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Effect of Removing Direct Payment for Health Care on Utilisation and Health Outcomes in Ghanaian Children: A Randomised Controlled Trial

Author

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  • Evelyn Korkor Ansah
  • Solomon Narh-Bana
  • Sabina Asiamah
  • Vivian Dzordzordzi
  • Kingsley Biantey
  • Kakra Dickson
  • John Owusu Gyapong
  • Kwadwo Ansah Koram
  • Brian M Greenwood
  • Anne Mills
  • Christopher J M Whitty

Abstract

Background: Delays in accessing care for malaria and other diseases can lead to disease progression, and user fees are a known barrier to accessing health care. Governments are introducing free health care to improve health outcomes. Free health care affects treatment seeking, and it is therefore assumed to lead to improved health outcomes, but there is no direct trial evidence of the impact of removing out-of-pocket payments on health outcomes in developing countries. This trial was designed to test the impact of free health care on health outcomes directly. Methods and Findings: 2,194 households containing 2,592 Ghanaian children under 5 y old were randomised into a prepayment scheme allowing free primary care including drugs, or to a control group whose families paid user fees for health care (normal practice); 165 children whose families had previously paid to enrol in the prepayment scheme formed an observational arm. The primary outcome was moderate anaemia (haemoglobin [Hb]

Suggested Citation

  • Evelyn Korkor Ansah & Solomon Narh-Bana & Sabina Asiamah & Vivian Dzordzordzi & Kingsley Biantey & Kakra Dickson & John Owusu Gyapong & Kwadwo Ansah Koram & Brian M Greenwood & Anne Mills & Christophe, 2009. "Effect of Removing Direct Payment for Health Care on Utilisation and Health Outcomes in Ghanaian Children: A Randomised Controlled Trial," PLOS Medicine, Public Library of Science, vol. 6(1), pages 1-1, January.
    • Handle: RePEc:plo:pmed00:1000007
    DOI: 10.1371/journal.pmed.1000007
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    1. Johnson, Ari & Goss, Adeline & Beckerman, Jessica & Castro, Arachu, 2012. "Hidden costs: The direct and indirect impact of user fees on access to malaria treatment and primary care in Mali," Social Science & Medicine, Elsevier, vol. 75(10), pages 1786-1792.
    2. Lépine, A. & Lagarde, M. & Le Nestour, A., 2015. "Free primary care in Zambia: an impact evaluation using a pooled synthetic control method," Health, Econometrics and Data Group (HEDG) Working Papers 15/20, HEDG, c/o Department of Economics, University of York.
    3. Hampshire, Kate R. & Porter, Gina & Owusu, Samuel Asiedu & Tanle, Augustine & Abane, Albert, 2011. "Out of the reach of children? Young people's health-seeking practices and agency in Africa's newly-emerging therapeutic landscapes," Social Science & Medicine, Elsevier, vol. 73(5), pages 702-710, September.
    4. Haushofer, Johannes & Chemin, Matthieu & Jang, Chaning & Abraham, Justin, 2020. "Economic and psychological effects of health insurance and cash transfers: Evidence from a randomized experiment in Kenya," Journal of Development Economics, Elsevier, vol. 144(C).
    5. Christabel C Enweronu-Laryea & Hilary D Andoh & Audrey Frimpong-Barfi & Francis M Asenso-Boadi, 2018. "Parental costs for in-patient neonatal services for perinatal asphyxia and low birth weight in Ghana," PLOS ONE, Public Library of Science, vol. 13(10), pages 1-14, October.
    6. Bagnoli, Lisa, 2019. "Does health insurance improve health for all? Heterogeneous effects on children in Ghana," World Development, Elsevier, vol. 124(C), pages 1-1.
    7. Lisa Bagnoli, 2017. "Does National Health Insurance Improve Children's Health ?National and Regional Evidence from Ghana," Working Papers ECARES ECARES 2017-03, ULB -- Universite Libre de Bruxelles.
    8. Powell-Jackson, Timothy & Ansah, Evelyn K., 2015. "The indirect effects of subsidised healthcare in rural Ghana," Social Science & Medicine, Elsevier, vol. 144(C), pages 96-103.
    9. Binagwaho, Agnes & Hartwig, Renate & Ingeri, Denyse & Makaka, Andrew, 2012. "Mutual health insurance and its contribution to improving child health in Rwanda," Passauer Diskussionspapiere, Volkswirtschaftliche Reihe V-66-12, University of Passau, Faculty of Business and Economics.
    10. Renard, Yohan, 2022. "From fees to free: User fee removal, maternal health care utilization and child health in Zambia," World Development, Elsevier, vol. 156(C).
    11. Alagidede, Paul & Baah-Boateng, William & Nketiah-Amponsah, Edward, 2013. "The Ghanian economy: and Overview," MPRA Paper 109687, University Library of Munich, Germany.
    12. Powell-Jackson, Timothy & Hanson, Kara & Whitty, Christopher J.M. & Ansah, Evelyn K., 2014. "Who benefits from free healthcare? Evidence from a randomized experiment in Ghana," Journal of Development Economics, Elsevier, vol. 107(C), pages 305-319.
    13. Paul Eze & Stanley Ilechukwu & Lucky Osaheni Lawani, 2023. "Impact of community-based health insurance in low- and middle-income countries: A systematic review and meta-analysis," PLOS ONE, Public Library of Science, vol. 18(6), pages 1-47, June.
    14. Robert Kaba Alhassan & Edward Nketiah-Amponsah & Daniel Kojo Arhinful, 2016. "A Review of the National Health Insurance Scheme in Ghana: What Are the Sustainability Threats and Prospects?," PLOS ONE, Public Library of Science, vol. 11(11), pages 1-16, November.
    15. P. M. Amegbor, 2017. "An Assessment of Care-Seeking Behavior in Asikuma-Odoben-Brakwa District: A Triple Pluralistic Health Sector Approach," SAGE Open, , vol. 7(2), pages 21582440177, June.
    16. Moses Ocan & Racheal Bakubi & Loyce Nakalembe & Deborah Ekusai-Sebatta & Nsobya Sam, 2024. "Experience of healthcare personnel on Co-payment mechanism and the implications on its use in private drug outlets in Uganda," PLOS ONE, Public Library of Science, vol. 19(5), pages 1-15, May.
    17. Lama Bou-Karroum & Domenico G Iaia & Fadi El-Jardali & Clara Abou Samra & Sabine Salameh & Zeina Sleem & Reem Masri & Aya Harb & Nour Hemadi & Nadeen Hilal & Layal Hneiny & Sahar Nassour & Mehr Gul Sh, 2024. "Financing for equity for women’s, children’s and adolescents’ health in low- and middle-income countries: A scoping review," PLOS Global Public Health, Public Library of Science, vol. 4(9), pages 1-49, September.

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