Effect of removing direct payment for health care on utilisation and health outcomes in Ghanaian children:

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dc.contributor.author Ansah, E.K.
dc.contributor.author Narh-Bana, S.
dc.contributor.author Asiamah, S.
dc.contributor.author Dzordzordzi, V.
dc.contributor.author Biantey, K.
dc.contributor.author Dickson, K.
dc.contributor.author Gyapong, J.O.
dc.contributor.author Koram, K.A.
dc.contributor.author Greenwood, B.M.
dc.contributor.author Mills, A.
dc.contributor.author Whitty, C.J.M.
dc.date.accessioned 2013-06-26T14:21:42Z
dc.date.accessioned 2017-10-16T13:04:21Z
dc.date.available 2013-06-26T14:21:42Z
dc.date.available 2017-10-16T13:04:21Z
dc.date.issued 2009
dc.identifier.citation Ansah, E. K., Narh-Bana, S., Asiamah, S., Dzordzordzi, V., Biantey, K., Dickson, K., . . . Whitty, C. J. M. (2009). Effect of removing direct payment for health care on utilisation and health outcomes in Ghanaian children: A randomised controlled trial. PLoS Medicine, 6(1), 0048-0058. en_US
dc.identifier.issn 15491277
dc.identifier.uri http://197.255.68.203/handle/123456789/4179
dc.description.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] < 8 g/dl); major secondary outcomes were health care utilisation, severe anaemia, and mortality. At baseline the randomised groups were similar. Introducing free primary health care altered the health care seeking behaviour of households; those randomised to the intervention arm used formal health care more and nonformal care less than the control group. Introducing free primary health care did not lead to any measurable difference in any health outcome. The primary outcome of moderate anaemia was detected in 37 (3.1%) children in the control and 36 children (3.2%) in the intervention arm (adjusted odds ratio 1.05, 95% confidence interval 0.66-1.67). There were four deaths in the control and five in the intervention group. Mean Hb concentration, severe anaemia, parasite prevalence, and anthropometric measurements were similar in each group. Families who previously self-enrolled in the prepayment scheme were significantly less poor, had better health measures, and used services more frequently than those in the randomised group. Conclusions: In the study setting, removing out-of-pocket payments for health care had an impact on health care-seeking behaviour but not on the health outcomes measured. Trial registration: ClinicalTrials.gov (#NCT00146692). © 2009 Ansah et al. en_US
dc.language.iso en en_US
dc.subject EMTREE drug terms: amodiaquine plus artesunate; hemoglobin EMTREE medical terms: anemia; article; child; clinical trial; controlled clinical trial; controlled study; disease severity; female; Ghana; health care access; health care utilization; health insurance; help seeking behavior; human; infant; major clinical study; malaria; male; mortality; preschool child; primary medical care; randomized controlled trial; anemia; economics; fee; Ghana; health care cost; health care delivery; health service; malaria; outcome assessment; parasitemia; patient attitude; questionnaire; statistics; utilization review en_US
dc.title Effect of removing direct payment for health care on utilisation and health outcomes in Ghanaian children: en_US
dc.type Article en_US


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  • Immunology Department [61]
    The Department of Immunology conducts research in the field of immunology of infectious and non-infectious diseases. The Department has the overall goal of contributing knowledge to better diagnosis, management, control and prevention of infectious and non-infectious diseases in Ghana and worldwide. This is consistent with the overall strategy of the Noguchi Memorial Institute for Medical Research (NMIMR) and in line with the strategy of the College of Health Sciences of the University of Ghana.

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