Evaluation of public policies and social inequalities in access to health services.

Summary Despite the stated objectives of respecting the principle of horizontal equity, social inequalities in the use of health care are observed in countries with socialized health care systems.This thesis proposes, through four studies, to contribute to the analysis of public policies in the health care system, from the point of view of equity in the use of health care services. The introduction describes the social inequalities in the use of health care in France and the main mechanisms that may be at the origin of these inequalities within the French health care system. The first chapter studies the links between financial barriers to access to health care and health status. It shows that foregoing care for financial reasons is associated with a worse future health status.The second chapter proposes an analysis of the doctor-patient interaction and its role in the formation of inequalities in the use of care. We study the categorizations made by doctors about their patients according to their social situations. We then show the relationship between these categorizations and the practices observed. The first one proposes an analysis of the reform and its context, in particular the role of the different actors. The second proposes a study of the consequences of the reform on financial access to specialist care.