Health insurance system fragmentation and COVID-19 mortality: Evidence from Peru

Area of Science:

• Health Economics
• Epidemiology
• Public Health Policy

Background:

• Peru's health insurance system is fragmented, limiting provider access to network-specific individuals.
• Two major sub-systems cover a significant portion of the population, with some individuals holding dual insurance.
• Dual insurance allows access to providers from both sub-systems, potentially mitigating access barriers.

Purpose of the Study:

• To investigate the impact of dual health insurance on COVID-19 mortality in Peru.
• To quantify the reduction in COVID-19 mortality risk associated with dual insurance coverage.

Main Methods:

• Utilized data from 24.7 million individuals enrolled in one or both major Peruvian health insurance sub-systems.
• Employed recursive bivariate probit models with an instrumental variable approach.
• Instrumental variable based on the difference in distance to the nearest hospital across the two insurance sub-systems.

Main Results:

• Dual insurance was associated with a 0.23% reduction in COVID-19 mortality risk.
• This represents a relative risk reduction compared to the sample mean mortality risk of 0.54%.
• An estimated 56,418 COVID-19 deaths could have been averted within the sample if universal dual insurance was implemented.

Conclusions:

• Dual health insurance in Peru demonstrably reduces COVID-19 mortality risk.
• Expanding dual insurance coverage presents a viable strategy for mitigating pandemic-related mortality.
• Policy interventions promoting dual insurance could significantly enhance public health outcomes and reduce preventable deaths.