Evolution of medical coverage and access to health services in Paraguay (1997 – 2024)

Abstract

Introduction. Paraguay maintains one of the lowest health insurance coverage rates in Latin America, with over 70% of the population lacking financial protection in health. This situation worsens in rural areas where geographic, economic, and cultural barriers persist, limiting effective access to healthcare services. Objective. To analyze the evolution of health coverage and health service access indicators in Paraguay (1997-2024), identifying territorial and gender disparities. Materials and Methods. Descriptive observational study with repeated cross-sectional design, using data from the National Statistics Institute's Permanent Household Surveys (1997-2024). Data from 5.9 million inhabitants were analyzed using descriptive statistics, calculating proportions stratified by area of residence and sex. Main variables: health insurance coverage and access to services during illness or accident. Results. Coverage increased from 18.2% (1997/98) to 25.9% (2021), with 71.4% remaining without coverage in 2024. Urban-rural gaps persisted: 32.9% urban coverage versus 13.9% rural (2021). Effective access improved from 64.1% to 73.1% (2022-2024), although 31% of sick rural population did not consult services. Women showed higher consultation rates (75.1%) than men (70.6%), with accentuated gaps in rural areas. Conclusion. Analysis of 27 years of health indicator trends in Paraguay (1997-2024) reveals an interesting picture characterized by gradual progress in national health coverage. However, Paraguay continues to face critical inequalities, with 4.2 million people lacking financial protection. Urban-rural disparities create a dual system where residence determines access to healthcare, highlighting the urgent need for structural reforms toward universal coverage with territorial equity.