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I would like to share some observations on the studies referenced in the blog as they perhaps merit some further assessment: --On the Ansah study: "The purpose of Ansah and colleagues' study was not to examine wide-scale national experiences of abolishing user fees, as happened in countries such as Niger and Uganda. Rather, the study was a pilot project on free access to a prepayment scheme in the Dangme West District in southern Ghana, and to verify whether free access through pre-payment schemes would improve members' health. Thus, what was being tested was the effectiveness of pre-payment schemes, more than the abolition of user fees." http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000008 --On the Das study in HA, perhaps the interpretation of another World Bank staff member, Adam Wagstaff, is relevant to the discussion: "The results on the public-private differences are pretty interesting. In rural MH both sectors do equally – and very – badly in terms of ensuring the patient gets the right treatment. In Delhi by contrast going to the private sector halves the odds of getting the correct treatment, even though it raises the number of recommended questions the provider asks. It is the latter quality indicator that Das et al are presumably referring to in their conclusion when they say “we observed better quality care in the private sector”. That’s a bit misleading – it’s surely the correctness of the treatment prescribed that matters at the end of the day, not the number of questions asked. This work isn’t exactly a great advertisement for India’s private sector, or for the view that financial incentives will improve quality. But it’s not exactly a great advertisement for the public sector either. It also begs the question: Why does the private sector in Delhi do worse on the correctness-of-treatment indicator while the private and public sectors in rural MH do just as badly as one another? " http://blogs.worldbank.org/developmenttalk/shocking-facts-about-primary-health-care-in-india-and-their-implications --On the Cohen and Dupas study - this is what the authors of the study concluded from trial results : "Overall, our results suggest that free distribution of ITNs could save many more lives than cost-sharing programs have achieved so far, and, given the large positive externality associated with widespread usage of ITNs, would likely do so at a lesser cost per life saved." Also, it is important to note that there are other studies that show the opposite conclusion than the one in the blog: for example, Partners in Health cite a number of studies in support of abolishing fees...http://parthealth.3cdn.net/71d53fd770a3650456_zrm6bt8j6.pdf. I guess the question then is whether universal health coverage (UHC) is worth it - in the sense of expanding access (assuming that financial protection and peace of mind matter). Can we prove UHC improves outcomes? And the answer has to be yes if the quality of care is good...http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61485-8/fulltext.