Emergency care in Peru: can a clinic refuse you if you cannot pay up front?

The sentence, because it may be all you have time to read

You are at the desk. They want a card, a deposit, or your signature on a pagaré before anyone moves. Here is what you can say, and it is written almost in those words in article 6 of Decreto Supremo 027-2015-SA:

La IPRESS está obligada a prestar dicha atención, en tanto subsista el estado de grave riesgo para la vida y la salud, no pudiendo condicionar esta atención a la presentación de documento alguno, ni a la suscripción de pagaré, letra de cambio o cualquier otro medio de pago.

IPRESS is the technical name for any facility that provides health services: a hospital, a clinic, a medical centre, a rural health post. The sentence covers the three things people actually meet at the door:

Who is bound: everyone

Article 39 of the General Health Law leaves no room:

Los establecimientos de salud sin excepción están obligados a prestar atención médico quirúrgica de emergencia a quien la necesite y mientras subsista el estado de grave riesgo para su vida y salud.

Sin excepción — without exception. Article 3 of the same law says it from the patient’s side: everyone has the right to receive emergency medical and surgical care at any health facility, for as long as the state of grave risk to life or health continues. The regulation uses the same words again: «Todos los establecimientos de salud, sin excepción».

Being a private clinic is not an exit. DS 027-2015-SA covers «cualquier IPRESS pública, privada o mixta», and DS 016-2002-SA speaks of a facility that is «público, no público o privado».

None of this depends on your nationality or your migration status. Not one of the rules cited on this page attaches that condition. If you are a foreign resident or a visitor, the obligation on the facility is identical.

What counts as an emergency, and who decides

The definition is in article 3.1 of DS 016-2002-SA:

Es la que se presta en un establecimiento de salud a los pacientes que en forma repentina e inesperada presentan alteración de la salud, poniendo en peligro inminente la vida o grave riesgo para la salud y que requiere atención y procedimientos médicos y/o quirúrgicos inmediatos, empleando los recursos de personal, equipamiento y manejo terapéutico de acuerdo a su categoría.

In short: a sudden, unexpected change in health that puts life in imminent danger or health at grave risk and needs immediate medical or surgical attention. The «estado de grave riesgo» that recurs throughout these rules is defined by the same regulation as one that puts life or health in imminent danger, or may leave disabling after-effects.

Who classifies it matters as much as the definition. Article 5 of the regulation:

La determinación de la condición de emergencia médica es realizada por el profesional médico encargado de la atención, bajo responsabilidad.

DS 027-2015-SA says it again: the emergency is determined «únicamente por el profesional médico» and, exceptionally, where there is no doctor at a first-level facility, by the clinical staff. If the person telling you this is not an emergency sits behind an admissions counter and is not a doctor, that call is not theirs to make.

Childbirth is inside this. The law that created the duty and its regulation are titled, literally, «emergencias y partos» — emergencies and births. The regulation defines parto and proceso del parto, and its article 4 adds that obstetric emergencies include care of the unborn child.

The notice that should be on the wall

The same article 4 imposes a second duty almost nobody invokes: beyond treating you, the facility must «poner en conocimiento del público ese derecho en algún lugar visible de la zona de atención por emergencia» — display this right somewhere visible in the emergency area.

If you look around and that notice is not there, you are looking at a breach of the regulation. It does not solve your emergency, but it is a concrete thing to record in your reclamo.

Treatment first, billing after — this is not free care

Worth stating plainly so nobody feels misled later. The rule bans conditioning care. It does not ban charging for it.

• Reimbursement for emergency care «se realizará en forma posterior a la atención» — after the care, not before (DS 016-2002-SA, art. 11). If there is insurance, the claim goes to the insurer; if not, to the person treated or those legally responsible for them.
• Billing starts once the person «no presente ningún riesgo para su vida o su salud» (art. 12), and from that point the patient or the family decides where treatment continues.
• DS 027-2015-SA ends the same way: once the emergency is over, the facility claims from the insurer, and where the person has no insurer it «iniciará la gestión de cobranza de los gastos por la atención de emergencia, una vez culminada la misma».

Article 40 of the General Health Law requires the facility to inform you of the economic terms of the service, but it expressly carves out of the prior-authorisation rule «la atención de emergencia destinada a enfrentar la situación que pone en peligro inminente la vida o la salud del paciente». They inform you; they do not wait for your signature to act.

Who pays nothing

The indigencia assessment is made by the facility’s social work service, or whoever stands in for it, and it happens after the emergency has been treated (DS 016-2002-SA, arts. 13 and 15). The regulation lists what gets looked at: age, education, occupation, employment status, income, household size, whether you hold any health insurance, your housing, social problems, and illnesses causing incapacity.

Asking for that assessment is your right. If a bill arrives without the social work service having seen you, ask for it in writing.

If the facility cannot handle the case

It cannot simply send you back out. DS 027-2015-SA: where the facility «no contase con la capacidad resolutiva necesaria, deberá referirlo de inmediato a un establecimiento de mayor nivel». DS 016-2002-SA adds the step before that: whoever is responsible for emergency care must secure proper medical assessment, treatment, «o la estabilización de sus condiciones generales en caso necesiten ser transferidos», and where the specialist is missing, call one in or transfer the patient under MINSA’s referral rules.

Where to complain, and where to report

Two different routes. Keep them apart.

Reclamo — to the facility itself. It is the user’s expression of dissatisfaction with the service received, and it goes in the Libro de Reclamaciones en Salud, on paper or online. The maximum time to deal with a reclamo does not exceed thirty business days counted from the day after it is received. Filing costs nothing.

Denuncia — to SUSALUD. It is the formal report of acts or omissions by the facility that may breach users’ rights. The title of DS 002-2019-SA sets the reach itself: it is the regulation on complaints and reports by users of IAFAS, IPRESS and UGIPRESS «públicas, privadas o mixtas». A private clinic is inside it. DS 002-2019-SA puts the practical point in six words: «El trámite de denuncia es gratuito».

On the sanction side, Decreto Legislativo 1158 gives SUSALUD written warnings, fines of up to 500 UIT, restriction of one or more of a facility’s services, temporary closure of up to six months, and permanent closure.

What this page does not do

It does not tell you whether your case is an emergency — a doctor classifies that. It does not reproduce SUSALUD’s schedule of infractions, so we do not claim how refusing an emergency is graded. We publish no SUSALUD phone number we could not confirm on SUSALUD’s own portal. And it does not cover any criminal route.

What if the clinic doesn’t pay the SUSALUD fine?

If your report results in a sanction against the facility, that fine can go unpaid. We explain what happens then in what happens if a clinic doesn’t pay a SUSALUD fine?.