As discussed in Chapter 1, OOP in Peru represented 29% of total health expenditure, a figure significantly above the OECD average, although similar to other LAC countries. But this does not mean that SIS, in practice, can rely on resources that are consistent with the number of its affiliates or the actuarial cost of providing benefits. In 2015, SIS’s average expenditure per affiliate was S/.82.81 (including all regimes) (equivalent to USD 31 or EUR 24), which represents a mere 23% of the estimated cost. Similar gaps between the expected cost and actual allocations to SIS have been identified almost since the inception of SIS (Prieto et al.,