Equity Effects of Public Health Insurance on Hypertension in Peru: Insights from a Panel Analysis of the Peruvian Demographic and Health Survey 2013-2019

BACKGROUND: Public health insurance is a key mechanism for strengthening health systems for low-income populations. In Peru, public coverage is provided through Seguro Integral de Salud (SIS). Evaluating the health impact of SIS relative to lack of coverage or other coverage schemes is important for quantifying the health equity implications of the public health system in Peru.

OBJECTIVES: This paper investigates the effect of public health insurance on the hypertension control cascade to better inform health policy for reducing health disparities in low-income populations.

METHODS: Individual-level data on three hypertension outcomes that define the hypertension control cascade (awareness, treatment and control) is obtained from the Peruvian Demographic and Health Survey, 2013-2019. Augmenting the dataset with GPS coordinates, we first conduct a spatial analysis to explore spatial correlations between health coverage types and hypertension outcomes. We then employ a region-fixed effects regression model to examine the effects of coverage on hypertension outcomes while controlling for individual characteristics and regional heterogeneity. We investigate how these effects vary across populations with different socioeconomic characteristics such as income, education, or employment status.

RESULTS: Spatial analysis reveals higher rates of uncontrolled hypertension in areas of Peru that have lower SIS coverage. Region-fixed effect regression models demonstrate a strong positive association between SIS coverage and hypertension awareness, treatment, and control, even after accounting for individual socio-economic confounding factors. The associations are larger in magnitude for poorer, less educated, and unemployed populations.

CONCLUSIONS: The spatial distribution of health coverage in Peru aligns with patterns of hypertension outcomes, underscoring the importance of controlling for fixed spatial characteristics when estimating the health impacts of coverage. The findings provide evidence that public health coverage targeting vulnerable populations in Peru can help to improve health equity in the context of hypertension.