How Assured Is Health in Peru? A Cross-Sectional Analysis of the 2019 National Household Survey

In Peru, disparities in medical services have been reported, but costs have not been assessed based on the different health insurance (HI) available. In this cross-sectional study, we aimed to determine the differences in the cost of consultations and medicines in Peruvians with different types of HI according to the 2019 National Household Survey (ENAHO), which is a representative dataset of the Peruvian population.

A multivariate-regression model was used to analyze the relationship between the expenditure on consultations, medicines, dental services, and other expenses and the type of HI. In this case, the type depends on the provider: (1) Social HI called "Seguro Integral de Salud" (SIS) of the Ministry of Health (MINSA); (2) ESSALUD Social Insurance; (3) Armed Forces; and (4) Private sector. Our regressions include demographic controls, and we declared the corresponding survey design to obtain correct standard errors.

A total of 15,592,649 (47.7%) and 8,159,941 (25%) people had SIS and ESSALUD, respectively. In the first quartile, 77.6% had access to HI through the SIS and 16.1% were uninsured; in the fourth quartile, only 17.3% had access to the SIS. 80% and 6% of people in rural areas have access to SIS and ESSALUD, respectively. In urban areas, there is a higher percentage of people who do not have HI (24% vs. 14% in rural areas) (p < 0.05). We found that a SIS affiliate spends an average of USD 22 (80 Soles) on consultations and USD 85 (306 Soles) on medicine. The ESSALUD affiliate spends USD 36 (130 Soles) on consultations and USD 116 (420 Soles) on medicine.

Our results showed differences in the expenditures on consultations, availability of medicines, and costs among people presenting different types of HI affiliations according to ENAHO 2019, where the SIS covers a wide range of insured persons generating high disbursements.