Cette recherche se propose d’étudier l’impact du vieillissement futur de la population algérienne sur l’équilibre financier du système des retraites et les dépenses de santé. Après une période de croissance rapide de la population, l’Algérie est entrée dans une phase de vieillissement démographique. Cette dernière a marqué la pyramide des âges pour la premièrefois en 1998, avec une modification importante de la structure par âge confirmée par le dernier recensement de 2008. En Algérie, comme l’a été la baisse de la fécondité, le vieillissement de la population, dans les deux à trois décennies à venir, devrait suivre un rythme rapide, voire extrêmement rapide, comparé à celui observé dans les pays développés. Ce phénomène aura des conséquences dans beaucoup de domaines ; notamment au niveau du financement des retraites, et de la maîtrise des dépenses de santé. Dans les deux à trois décennies à venir les dépenses de retraites et de santé devraient connaître une croissance importante sous l’effet du vieillissement. Il incombe aux pouvoirs publics de s’y préparer et de s’y adapter afin de relever le défi qu’imposera le vieillissement futur de la population algérienne afin de garantir l’équilibre financier et la pérennité des deux systèmes, à savoir celui des retraites et de la santé. / The research aims to study the impact of future aging of the Algerian population on the financial balance of the pension system and health expenditure. After a period of rapid demographic growth, Algeria entered a phase of population aging. This was noticed on the age-sex pyramid for the first time in 1998, with a significant change in the age structure. Thischange was confirmed by the last census in 2008. In Algeria, as for fertility, aging is likely to follow a rapid or extremely rapid pace, within two to three decades, compared with observed experiences in developed countries. This will imply consequences in many areas including in pensions’ funding and health expenditure control. Within two to three decades, the pension and health spending will grow significantly as a result of aging. The government has to face the challenge of the future burden of aging of the Algerian population and to ensure the financial stability and sustainability of both systems, namely pensions and health.

Die Arbeit analysiert die Bedeutung des demografischen Wandels für die Entwicklung der Gesundheitsausgaben in Deutschland bis zum Jahr 2050. Anhand von Querschnittsdaten der amtlichen Statistik für den Bereich der Krankenhäuser wird unter der Annahme konstanter Altersprofile der Gesundheitsausgaben pro Kopf sowie konstanter Inzidenzraten der isolierte demografisch bedingte Ausgabenanstieg prognostiziert. Der theoretische Teil der Arbeit stellt weitere Einflussfaktoren sowie die Medikalisierungs- und Kompressionsthese zur Entwicklung von Morbidität im Alter vor. Als Antwort auf den diagnostizierten Anstieg der Ausgaben werden mögliche Reformansätze diskutiert.:1. Einleitung 1.1 Zielsetzung 1.2 Methodisches Vorgehen 2. Die Ausgangslage: Demografische Entwicklung und Gesundheitswesen in Deutschland 2.1 Entwicklungslinien des demografischen Wandels 2.2 Das deutsche Gesundheitswesen im Überblick 2.3 Determinanten der Kostenentwicklung im Gesundheitswesen 2.3.1 Demografische Entwicklung 2.3.2 Medizinisch-technischer Fortschritt 2.3.3 Veränderungen von Angebotsstruktur und Nachfrageverhalten 2.3.4 Veränderungen des rechtlichen Rahmens 3. Altersabhängigkeit der Gesundheitsausgaben 3.1 Zwei Thesen zum Einfluss der demografischen Entwicklung 3.1.1 Kompressions- und Medikalisierungsthese 3.1.2 Empirische Evidenz der beiden Thesen 3.2 Der Einfluss der Nähe zum Tod auf die Gesundheitsausgaben 3.3 Beeinflussung der Kostenprofile 3.4 Bisherige Arbeiten zum Einfluss der demografischen Entwicklung auf die Gesundheitsausgaben 4. Prognose des demografiebedingten