Inequality in the distribution of resources and health care in the poverty quintiles: Evidence from Peruvian comprehensive health insurance 2018-2019

Introduction: In many regions of the world, healthcare is inequitable and limited, affecting poor populations who need greater health opportunities. Given that Peru's comprehensive health insurance (SIS) seeks to enhance its coverage for the entire population, it is important to know if its coverage benefits the poorest populations. Objectives: To determine the allocation of SIS resources and care to the poorest quintile during 2018 and 2019 in Peru. Methods: We conducted a secondary analysis of data from five Peruvian technical institutions. In 39,8207 Peruvian households, we analyzed the per capita budget assigned to the population affiliated with SIS in microregions of quintile 1 and quintile 2 (poor), and quintile 4 and quintile 5 (non-poor), health coverage, and the level of poverty considering the human development index (HDI) and the regional competitiveness index (RCI). Results: The poorest regions are inversely correlated with HDI and RCI and have an average service of 25.0% affiliates. In poor areas, the allocated budget was lower (approximately $303,000 to $2.2 million), but the proportion of members requiring care was higher (>70.0%). The budget allocated to health was unfair (p<0.05) between poor areas (maximum resources from $96.28 to $108.14) and non-poor areas (maximum resources from $150.00 to $172.43). Low budget allocations and low household per capita income contributed to poverty in quintile 1 and quintile 2 (p<0.01). Conclusions: the poorest regions have greater inequity and the majority of affiliates do not use or do not have access to SIS services, but they have a greater need for health care. In addition, poor regions have a high amount of population without SIS coverage, and low allocated budgets, which affects competitiveness and regional development.