Flor de María Philipps, Superintendent of Susalud, discusses her role in ensuring that healthcare providers throughout Peru are performing to the best of their ability.
What is the main mission of Susalud?
Our mission is to protect health-related rights of Peruvians. We are a public organization under the Ministry of Health, and we are responsible for registering, authorizing, regulating and supervising the functioning of the institutions that finance health services. Susalud also supervises all public, private or mixed entities that provide health services, such as hospitals and clinics.
What are the origins of Susalud and how did you get involved?
I am a medical doctor and my specialty is in health management. In 2012 I was invited to assume the position of Superintendent of Sunasa.
However, at that time there was no organization responsible for overseeing all funders and providers of public and private health. In 2013, a major reform was established regarding health; everything in this reform is based on the constitutional premise that all Peruvians have the right to health protection in this country.
At that time, Sunasa became Susalud, an organization with authority and supervision over all agents and financiers in the public and private health sectors. Similarly, we have authority over healthcare providers. We can also exercise disciplinary powers under our legal mandate. This includes regulations, risks and safety measures for the protection of citizens’ health rights.
What priorities did you set for yourself when you became superintendent?
The first goal was to provide financial protection for all Peruvians regardless of social or financial status. Secondly, we wanted to provide more and better services, which included the construction of new and modern facilities. Thirdly, we aimed to ensure the protection of health rights of Peruvians; there are many circumstances that limit that protection. Sometimes this is the result of citizens’ ignorance or other misunderstanding; this is where the superintendent’s position becomes extremely important.
Can you describe some of the most common problems found in Susalud?
Often times, an insured patient wants to receive care, but is charged outrageous fees despite being insured. Additionally, patients with specific medical conditions often do not have medical specialists available for their problem; this increases health risks and undermines health rights. Furthermore, patients can be treated inappropriately and this could present severe or serious complications, causing illness or death.
How does Susalud ensure proper knowledge about health rights for Peruvians?
The first logical step is to publicize their rights, as well as through educational programs. The Superintendence promotes health rights through various public activities in schools, parks and other public places; this means that the more informed our citizens are, the better we can defend their rights. This organization also regularly checks that each hospital has a claims department. We also have trained healthcare professionals to solve unexpected situations; when a patient goes to any hospital in our country with a need for real help, our “delegates” will be there to make everything easier for our patients.
Another area of responsibility for Susalud is the processing of medical audits for extreme cases such as severe complications or death. We also develop public participation in all regions across the country. This is really important to us because it enriches the relationship between the citizen and the state; in other words, the power being united emanates from its citizens, who must be protected by the state.
We also have a responsibility for overseeing hospitals so that patients can be cared for in the best possible conditions. Susalud is also responsible for the supervision of fund managers to ensure proper use of funds and resources. We monitor all accounts and transactions, ensuring financial soundness in health. This is because we really want people to feel confident in the capacity of Peru’s health sector.
What will be the main challenges Susalud must face in the future?
A major challenge will be to move forward in our fight against informality in the health sector. The main idea here is that refusing service to people who are not properly registered could pose as a health threat for others, depending on the situation. We also want to be closer to citizens and help them solve their grievances, and ensure that this can be done in hospitals that are truly safe.
What are your long term goals?
We would like Susalud to be present throughout Peru and well established in the minds of all citizens. I like to think of ourselves as an organization that always works effectively, timely, fairly and with transparency. As a very young organization Susalud will mature in the coming years, and we would like the portability of services based on health insurance law in Peru to be met. Everyone should be treated with the same level of expertise regardless of where they are from. Ideally, in 2021, every Peruvian citizen will have health insurance and should have a solid grounding in their rights for health protection. This will contribute to a healthier and safer Peru.