and the beginning of 2022. Participants were selected with a combination of purposive, convenience, and snowball sampling until reaching saturation at 14 interviews. Participants' answers were grouped according to the topics explored, enabling comparisons and identification of themes.
resultsThe responses revealed that 4 interconnected influences affect the Peruvian health system. Political instability affects the sustainable development of health policies. The fiscal cycle limits the public health expenditure to a low 3% of the gross domestic product. The budget cycle is based on the low motivation of the Ministry of Health (MOH) to establish a proper budgeting process. The execution cycle represents the results of chronic underinvestment with a lack of professionals, equipment, and data affecting the access to care expressed by a high out-of-pocket share in health expenditure.
conclusionTo escape these cycles, the MOH needs to be able to argue in economic terms for the prioritization of health, showing the economic rationale for investment in health. Taxes need to finance the additional investment within the available fiscal space. The rigidity of the budget law needs to be adapted, and a technical budget that is oriented to the current and future health priorities needs to be elaborated.
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