Using a Discounted Hour at Clinics to Extend Healthcare Access to the Underserved

We test whether adding a lower-priced but more restrictive type of visit at health clinics can expand access without significantly undermining revenues. Specifically, we evaluate a daily "discounted window" at clinics in rural Uganda during which nurses conduct group appointments priced at a flat fee of 1000 UGX (roughly $0.30), which is 10 to 15% of the average regular fee. Among villages in the catchment area of 44 health clinics, we distribute vouchers that confer eligibility for the discounted window in randomly selected treatment villages. Enrolled households in control villages instead receive a voucher that entitles them to a very small discount. To provide a benchmark, in a third arm, enrolled households receive a voucher that entitles them to the 1000 UGX price for regular visits any time during operating hours. Using the clinics' administrative data on patient visits, we will compare visit volumes across arms, distinguishing between patients who were versus were not underserved at baseline. The study examines both sides of a trade-off of using second-degree price discrimination instead of only the higher-price option: gains in access for individuals who would have been screened out by the fees versus revenue loss from existing patients shifting to the new lower-priced option.