Demand for health care and health expenditures in peri-urban areas in a subsidized context in Pikine, Senegal.

Summary Improving access to health care for the population is now at the heart of poverty reduction policies. In this context, more and more countries in sub-Saharan Africa (SSA) are adopting policies to eliminate direct payments for care at the point of service. These policies aim to increase the demand for care by removing some of the financial barrier to accessing care and reduce the financial burden of illness that contributes to catastrophic expenditures. With the massive urbanization observed in the world and in particular in the countries of SSA, the management of the health of the peri-urban population has become more complex. The increase in the burden of morbidity linked to chronic diseases, plus that of communicable diseases which is still significant, makes it more difficult to control the health situation in these countries. The challenges posed by these changes have led to a renewed interest in the issues of access to health care and household health expenditures in urban areas. This thesis, based on data collected in the field, focuses on the demand for health care and the health expenditures of individuals in peri-urban areas. Chapter I presents the theoretical framework for analyzing the demand for health care and the specificities of this market, and presents Senegal. Chapter II presents the methodology for data collection and a detailed analysis of the types of illnesses identified, the therapeutic itinerary of patients and their health care expenditures. Chapter III focuses on the analysis of health care demand behavior related to acute symptoms reported by individuals. The analysis is carried out by estimating a multinomial probit. Chapter IV analyzes the determinants of individuals' health care expenditures with a Heckman model.