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Who benefits from free healthcare? Evidence from a randomized experiment in Ghana

Author

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  • Powell-Jackson, Timothy
  • Hanson, Kara
  • Whitty, Christopher J.M.
  • Ansah, Evelyn K.

Abstract

We examine the impact of removing user fees for healthcare in rural Ghana using data from a randomized experiment that includes rich information on objective measures of child health status. We find that free care increased use of formal healthcare shifting care seeking away from informal providers, with particularly strong effects for children who were anaemic at baseline. There was no health effect on the intervention population taken overall. However, consistent with the utilization findings, there were health improvements amongst those with anaemia initially. Further benefits included a large reduction in health spending, with the effect greater at higher levels of the medical spending distribution. Free care was found to have no influence on a range of malaria prevention behaviours or on the incidence of self-reported illness, suggesting that ex-ante moral hazard is unlikely to be a concern in this particular setting.

Suggested Citation

  • Powell-Jackson, Timothy & Hanson, Kara & Whitty, Christopher J.M. & Ansah, Evelyn K., 2014. "Who benefits from free healthcare? Evidence from a randomized experiment in Ghana," Journal of Development Economics, Elsevier, vol. 107(C), pages 305-319.
    • Handle: RePEc:eee:deveco:v:107:y:2014:i:c:p:305-319
    DOI: 10.1016/j.jdeveco.2013.11.010
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    Cited by:

    1. Teresa Molina Millán & Karen Macours, 2017. "Attrition in randomized control trials: Using tracking information to correct bias," FEUNL Working Paper Series novaf:wp1702, Universidade Nova de Lisboa, Faculdade de Economia.
    2. Sautmann,Anja & Brown,Samuel & Kline,Dean Mark, 2020. "Subsidies, Information, and the Timing of Children’s Health Care in Mali," Policy Research Working Paper Series 9486, The World Bank.
    3. Yohan Renard, 2022. "From fees to free: User fee removal, maternal health care utilization and child health in Zambia," Post-Print hal-04216814, HAL.
    4. Aurélia Lépine & Mylène Lagarde & Alexis Le Nestour, 2018. "How effective and fair is user fee removal? Evidence from Zambia using a pooled synthetic control," Health Economics, John Wiley & Sons, Ltd., vol. 27(3), pages 493-508, March.
    5. Jeremy Barofsky & Stephen D. Younger, 2019. "The Effect of Government Health Expenditure on the Income Distribution: A Comparison of Valuation Methods in Ghana," Commitment to Equity (CEQ) Working Paper Series 66, Tulane University, Department of Economics.
    6. Anja Sautmann & Samuel Brown & Mark Dean, 2016. "Subsidies, Information, and the Timing of Childrenís Health Care in Mali," Working Papers 2016-2, Brown University, Department of Economics.
    7. Indra Kurniawan, Muhammad, 2021. "Has access to health insurance through the Indonesian social security system improved peoples understanding of health issues? Evidence from a national survey," Warwick-Monash Economics Student Papers 14, Warwick Monash Economics Student Papers.
    8. Lépine, A. & Lagarde, M. & Le Nestour, A., 2015. "Free primary care in Zambia: an impact evaluation using a pooled synthetic control method," Health, Econometrics and Data Group (HEDG) Working Papers 15/20, HEDG, c/o Department of Economics, University of York.
    9. Teresa Molina Millan & Karen Macours, 2017. "Attrition in randomized control trials: Using tracking information to correct bias," NOVAFRICA Working Paper Series wp1702, Universidade Nova de Lisboa, Nova School of Business and Economics, NOVAFRICA.
    10. Bagnoli, Lisa, 2019. "Does health insurance improve health for all? Heterogeneous effects on children in Ghana," World Development, Elsevier, vol. 124(C), pages 1-1.
    11. Powell-Jackson, Timothy & Ansah, Evelyn K., 2015. "The indirect effects of subsidised healthcare in rural Ghana," Social Science & Medicine, Elsevier, vol. 144(C), pages 96-103.
    12. Renard, Yohan, 2022. "From fees to free: User fee removal, maternal health care utilization and child health in Zambia," World Development, Elsevier, vol. 156(C).
    13. Strupat, Christoph & Klohn, Florian, 2018. "Crowding out of solidarity? Public health insurance versus informal transfer networks in Ghana," World Development, Elsevier, vol. 104(C), pages 212-221.
    14. Sven Neelsen & Owen O'Donnell, 2017. "Progressive universalism? The impact of targeted coverage on health care access and expenditures in Peru," Health Economics, John Wiley & Sons, Ltd., vol. 26(12), pages 179-203, December.
    15. Boutin, Delphine & Petifour, Laurene & Allard, Yvonne & Kontoubré, Souleymane & Ridde, Valéry, 2024. "Comprehensive Assessment of the Impact of Mandatory Community-Based Health Insurance in Burkina Faso," IZA Discussion Papers 17094, Institute of Labor Economics (IZA).
    16. Raju,Dhushyanth & Younger,Stephen D., 2022. "The Financial Risk Reduction Provided by Ghana’s National Health Insurance Scheme," Policy Research Working Paper Series 10073, The World Bank.
    17. P. M. Amegbor, 2017. "An Assessment of Care-Seeking Behavior in Asikuma-Odoben-Brakwa District: A Triple Pluralistic Health Sector Approach," SAGE Open, , vol. 7(2), pages 21582440177, June.
    18. Raphaël Cottin, 2018. "Free health care for the poor: a good way to achieve universal health coverage? Evidence from Morocco," Working Papers DT/2018/16, DIAL (Développement, Institutions et Mondialisation).

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    More about this item

    Keywords

    User fee removal; Healthcare subsidies; Ghana; Randomized experiment;
    All these keywords.

    JEL classification:

    • D12 - Microeconomics - - Household Behavior - - - Consumer Economics: Empirical Analysis
    • I10 - Health, Education, and Welfare - - Health - - - General
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • I31 - Health, Education, and Welfare - - Welfare, Well-Being, and Poverty - - - General Welfare, Well-Being

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