EsSalud ratings affirmed at BBB as Fitch maintains stable outlook in Peru

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EsSalud rating affirmed by Fitch

Highlights

Fitch affirmed EsSalud's Long-Term Foreign and Local Currency IDRs at 'BBB' with Stable Outlook, aligned with Peru's sovereign rating outlook as of June 2024.
Preliminary 2025 statements show marginally negative EBITDA, but Fitch projects gradual EBITDA margin improvement and marginally positive figures by end of rating horizon.
EsSalud covers about 37% of Peru's population, with PPP payment obligation defaults potentially impacting Peru's PPP market and future infrastructure investment appetite.

Rating support framework and financial profile

As reported by Fitch Ratings, Seguro Social de Salud del Peru, known as EsSalud, has its Long-Term Foreign and Local Currency Issuer Default Ratings affirmed at 'BBB' with a Stable Outlook, mirroring Peru's sovereign rating outlook.

The rating agency says the IDRs are driven by a Government-Related Entity support score of 50, indicating a virtually certain likelihood of extraordinary support from the Peruvian sovereign if needed. Fitch assesses EsSalud's Standalone Credit Profile at 'bbb', but says that measure does not drive the issuer ratings and has limited relevance to the overall assessment.

Fitch says EsSalud's preliminary 2025 financial statements show marginally negative EBITDA, while preliminary 2024 data had also pointed to negative EBITDA before audited accounts later showed a positive result. Because of that pattern, the agency says it views the 2025 preliminary figures with caution and projects EBITDA margins will gradually improve and remain marginally positive by the end of the rating horizon.

EsSalud's financial profile remains assessed in the 'aa' category, supported by low net adjusted debt and the absence of direct debt, with obligations mainly tied to public-private partnership payments. Fitch projects net adjusted debt to EBITDA at 2.6x by 2030, debt service coverage at 1.4x to 2.0x, and gross interest coverage at 1.0x to 2.0x over the 2026 to 2030 rating case horizon.

State linkages and healthcare system implications

EsSalud provides essential healthcare services to formal-sector workers, pensioners and eligible dependents within Peru's social security system, with revenue derived mainly from mandatory employer-paid social security contributions. Fitch says that policy role, together with EsSalud's coverage of about 37% of Peru's population, supports a very strong assessment of its importance to public healthcare delivery.

The agency also points to close ties with the Ministry of Labor and Employment Promotion and the Ministry of Health, while noting that EsSalud's autonomy is relatively limited. Peru's central government oversees its budget through FONAFE, appoints its executive director and sets the social security contribution rate that serves as the entity's main revenue source.

Fitch adds that EsSalud has indirectly incurred debt through PPP arrangements for hospitals and medical distribution centers in metropolitan Lima. A default on those payment obligations could have significant repercussions for Peru's PPP market and weaken investor appetite for future strategic infrastructure projects.

Previously, we examined how geopolitical shocks and higher fiscal spending are straining sovereign ratings in emerging markets.

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