Use of primary health care by people with disabilities: economic analyses based on data from the Handicap-Santé survey.

Summary Disability is multifactorial. All of its components are potential sources of barriers and disadvantages. The originality of this thesis is to take into account the complexity of the definition of disability in the analysis of the use of primary health care. The ultimate goal of primary health care is better health for all, through the reduction of exclusion and social inequalities in access to the health system. We understand disability in different ways until we integrate the three dimensions of "a disability situation" (functional dimension, environmental dimension, and social participation) in a single explanatory model. First, we analyze the functional dimension by considering disabled people as physically limited. Then, we investigate the environmental dimension through a study of adults living in institutions. Finally, we adopt a global vision of disability by simultaneously integrating all dimensions through the measurement of latent capabilities. The estimated model approaches an inter-individual comparability revealing, all other things being equal, the levels on which to act to mitigate inequalities. The analyses suggest that a favorable societal and/or socioeconomic environment could compensate for the negative effects of cognitive and physical limitations and restrictions. We conclude that there are several possible ways to improve the use of primary care: action on the environmental dimension and on social participation.