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

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 as...

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Autores principales: Ansah, Evelyn Korkor, 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
Formato: Texto
Lenguaje:English
Publicado: Public Library of Science 2009
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2613422/
https://www.ncbi.nlm.nih.gov/pubmed/19127975
http://dx.doi.org/10.1371/journal.pmed.1000007
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author Ansah, Evelyn Korkor
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
author_facet Ansah, Evelyn Korkor
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
author_sort Ansah, Evelyn Korkor
collection PubMed
description 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).
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spelling pubmed-26134222009-01-06 Effect of Removing Direct Payment for Health Care on Utilisation and Health Outcomes in Ghanaian Children: A Randomised Controlled Trial Ansah, Evelyn Korkor 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 PLoS Med Research Article 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). Public Library of Science 2009-01 2009-01-06 /pmc/articles/PMC2613422/ /pubmed/19127975 http://dx.doi.org/10.1371/journal.pmed.1000007 Text en : © 2009 Ansah et al. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Ansah, Evelyn Korkor
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
Effect of Removing Direct Payment for Health Care on Utilisation and Health Outcomes in Ghanaian Children: A Randomised Controlled Trial
title Effect of Removing Direct Payment for Health Care on Utilisation and Health Outcomes in Ghanaian Children: A Randomised Controlled Trial
title_full Effect of Removing Direct Payment for Health Care on Utilisation and Health Outcomes in Ghanaian Children: A Randomised Controlled Trial
title_fullStr Effect of Removing Direct Payment for Health Care on Utilisation and Health Outcomes in Ghanaian Children: A Randomised Controlled Trial
title_full_unstemmed Effect of Removing Direct Payment for Health Care on Utilisation and Health Outcomes in Ghanaian Children: A Randomised Controlled Trial
title_short Effect of Removing Direct Payment for Health Care on Utilisation and Health Outcomes in Ghanaian Children: A Randomised Controlled Trial
title_sort effect of removing direct payment for health care on utilisation and health outcomes in ghanaian children: a randomised controlled trial
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2613422/
https://www.ncbi.nlm.nih.gov/pubmed/19127975
http://dx.doi.org/10.1371/journal.pmed.1000007
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