Socioeconomic Inequalities in Health Service Utilization in the Peruvian Population: A National Population-Based Study.

Background/Objectives: Socioeconomic inequalities continue to shape health service use in low- and middle-income countries. This study aimed to quantify socioeconomic inequalities in formal health service utilization among Peruvian adults using nationally representative data. Methods: A cross-sectional analytical study was conducted using the 2023 National Household Survey (ENAHO). The sample included 77,793 adults aged 18 years or older. Formal health service utilization was defined as self-reported use of outpatient, emergency, or hospitalization services during the preceding 12 months. Survey-weighted Poisson regression with robust variance was used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs). Results: Overall, 15.94% of adults reported using formal health services in the previous year. In the adjusted model, utilization was higher among women (aPR: 1.47; 95% CI: 1.41-1.55) and adults aged 60 years or older (aPR: 1.74; 95% CI: 1.57-1.92). Compared with uninsured adults, service utilization was higher among those covered by SIS (aPR: 2.59; 95% CI: 2.29-2.93), EsSalud (aPR: 2.90; 95% CI: 2.56-3.29), Armed Forces/Police insurance (aPR: 3.04; 95% CI: 2.36-3.91), and private insurance (aPR: 2.32; 95% CI: 1.77-3.03). Non-extreme poverty (aPR: 0.72; 95% CI: 0.67-0.78) and extreme poverty (aPR: 0.68; 95% CI: 0.59-0.78) were associated with lower utilization. Conclusions: Formal health service utilization remains low and unequal in Peru. Insurance coverage was strongly associated with greater service use, whereas poverty was associated with lower utilization.