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

## TL;DR

This study examines why many Peruvian adults don't use formal health services, finding that non-use is high and influenced by factors like education, insurance, and region.

## Contribution

The study provides national trends and identifies sociodemographic and regional factors associated with non-use of formal health services in Peru from 2015 to 2024.

## Key findings

- Non-use of formal health services declined until 2019 but increased during 2020–2021.
- Women, those with higher education, and insured individuals were less likely to forgo formal care.
- Non-use was higher in the Highlands and lower in Metropolitan Lima.

## Abstract

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.