Improved Access to Quality Care and Healthcare Use

London School of Economics and Political Science

Status: Completed

Conditions: Health Knowledge, Attitudes, Practice; Health Care Utilization; Health, Subjective

Treatments: Other: Far distance; Other: Free high-quality care; Other: Close distance

Study type: Interventional

Funder types: Other

Identifiers

NCT06275867

SOPRIMA//T023635

Details and patient eligibility

About

This study is an individual-level randomised controlled trial which looks at the effect of providing free access to higher quality providers in urban South Africa. The study will recruit about 1,500 individuals with a child aged 5 or under. They will be randomly allocate to a control group (CONTROL) with the default free access to government facilities or one of the two treatment groups where they will have free access to private providers located either relatively close (CONVENIENT) by or relatively far (INCONVENIENT). The primary outcomes be overuse and underuse of healthcare services for children under 5

Full description

In many low-income settings, provision of social services by the public sector is plagued by problems of quality and low accountability to users. As a result, low expected benefits or fear of neglect by service providers may delay the use of needed services, even when those are free.

In South Africa, the health system is characterised by stark inequalities, with most of the population only able to seek care in free government facilities. The low quality of the public sector, where patients wait long times to be seen by nurses, is believed to lead many to delay needed care and prevent health outcome improvement. The government of South Africa is developing proposals to introduce a national health insurance scheme that would provide free access to private providers who deliver higher care quality. However, concerns about the unequal geographical distribution of private providers raise questions about the potential benefits of the reform. This study asks several questions to inform this reform:

1. Does access to higher-quality care reduce under-use of services for children but also increase overuse?
2. Does access to higher-quality care lead to improved health knowledge of parents and better health outcomes for children?
3. Are these effects mitigated by the distance to the contracted providers? A randomised controlled trial is used to answer these questions. The study will recruit about 1,500 individuals who are the primary caregiver of at least one child aged six or under. and randomly allocate them to a control group (CONTROL) with the default free access to government facilities or one of the two treatment groups where they will have free access to private providers located either relatively close (CONVENIENT) by or relatively far (INCONVENIENT).

The primary outcomes will be the proportion of visits that are considered unnecessary (overuse) and the number of days of illness where care-seeking is recommended by guidelines but not sought by the child's parent or guardian.

Secondary outcomes will include (1) the number of days with ill-health symptoms; (2) out-of-pocket expenditures; (3) health knowledge of parents; (4) subjective and (5) objective measures of child's health.

Enrollment: 1,500 patients

Sex: All

Ages: 2 months to 6 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• parent has a child aged under 6 years old and over 2 months old

Exclusion criteria

• is planning to move out of the area in the next 3 months
• has private medical aid

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

---

1,500 participants in 3 patient groups

Control group

No Intervention group

Description:

In this group, participants will have free access to government facilities (usual care)

Convenient group

Experimental group

Description:

In this group, for the duration of the study, participants will be given free access to a small number of private providers located relatively close by (less than 30 minutes).

Treatment:

Other: Close distance

Other: Free high-quality care

Inconvenient group

Experimental group

Description:

In this group, for the duration of the study, participants will be given free access to a small number of private providers located relatively far (about one hour).

Treatment:

Other: Free high-quality care

Other: Far distance