NCT06275867

Improved Access to Quality Care and Healthcare Use

The Impact of Access to Higher-quality Care Services on Health-seeking Patterns

• Status: Completed
• Phase: N/A
• Study type: Interventional
• Enrollment: 1,500 (actual)
• Sponsor: London School of Economics and Political Science · Academic / Other
• Sex: All
• Age: 2 Months – 6 Years
• Healthy volunteers: Accepted

Summary

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

Detailed 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.

Conditions

• Health Care Utilization
• Health Knowledge, Attitudes, Practice
• Health, Subjective

Interventions

Type	Name	Description
OTHER	Free high-quality care	Participants are able to take their child to receive free consultations and treatment in a network of contracted private healthcare providers.
OTHER	Close distance	The network of contracted providers is located close to where participants live.
OTHER	Far distance	The network of contracted providers is located far to where participants live.

Timeline

• Start date: 2024-01-20
• Primary completion: 2024-06-10
• Completion: 2024-08-30
• First posted: 2024-02-23
• Last updated: 2024-10-15

Locations

1 site across 1 country: South Africa