Kostenanstiegs 4.1 Methodik 4.2 Die Daten 4.2.1 Bevölkerungsvorausberechnung 4.2.2 Diagnosedaten 4.2.3 Gesundheitsausgaben 4.3 Zugrundeliegende Annahmen 4.4 Ergebnisse 5. Diskussion der Prognoseresultate 5.1 Einordnung der Ergebnisse 5.2 Gesellschaftspolitische Implikationen 5.3 Implikationen für die künftige Ausgestaltung des Gesundheitswesens 6. Fazit: Demografische Katastrophe oder Strohfeuer / The paper analyses the effects of continued demographic change on health expenditure in Germany until 2050. Using cross sectional data from official statistics for hospitals the isolated effect of demographic change on future expenditure is predicted by assuming time-invariant age-specific expenditure profiles per capita and incidence for specific groups of diagnoses. Further influencing factors as well as competing theories of compression versus expansion of morbidity are presented. As a reaction to the challenge of expected further increases in health expenditure, possible reforms are discussed.:1. Einleitung 1.1 Zielsetzung 1.2 Methodisches Vorgehen 2. Die Ausgangslage: Demografische Entwicklung und Gesundheitswesen in Deutschland 2.1 Entwicklungslinien des demografischen Wandels 2.2 Das deutsche Gesundheitswesen im Überblick 2.3 Determinanten der Kostenentwicklung im Gesundheitswesen 2.3.1 Demografische Entwicklung 2.3.2 Medizinisch-technischer Fortschritt 2.3.3 Veränderungen von Angebotsstruktur und Nachfrageverhalten 2.3.4 Veränderungen des rechtlichen Rahmens 3. Altersabhängigkeit der Gesundheitsausgaben 3.1 Zwei Thesen zum Einfluss der demografischen Entwicklung 3.1.1 Kompressions- und Medikalisierungsthese 3.1.2 Empirische Evidenz der beiden Thesen 3.2 Der Einfluss der Nähe zum Tod auf die Gesundheitsausgaben 3.3 Beeinflussung der Kostenprofile 3.4 Bisherige Arbeiten zum Einfluss der demografischen Entwicklung auf die Gesundheitsausgaben 4. Prognose des demografiebedingten Kostenanstiegs 4.1 Methodik 4.2 Die Daten 4.2.1 Bevölkerungsvorausberechnung 4.2.2 Diagnosedaten 4.2.3 Gesundheitsausgaben 4.3 Zugrundeliegende Annahmen 4.4 Ergebnisse 5. Diskussion der Prognoseresultate 5.1 Einordnung der Ergebnisse 5.2 Gesellschaftspolitische Implikationen 5.3 Implikationen für die künftige Ausgestaltung des Gesundheitswesens 6. Fazit: Demografische Katastrophe oder Strohfeuer

Dans le contexte d’une population vieillissante, nous avons étudié l’impact de la présence de personnes âgées sur les dépenses catastrophiques de santé (DCS), ainsi que leur impact sur trois effets reliés (le fait d’éviter des traitements, la perte de revenu, et l’utilisation de sources de financement alternatives). Nous avons utilisé les données d’une enquête du National Sample Survey Organization (Inde) en 2004, portant sur les dépenses reliées à la santé. Nous avons choisi un état développé (Kerala) et un état en voie de développement (Bihar) pour faire une comparaison des effets de la présence de personnes âgées sur les ménages. Nous avons trouvé qu’il y avait plus de DCS au Kerala et que ceci était probablement lié à la présence accrue de personnes âgées au Kerala ce qui mène à plus de maladies chroniques. Nous avons supposé que l’utilisation de services de santé privés serait lié à une augmentation de DCS, mais l’effet a varié en fonction de l’état, du présence d’une personne âgée, et du type de service utilisé (ambulatoire ou hospitalisation). Nous avons aussi trouvé que les femmes âgées au Bihar utilisait les services de santé moins qu’elle ne devrait, que les ménages ayant plus de 4 personnes ont possiblement un effet protecteur pour les personnes âgées, et que certains castes et group religieux ont dû emprunter plus souvent que d’autres groupes pour payer les frais de santé. La présence de personnes âgées, les maladies chroniques, et l’utilisation de services de santé privées sont tous liés aux DCS, mais, d’après nos