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Public Library of Science, PLoS Medicine, 1(6), p. e1000007, 2009

DOI: 10.1371/journal.pmed.1000007

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

Journal article published in 2009 by Ek Ansah, Solomon Narh-Bana, Sabina Asiamah, Vivian Dzordzordzi, Kingsley Biantey, Kakra Dickson, Jo Gyapong, Ka Koram, Bm Greenwood, Anne Mills ORCID, Cj Whitty
This paper is made freely available by the publisher.
This paper is made freely available by the publisher.

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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]