title: Progressive universalism? The impact of targeted coverage on health care access and expenditures in Peru.
abstract: Like other countries seeking a progressive path to universalism, Peru has attempted to reduce inequalities in access to health care by granting the poor entitlement to tax-financed basic care without charge. We identify the impact of this policy by comparing the target population's change in health care utilization with that of poor adults already covered through employment-based insurance. There are positive effects on receipt of ambulatory care and medication that are largest among the elderly and the poorest. The probability of getting formal health care when sick is increased by almost two fifths, but the likelihood of being unable to afford treatment is reduced by more than a quarter. Consistent with the shallow coverage offered, there is no impact on use of inpatient care. Neither is there any effect on average out-of-pocket health care expenditure, but medical spending is reduced by up to 25% in the top quarter of the distribution. Copyright © 2017 John Wiley & Sons, Ltd.
authors.affiliation: Institute of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands.|Lima School of Economics, Lima, Peru.
authors.forename: Sven
authors.identifier: 0000-0002-1380-891X
authors.initials: S
authors.lastname: Neelsen
authors.affiliation: Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, the Netherlands.|Tinbergen Institute, Amsterdam, the Netherlands.|Faculty of Business and Economics, University of Lausanne, Lausanne, Switzerland.|School of Economics and Regional Studies, University of Macedonia, Thessaloniki, Greece.
authors.forename: Owen
authors.identifier: 0000-0002-6289-1924
authors.initials: O
authors.lastname: O'Donnell
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D005260:Female; D005382:Financing, Personal / Q000191:economics; D018166:Health Care Reform; D005102:Health Expenditures; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D007348:Insurance, Health / Q000191:economics*; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010568:Peru; D019472:Universal Health Insurance
keywords: Peru; health care; health financing; health insurance; universal coverage