Trends in Socioeconomic Inequalities in the Use of Formal Health Services Among Peruvian Adults in Need of Care: 2015–2024

Background: Although health insurance coverage has expanded in Peru, equitable access to formal healthcare remains uncertain. We examined 2015–2024 trends and poverty‑related inequalities in formal service use among adults reporting recent health problems. Methods: We analysed 10 annual rounds of Peru’s National Household Survey in a repeated cross‑sectional study. Eligible adults were aged ≥18 years and reported a health problem in the preceding four weeks. We excluded those who considered care unnecessary and those using both a healthcare facility and a pharmacy. Survey‑weighted prevalence and annual trends were estimated. Survey‑adjusted modified Poisson models yielded adjusted prevalence ratios (aPRs). A poverty‑by‑period interaction compared 2015–2019, 2020–2021, and 2022–2024. Results: Among 330,165 adults, 41.2% used formal health services. Utilisation declined 2.00% annually (95% CI, −2.25 to −1.75), dropped sharply in 2020, and recovered incompletely. Compared with non‑poor adults, use was lower in non‑extreme poverty (aPR, 0.80; 95% CI, 0.79–0.82) and extreme poverty (aPR, 0.74; 95% CI, 0.71–0.77). The poverty‑by‑period interaction was significant (P < 0.001), with the widest inequalities in 2020–2021 (aPRs, 0.74 and 0.61). Indigenous‑language speakers and Highlands residents had lower utilisation. Insurance was associated with greater use, but inequalities persisted. Conclusion: Formal healthcare use declined while socioeconomic inequalities widened during the pandemic. Equitable coverage requires addressing financial, territorial, and cultural barriers beyond insurance enrolment.