résultats, d’autres groupes retardent les conséquences économiques en empruntant ou évitant les traitements. Nous espérons que ces résultats seront utilisés pour approfondir les connaissances sur l’effet de personnes âgées sur les dépenses de santé ou qu’ils seront utilisés dans des discussions de politiques de santé. / In the context of an ageing population in India, we have examined the impact of the elderly on catastrophic health expenditure (CHE) and three related access impacts (avoidance of treatment, loss of income, and alternate sources of funding). We used data from the National Sample Survey Organization (India) survey on healthcare in 2004. We chose one developed state (Kerala) and one developing state (Bihar) to compare and contrast the impact of ageing on households. Our results showed that CHE was higher in Kerala and that this was likely due to more elderly that in turn have more chronic disease. We expected the use of private treatment to lead to higher levels of CHE, and while it did for some households, the impact of private treatment on CHE, varied by state, presence of elderly, and type of health service (inpatient or outpatient). We also found that elderly females in Bihar were at a disadvantage with regards to health services utilizations, that larger household size might have a protective effect on elderly households, and that some scheduled caste and Muslim households have to borrow more often than other groups in order to fund their treatment. While the elderly, chronic disease and private treatment are linked to CHE, our results suggest that other groups may simply be delaying the consequences of paying for healthcare, by avoiding treatment or borrowing money. We hope that these results be used to explore the impact of the elderly in more detail in future research, or that it contribute to health policy discussions.

Analysis of the impact of ageing on health care spending in selected countries of the Commonwealth Abstract This thesis examines and analyses development of population ageing in Australia, Canada and New Zealand and especially its impact on the spending in the sector of health care. It includes comparison of demographic trends and description of health care systems in selected countries. The analysis is then processed by an econometric model focused on the impact of population ageing on government spending and spending of the private sector on health care through life expectancy at birth, ratio of population aged 65 years and above and other indicators. The modelling is carried out using linear regression, vector autoregression and fixed effects model in panel data. The results show that population ageing indeed affects through different intensity both government and private sector spending on health care in Australia, Canada and New Zealand.

Dans le contexte d’une population vieillissante, nous avons étudié l’impact de la présence de personnes âgées sur les dépenses catastrophiques de santé (DCS), ainsi que leur impact sur trois effets reliés (le fait d’éviter des traitements, la perte de revenu, et l’utilisation de sources de financement alternatives). Nous avons utilisé les données d’une enquête du National Sample Survey Organization (Inde) en 2004, portant sur les dépenses reliées à la santé. Nous avons choisi un état développé (Kerala) et un état en voie de développement (Bihar) pour faire une comparaison des effets de la présence de personnes âgées sur les ménages. Nous avons trouvé qu’il y avait plus de DCS au Kerala et que ceci était probablement lié à la présence accrue de personnes âgées au Kerala ce qui mène à plus de maladies chroniques. Nous avons supposé que l’utilisation de services de santé privés serait lié à une augmentation de DCS, mais l’effet a varié en fonction de l’état, du présence d’une personne âgée, et du type de service utilisé (ambulatoire ou hospitalisation). Nous avons aussi trouvé que les femmes âgées au Bihar utilisait les services de santé moins qu’elle ne devrait, que les ménages ayant plus de 4 personnes ont possiblement un effet protecteur pour les personnes âgées, et que certains castes et group religieux ont dû emprunter plus souvent que d’autres groupes pour payer les frais de santé. La présence de personnes âgées, les maladies chroniques, et l’utilisation de services de santé privées sont tous liés aux DCS, mais, d’après nos résultats, d’autres groupes retardent les conséquences économiques en empruntant ou évitant les traitements. Nous espérons que ces résultats seront utilisés pour approfondir les connaissances sur l’effet de personnes âgées sur les dépenses de santé ou qu’ils seront utilisés dans des discussions de politiques de santé. / In the context of an ageing population in India, we have examined the impact of the elderly on catastrophic health expenditure (CHE) and three related access impacts (avoidance of treatment, loss of income, and alternate sources of funding). We used data from the National Sample Survey Organization (India) survey on healthcare in 2004. We chose one developed state (Kerala) and one developing state (Bihar) to compare and contrast the impact of ageing on households. Our results showed that CHE was higher in Kerala and that this was likely due to more elderly that in turn have more chronic disease. We expected the use of private treatment to lead to higher levels of CHE, and while it did for some households, the impact of private treatment on CHE, varied by state, presence of elderly, and type of health service (inpatient or outpatient). We also found that elderly females in Bihar were at a disadvantage with regards to health services utilizations, that larger household size might have a protective effect on elderly households, and that some scheduled caste and Muslim households have to borrow more often than other groups in order to fund their treatment. While the elderly, chronic disease and private treatment are linked to CHE, our results suggest that other groups may simply be delaying the consequences of paying for healthcare, by avoiding treatment or borrowing money. We hope that these results be used to explore the impact of the elderly in more detail in future research, or that it contribute to health policy discussions.

nÃo hà / The thesis consists of three chapters that have in common estimation models for panel data. The first chapter titled "Energy Consumption, GDP per capita and Exports: Evidence of long-term causality in a panel for the Brazilian States" analyzes the order of causality between the variables and then checks the long-term elasticities using the methodology FMOLS. It shows that GDP per capita is caused by their own past achievements, by consumption of electricity and exports. The consumption of electricity and exports, only are not caused by GDP per capita. Through the model FMOLS were estimated elasticities of long-term. The 1% increase in energy consumption and exports increased respectively 0.07% and 0.04 % in GPD per capita. The second chapter, entitled "Sustainability of Health Expenditure and Sanitation in Brazil: an analysis with Panel Data for the period 1985 to 2005" examines the sustainability of Health Expenditure and Sanitation of the states and the Federal District of Brazil, during the period 1985 to 2005. For this, we use the ratio of Expenditure by Function (Health and Sanitation) and GDP. The unit root tests for panel data refute the null hypothesis of presence of the unit root (the stochastic process is stationary) at 5% significance level. Accordingly, we can infer that the policy of health expenditure as a proportion of GDP remained almost stable (sustainable) over the period in question. The third chapter entitled "Formation of