Objectives. Correlate affiliation to health insurance with the use of medical services, living conditions and perceived health of residents in 12 districts of Lima. Material and methods. Descriptive cross-population study, conducted between January and March 2006 in 12 districts of Lima city, using a health survey of 72 questions. Results. 4355 interviews were obtained, 48% had no health insurance. Compared with people who had private health insurance, social security or healing, participants without insurance or coverage by public insurance had lower level of education and living (p<0.001). Participants without insurance or with public insurance when they perceive disease increased use pharmacies than doctor (p<0.001). The public system is the principal care system that provides care to 62.1% of the respondents, including people from other insurance systems. The perception of an optimal health condition was associated with having a private health system coverage (OR = 2.5; IC95% = 1.87-3.38); and age less than 35 years (OR=2.1; IC95%=1.70-2.58). Conclusions. Health insurance systems in Lima city cover different socio-economic stratums; people using private insurance systems have better living conditions, better access to health services and optimal perception of their health.