Effect of Removing Direct Payment for Health Care on Utilisation and Health Outcomes in Ghanaian Children: A Randomised Controlled Trial
2009

Impact of Free Health Care on Ghanaian Children

Sample size: 2592 publication 10 minutes Evidence: moderate

Author Information

Author(s): Evelyn Korkor Ansah, Narh-Bana Solomon, Asiamah Sabina, Dzordzordzi Vivian, Biantey Kingsley, Dickson Kakra, Gyapong John Owusu, Koram Kwadwo Ansah, Greenwood Brian M, Mills Anne, Whitty Christopher J. M

Primary Institution: London School of Hygiene & Tropical Medicine

Hypothesis

Does removing direct payment for health care improve health outcomes in Ghanaian children?

Conclusion

Removing out-of-pocket payments for health care changed health care-seeking behavior but did not improve health outcomes.

Supporting Evidence

  • Children in the intervention group used formal health care more frequently than those in the control group.
  • There was no significant difference in the prevalence of moderate anaemia between the two groups.
  • Families who previously self-enrolled in the prepayment scheme were healthier and used services more frequently.

Takeaway

When families in Ghana didn't have to pay for health care, they went to clinics more often, but it didn't make the kids healthier.

Methodology

A randomized controlled trial comparing health outcomes and care utilization between children receiving free health care and those paying user fees.

Potential Biases

Potential selection bias as self-enrolled participants were healthier and wealthier than randomized participants.

Limitations

The study may not be generalizable to other settings, and indirect costs of care were not addressed.

Participant Demographics

Ghanaian children under 5 years old from low-income households.

Statistical Information

P-Value

0.86

Confidence Interval

95% CI 0.66–1.67

Statistical Significance

p<0.05

Digital Object Identifier (DOI)

10.1371/journal.pmed.1000007

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