Convergence Clubs and Analysis of the Determinants of Economic Growth" support the formation of 10 clubs of convergence for a sample of 112 countries with per capita GPD data from 1980 to 2014 using the Phillips and Sul methodology (2007). Logged clubs and estimated a panel to investigate the impact of macroeconomic variables in the dynamics of economic growth rate through the Arellano and Bond model (1991) showed that: i) Inflation impacts the growth rate negatively, with effect greater for clubs that converge to a higher level of per capita income ii) imports as a proportion of GDP have positive relationship with the growth rate of per capita income for the countries belonging to clubs intermediaries, and a negative effect for other clubs iii) Exports as a proportion of GDP have a positive effect for all clubs, but is more pronounced for clubs that converge to a lower level of income and iv) international reserves have a positive effect for clubs that converge to high levels of income and a negative effect on clubs that converge to low levels of income. / A tese à composta por trÃs capÃtulos que possuem em comum modelos de estimaÃÃo para dados em painel. O primeiro capÃtulo intitulado âConsumo de Energia ElÃtrica, PIB per capita e ExportaÃÃo: Uma evidÃncia de causalidade de longo prazo em um painel para os Estados brasileirosâ analisa a o ordem de causalidade entre as variÃveis e posteriormente verifica as elasticidades de longo prazo atravÃs da metodologia FMOLS. Evidencia-se que o PIB per capita à causado pelas suas prÃprias realizaÃÃes passadas, pelo consumo de energia elÃtrica e pelas exportaÃÃes. Jà o consumo de energia elÃtrica e as exportaÃÃes, apenas nÃo sÃo causados pelo PIB per capita. AtravÃs do modelo FMOLS, estimaram-se as elasticidades de longo prazo. O aumento de 1% no consumo de energia e exportaÃÃes aumenta respectivamente 0,07% e 0,04% no PIB per capita. O segundo capÃtulo, intitulado âSustentabilidade dos Gasto com SaÃde e Saneamento no Brasil: uma anÃlise com Dados em Painel para o perÃodo de 1985 a 2005â examina a sustentabilidade dos gastos com saÃde e saneamento dos Estados e do Distrito Federal brasileiro, durante o perÃodo de 1985 a 2005. Para isso, utiliza-se da razÃo entre a Despesa por FunÃÃo (SaÃde e Saneamento) e o PIB. Os testes de raiz unitÃria para dados em painel refutam a hipÃtese nula de presenÃa de raiz de raiz unitÃria (i.e., o processo estocÃstico à estacionÃrio) ao nÃvel de 5% de significÃncia. Nestes termos, pode-se inferir que a polÃtica de gastos com saÃde como proporÃÃo do PIB praticamente permaneceu estÃvel (i.e., sustentÃvel) ao longo do perÃodo em questÃo. O terceiro capÃtulo intitulado âFormaÃÃo de Clubes de ConvergÃncia e AnÃlise dos Determinantes do Crescimento EconÃmicoâ sustenta a formaÃÃo de 10 clubes de convergÃncia para uma amostra de 112 paÃses com dados do PIB per capita de 1980 a 2014 atravÃs da metodologia Phillips e Sul (2007). Identificados os clubes e estimado um painel para verificar o impacto de variÃveis macroeconÃmicas na dinÃmica da taxa de crescimento econÃmico atravÃs do modelo Arellano e Bond (1991), evidenciou-se: i) A inflaÃÃo impacta a taxa de crescimento de forma negativa, com efeito maior para clubes que convergem para um nÃvel de renda per capita mais elevado; ii) As importaÃÃes como proporÃÃo do PIB possuem relaÃÃo positiva com a taxa de crescimento da renda per capita para os paÃses pertencentes a clubes intermediÃrios, e efeito negativo para os clubes do extremo; iii) As exportaÃÃes como proporÃÃo do PIB possuem efeito positivo para todos os clubes, porÃm à mais acentuado para clubes que convergem para um nÃvel de renda mais baixo e; iv) As reservas internacionais possuem efeito positivo para clubes que convergem para elevados nÃveis de renda e efeito negativo para os clubes que convergem para baixos nÃveis de renda.

