Out-of-pocket health care spending is an inefficient and inequitable financing mechanism, as it reduces household well-being and can push families into poverty. This study estimates the impoverishment associated with out-of-pocket health care expenditures in Peru between 2010 and 2021 and identifies the factors associated with such impoverishment. Using microdata from the National Household Survey and a multivariate logit model, the study assesses the probability of falling into poverty related to such direct spending. The results show that 2,7% of non-poor households became impoverished during the period analyzed, a percentage that increased to 4,5% during the COVID-19 pandemic. This pattern was more pronounced in rural areas, especially in the highlands and the rainforest. Regarding associated factors, it was found that years of education, per capita income, health insurance coverage, and visits to health facilities are significantly associated with a lower probability of falling into poverty due to out-of-pocket expenditures. In contrast, the presence of chronic diseases, disability, a higher economic dependency ratio, pregnancy, the presence of young children, unmet basic needs, lack of sanitation services, and the use of solid fuels for cooking are associated with a higher probability of this risk. Health insurance coverage, while essential, remains insufficient if it is not accompanied by substantive improvements in the social determinants of health.