Co-payments and associated factors in the Peruvian private health care system

Abstract

Background The costs associated with health care are of critical importance to both decision-makers and users, given the limited resources allocated to the health sector. However, the available scientific evidence on health care costs in low-and-middle-income countries, such as Peru, is scarce. In the Peruvian context, the health system is fragmented, and the private health system and its financing models have received less research attention. We aimed to analyse user co-payments and associated factors within the private health care system. Methods Our study was cross-sectional, using free data from the Electronic Transaction Model of Standardized Billing Data - TEDEF-SUSALUD, between 2021–2022. Our unit of analysis is the benefits provided by users. We used the outcomes of co-payments, the total amount, proportion of co-payments, and co-payment of minimum salaries. Results Our study included 5,287,260 health services provided to users of the private health system in Peru. We found that the average co-payment for these services is lower for women than for men (β=-7.57; 95%CI: -8.01 to -7.13), as well as for persons aged 60 years or older (β = 8.43; 95%CI: 7.86 to 9.00) and for complementary health affiliations (β = 58.47; 95%CI: 57.77 to 59.17). However, no significant difference was observed in the amount of co-payments in terms of minimum salaries between the different groups. On the other hand, a significant difference was observed in the co-payment for hospitalization-related services, with an average of 503.7 soles per day, which is about half of the Peruvian daily minimum wage. Although co-payments per day of hospitalization represent on average only 14% of the total amount submitted, this does not exclude the possibility that a person requiring several days of hospitalization in a private facility may incur catastrophic health expenditures. Conclusions Our study provides a detailed overview of out-of-pocket payments in the private health care system in Peru and the factors associated with them. Policymakers must consider these findings when designing policies to promote a more equitable and accessible health system.