Introduction: The European Union (EU) is a political and economic confederation <p>composed by 27 member states (EU-27). The EU implemented several standardizations in laws, <p>justice and home affairs and shares the consensus that health care should be regulated by the <p>state. A high level of human protection should be ensured in all its member states. European <p>health systems are funded and managed by each national government and for historical <p>reasons health policy and health expenditure are not homogeneous. <p>Whereas cancer incidence is dependent on factors such as population age, life-style and <p>genetic predisposition, cancer mortality in general is dependent on the efficacy of health <p>systems in providing cancer prevention, efficient screening methods and treatments. <p>Around 20% of the breast cancers show amplification/overexpression of HER2 that is <p>associated with a more aggressive disease and worse clinical outcome. By targeting the HER2 <p>receptor trastuzumab has significantly improved overall survival and changed the natural <p>course of this disease. <p>Objectives: This study aims to evaluate (1) the association of health expenditure with <p>breast cancer outcome, (2) to explore to which degree the differences in breast cancer survival <p>are related to the speed of uptake of trastuzumab and its determinants and (3) to evaluate the <p>real usage of trastuzumab and its relation to breast cancer survival in the EU. <p>Results: Breast cancer survival was found strongly correlated with health expenditure. A <p>clear cutoff divides Western and Eastern Europe in that regard, with western countries showing <p>higher health expenditure and higher breast cancer survival than Eastern Europe. Trastuzumab <p>reimbursement was faster in Western European countries, a factor associated with higher <p>health expenditure and better health policy performance. Trastuzumab uptake is increasing all <p>over Europe in the last 12 years, however it is still being under used in Eastern countries while <p>in Western Europe the uptake is sufficient to treat virtually all patients in need of the drug. <p>Conclusion: Important discrepancies in breast cancer survival exist in the EU. Western <p>Europe has higher breast cancer survival and higher health expenditure than Eastern Europe. <p>This can be partially explained by the faster approval and increased uptake of trastuzumab in <p>Western countries. Higher health expenditure and better health policy performance were <p>factors linked to faster reimbursement and uptake of trastuzumab. / Doctorat en sciences médicales / info:eu-repo/semantics/nonPublished

This diploma thesis deals with the Czech healthcare system. Healthcare is generally reffered to as system but not always healthcare problems are solved systematically. Therefore systems theory, theory of complex adaptive systems and other notions, that are often used in healthcare, were described in this thesis. The objective of this thesis was analysis of impacts of patient's financial participation (20 %, 25 % and 30 %) on health care to their financial situation in the complex adaptive healthcare system. In this thesis four indicators were used -- poverty line, household subsistence spending, impoverished households, catastrophic health expenditure. The World Health Organization defined this indicators for World Health Survey in different countries. The indicators were applied to a sample of Czech households and some impacts of increased participation were calculated. It results from this calculation that the increased participation of households has virtually only small impacts to their financial situation. By the indicators of poverty just few households would be on the poverty line. Nevertheless, this results aren't generalized to the whole Czech population. With this indicators we should further work and develop them in order that they could serve as tool to evaluation of state's intervetion into healthcare system.

States are facing tough economic times as a result of the housing market bubble exploding. States have been declaring budget deficits and major program cuts, since revenues have not kept up with expenditures and rainy day funds have been practically exhausted. State tax revenues have decreased, resulting from a decline in income tax revenues, one of the major sources of revenues for a large number of states (41 in total). A majority of these states have come to depend heavily on the revenue they collect from income taxes, which can represent as much as 40% of state tax revenue. This thesis focuses on the impact that income tax revenue has on state budgets and how it affects certain expenditures. To provide a more complete understanding on how fiscal policy affects the citizen directly, this thesis compares the changes in state's total tax revenue and spending on education and health programs between states that levy income tax and states that do not. Data from the United States Census Bureau and the National Association of State Budget Officials was analyzed by calculating the growth rate and relevant elasticities during 2006-2010, the years before, during, and after the last recession. Results will show a difference in changes in revenue and expenditure between the two types of states and a more sensitive elasticity for non-income tax states for both revenue and expenditure. With a better understanding of how the tax base behaves and how revenue affects programs, an improved tax policy that could produce more efficient services for citizens might be created.

