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ORIGINAL RESEARCH article

Front. Public Health
Sec. Children and Health
Volume 12 - 2024 | doi: 10.3389/fpubh.2024.1405244
This article is part of the Research Topic Public Health Outcomes: The Role of Social Security Systems in Improving Residents' Health Welfare View all articles

Impact of comprehensive health insurance affiliation on mortality in children under one year: an analysis of the Demographic and Health Survey 2010-2022 in Peru Authors

Provisionally accepted
Marcos Espinola-Sánchez Marcos Espinola-Sánchez 1,2*Andres Campaña-Acuña Andres Campaña-Acuña 1Diego Urrunaga-Pastor Diego Urrunaga-Pastor 3*Jorge L. Maguiña Jorge L. Maguiña 1Manuel Jumpa Manuel Jumpa 1Oscar Ugarte-Ubillus Oscar Ugarte-Ubillus 1
  • 1 Escuela Nacional de Salud Pública, Dirección de Investigación, Lima, Peru
  • 2 Facultad de Ciencias de la Salud, Universidad Privada del Norte, Lima, Peru
  • 3 Scientific University of the South, Villa EL Salvador, Peru

The final, formatted version of the article will be published soon.

    Objective: To assess the impact of Comprehensive Health Insurance (CHI) coverage on mortality in children under one year of age in the Peruvian population from 2010 to 2022. Additionally, the study evaluated how CHI affects infant mortality according to wealth quintiles in the Peruvian population. Methods: A causal inference analysis with observational data was applied, employing propensity score matching. Participants included children under one year of age, surveyed through the National Demographic and Family Health Survey (ENDES) from 2010 to 2022. Variables measured included CHI affiliation and death in children under one year. Methods such as inverse probability weighting adjusted by regression, Average Treatment Effect on the Treated (ATET) estimation, and endogeneity test were applied. Results: The study population consisted of 26,319 children under one year, with 11,922 not affiliated with CHI and 14,397 affiliated. The ATET analysis as an exogenous treatment of CHI showed a significant reduction in infant mortality in the overall population of children by 12.6% (95% CI: 12.1% to 13.1%), in the poverty subgroup by 15.6% (95% CI: 14.9% to 16.3%), and in the non-poverty subgroup by 6% (95% CI: 5.5% to 6.4%). However, endogeneity was observed in the ATET for the non-poverty subgroup and for the overall population of children. Conclusions: CHI affiliation contributes to reducing mortality in children under one year in the population with low economic incomes in Peru. However, this relationship is inconclusive for the general population and for the population with medium and high incomes, highlighting the importance of considering socioeconomic, demographic, and other insurance factors.

    Keywords: Comprehensive Health Insurance, impact assessment, DHS (Demographic and Health Survey), Cox model, Infant Mortality

    Received: 22 Mar 2024; Accepted: 31 Dec 2024.

    Copyright: © 2024 Espinola-Sánchez, Campaña-Acuña, Urrunaga-Pastor, Maguiña, Jumpa and Ugarte-Ubillus. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Marcos Espinola-Sánchez, Escuela Nacional de Salud Pública, Dirección de Investigación, Lima, Peru
    Diego Urrunaga-Pastor, Scientific University of the South, Villa EL Salvador, Peru

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