Who Benefits from Removing User Fees for Health Care? Evidence from a Randomised Experiment in Ghana

41 Pages Posted: 25 Feb 2012 Last revised: 11 Mar 2012

See all articles by Timothy Powell-Jackson

Timothy Powell-Jackson

London School of Hygiene and Tropical Medicine

Kara Hanson

London School of Hygiene and Tropical Medicine

Christopher Whitty

London School of Hygiene and Tropical Medicine

Evelyn Ansah

Ghana Health Services - Research & Development Division

Date Written: February 15, 2012

Abstract

The extent to which removing user fees for health care in developing countries improves population health rests, in part, on how behavioural responses vary across individuals with different health needs. Using data from a randomised experiment of free care in Ghana and a measure of baseline health that is both objective and broad-based, we examined differential effects for initially ill and healthy children. We find that free care improved health seeking behaviour, lowered out-of-pocket spending and reduced anaemia amongst children who were ill at baseline but had no effect on initially healthy children. Whilst there was no health effect on the intervention population taken overall, the evidence suggests that removing user fees may have enabled individuals with the greatest health need to take up primary health care, thereby improving their health. There was no indication that free care encouraged frivolous use of services.

Keywords: User Fees, Health Need, Health Insurance, Ghana

JEL Classification: I10, I18, I31, D12

Suggested Citation

Powell-Jackson, Timothy and Hanson, Kara and Whitty, Christopher and Ansah, Evelyn, Who Benefits from Removing User Fees for Health Care? Evidence from a Randomised Experiment in Ghana (February 15, 2012). Available at SSRN: https://ssrn.com/abstract=2010476 or http://dx.doi.org/10.2139/ssrn.2010476

Timothy Powell-Jackson (Contact Author)

London School of Hygiene and Tropical Medicine ( email )

Keppel Street
London, WC1E 7HT
United Kingdom

Kara Hanson

London School of Hygiene and Tropical Medicine ( email )

Keppel Street
London, WC1E 7HT
United Kingdom

Christopher Whitty

London School of Hygiene and Tropical Medicine ( email )

Keppel Street
London, WC1E 7HT
United Kingdom

Evelyn Ansah

Ghana Health Services - Research & Development Division ( email )

P.O. Box MB-190
Ghana, Greater Accra
Ghana

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