In this paper we provide an overview of the curative health care system in Ghana, discuss the determinants of its utilization, and simulate utilization patterns under alternative access policies. The figures point to two major challenges to improve access, viz. the geographical coverage of health facilities and health workers, and the financing of necessary health care of the poor. Ghana has a fair number of facilities (about 1 per 10,000 inhabitants and per 140 km2) but doctors are scarce (about 1 per 11,000 inhabitants) and both are highly unevenly spread in favor of urbanized regions. Almost one third of the population lives outside a 5-km radius of medical assistants and nurses, while one quarter is more than 15 km away from a doctor, who is the preferred health care provider when available. Moreover, the private cost of consultation and treatment is significant and shows large variation, restricting access to necessary health care for the poor. We use multinominal logit and probit techniques to explore opportunities to improve access. Simulations show positive, but modest, effects of reducing the distance to orthodox facilities in rural area and of replacing part of the private cost by national health insurance with income dependent premium. Thus, at the current stage of development, the provision of adequate health care at affordable prices to all remains a formidable challenge.