近年来，许多发展中国家大规模扩大医疗保险覆盖面。虽然人们普遍认为这具有积极的影响，但迄今为止，还不清楚医疗保险通过哪些渠道促进个人的福祉。更一般地说，影响通常不会在个人层面上被量化。这主要有两个原因。首先，我们缺乏关于医疗保健利用和健康结果的详细数据，其次，不容易控制选择保险。第二个问题意味着，对保险覆盖面的利用情况或结果衡量标准进行回归，将产生有偏差的结果，并且不能估计健康保险的因果影响。本文在这两个方面都取得了进展。我们使用丰富的调查数据来评估正式劳动力市场之外的个人获得秘鲁社会健康保险(Seguro Integral de Salud)对各种医疗保健利用、预防保健、医疗支出和健康指标的影响。我们通过利用模糊回归间断设计来解决第二个问题。如果根据多个变量计算出的福利指数低于特定的门槛，就可以享受该福利。 We base our analysis on a natural experiment that is generated by variation in the index around the threshold. We interpret our results through the lens of a simple model. As expected, and in contrast to studies for a number of other countries, we find strong effects of insurance coverage on measures of health care utilization, such as visiting a doctor, receiving medication and medical analysis. The program does not strongly incentivice individuals or health care providers to invest into preventive care. In line with this, in general, we find no effects of insurance coverage on preventive care. The only exceptions to this are our findings that, controlling for selection into insurance coverage, women of fertile age with insurance are more likely to receive pregnancy care and that insured individuals are more likely to be vaccinated. This is in line with the stark decrease in maternal and child mortality that was observed after the program was introduced. As for health care expenditures, we generally find positive effects on the mean and the variability. We complement these findings with quantile treatment effect estimates that show increases at the high end of the distribution. Our interpretation is that insured individuals are encouraged by health care professionals to undertake important treatments and pay for this themselves. At the same time, we find no clear effects on health outcomes at the micro level.