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Trends and Factors Associated with the Non-Use of Formal Health Services in Peru, 2015–2024

Arce-Huamani M.A.; Caceres-Cuellar G.A.; Guevara-Paz A.Y.; Carrascal-Astola W.; Ortiz-Arica M.M.; Torres-Roman J.S. · International Journal of Environmental Research and Public Health (2026) · DOI: 10.3390/ijerph23020183

Resumen

Background/Objectives: Effective use of health services is essential for universal health coverage, yet many adults in Peru still forgo formal care despite illness. Evidence describing national trends and determinants of non-use of formal health services remains limited. This study aimed to estimate national trends from 2015 to 2024 and identify factors associated with non-use among Peruvian adults. Methods: We conducted a repeated cross-sectional analysis of annual secondary microdata from the Peruvian National Household Survey (ENAHO, 2015–2024). Adults aged ≥ 18 years who reported a health problem in the last four weeks were included. Non-use was defined as not seeking care at any public or private provider (IPRESS). Survey-weighted descriptive analyses and modified Poisson regression models estimated prevalence ratios (PRs) with 95% confidence intervals, adjusting for sex, age, education, marital status, health insurance, chronic illness, disability, area, and region. Results: Among 330,165 adults, 41.5% did not use formal health services. Non-use declined until 2019, rose sharply during 2020–2021, and partially recovered thereafter. In adjusted models, non-use was lower among women (PR = 0.92; 95% CI 0.91–0.93), those with higher education (PR = 0.88; 0.86–0.90), and participants insured by EsSalud (PR = 0.65) or SIS (PR = 0.76). It was higher in the Highlands (PR = 1.07) and lower in Metropolitan Lima (PR = 0.88). Conclusions: Non-use of formal health services in Peru remains high and unequal. Expanding effective coverage, strengthening primary care, and improving health literacy are essential to achieve equitable access.

Instituciones: Universidad Tecnológica del Perú; Universidad Privada Norbert Wiener