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Health insurance system fragmentation and COVID-19 mortality: Evidence from Peru

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  • Misael Anaya-Montes
  • Hugh Gravelle

Abstract

Peru has a fragmented health insurance system in which most insureds can only access the providers in their insurer’s network. The two largest sub-systems covered about 53% and 30% of the population at the start of the pandemic; however, some individuals have dual insurance and can thereby access both sets of providers. We use data on 24.7 million individuals who belonged to one or both sub-systems to investigate the effect of dual insurance on COVID-19 mortality. We estimate recursive bivariate probit models using the difference in the distance to the nearest hospital in the two insurance sub-systems as Instrumental Variable. The effect of dual insurance was to reduce COVID-19 mortality risk by 0.23% compared with the sample mean risk of 0.54%. This implies that the 133,128 COVID-19 deaths in the sample would have been reduced by 56,418 (95%CI: 34,894, 78,069) if all individuals in the sample had dual insurance.

Suggested Citation

  • Misael Anaya-Montes & Hugh Gravelle, 2024. "Health insurance system fragmentation and COVID-19 mortality: Evidence from Peru," PLOS ONE, Public Library of Science, vol. 19(8), pages 1-28, August.
    • Handle: RePEc:plo:pone00:0309531
    DOI: 10.1371/journal.pone.0309531
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