Health economists, national decision-makers and global health specialists have been interested in calculating the cost of a disease for many years. Only more recently they started to generate more comprehensive frameworks and tools to estimate the full range of healthcare related costs of illness in a user’s perspective in resource-poor settings. There is now an ongoing trend to guide health policy, and identify the most effective ways to achieve universal health coverage. The user fee exemptions health financing schemes, which grounded the tuberculosis control strategy, have been designed to improve access to essential care for ill individuals with a low capacity to pay. After decades of functioning and substantial progress in tuberculosis detection rate and treatment success, this thesis analyses the extent of the coverage (financial and social protection) of two disease control programs in West Africa. Learning from the concept of the medical poverty trap (Whitehead, Dahlgren, et Evans 2001) and available framework related to the economic consequences of illness (McIntyre et al. 2006), a conceptual framework and a data collection tool have been developed to incorporate the direct, indirect and intangible costs and consequences of illness incurred by chronic patients. In several ways, we have sought to provide baseline for comprehensive analysis and standardized methodology to allow comparison across settings, and to contribute to the development of evidence-based knowledge.<p><p>To begin, filling a knowledge gap (Russell 2004), we have performed microeconomic research on the households’ costs-and-consequences-of-tuberculosis in Burkina Faso and Benin. The two case studies have been conducted both in rural and urban resource-poor settings between 2007 and 2009. This thesis provides new empirical findings on the remaining financial, social and ‘healthcare delivery related organizational’ barriers to access diagnosis and treatment services that are delivered free-of-charge to the population. The direct costs associated with illness incurred by the tuberculosis pulmonary smear-positive patients have constituted a severe economic burden for these households living in permanent budget constraints. Most of these people have spent catastrophic health expenditure to cure tuberculosis and, at the same time, have faced income loss caused by the care-seeking. To cope with the substantial direct and indirect costs of tuberculosis, the patients have shipped their families in impoverishing strategies to mobilize funds for health such as depleting savings, being indebted and even selling livestock and property. Damaging asset portfolios of the disease-affected households on the long run, the coping strategies result in a public health threat. In resource-poor settings, the lack of financial protection for health may impose inability to meet basic needs such as the rights to education, housing, food, social capital and access to primary healthcare. Special feature of our work lies in the breakdown of the information gathered. We have been able to demonstrate significant differences in the volume and nature of the amounts spent across the successive stages of the care-seeking pathway. Notably, pre-diagnosis spending has been proved critical both in the rural and urban contexts. Moreover, disaggregated cost data across income quintiles have highlighted inequities in relation to the direct costs and to the risk of incurring catastrophic health expenditure because of tuberculosis. As part of the case studies, the tuberculosis control strategies have failed to protect the most vulnerable care users from delayed diagnosis and treatment, from important spending even during treatment – including significant medical costs, and from hidden costs that might have been exacerbated by poor health systems. To such devastating situations, the tuberculosis patients have had to endure other difficulties; we mean intangible costs such as pain and suffering including stigmatization and social exclusion as a result of being ill or attending tuberculosis care facilities. The analysis of all the social and economic consequences for tuberculosis-affected households over the entire care-seeking pathway has been identified as an essential element of future cost-of-illness evaluations, as well as the need to conduct benefit incidence assessment to measure equity.<p><p>This work has allowed identifying a series of policy weaknesses related to the three dimensions of the universal health coverage for tuberculosis (healthcare services, population and financial protection coverage). The findings have highlighted a gap between the standard costs foreseen by the national programs and the costs in real life. This has suggested that the current strategies lack of patient-centered care, context-oriented approaches and systemic vision resulting in a quality issue in healthcare delivery system (e.g. hidden healthcare related costs). Besides, various adverse effects on households have been raised as potential consequences of illness; such as illness poverty trap, social stigma, possible exclusion from services and participation, and overburdened individuals. These effects have disclosed the lack of social protection at the country level and call for the inclusion of tuberculosis patients in national social schemes. A last policy gap refers to the lack of financial protection and remaining inequities with regards to catastrophic health expenditure still occurring under use fee exemptions strategies. Thereby, one year before 2015 – the deadline set for the Millennium Development Goals – it is a matter of priority for Benin and Burkina Faso and many other countries to tackle adverse effects of the remaining social, economic and health policy and system related barriers to tuberculosis control. These factors have led us to emphasize the need for countries to develop sustainable knowledge. <p><p>National decision-makers urgently need to document the failures and bottlenecks. Drawing on the findings, we have considered different ways to strengthen local capacity and generate bottom-up decision-making. To get there, we have shaped a decision framework intended to produce local evidence on the root causes of the lack of policy responsiveness, synthesize available evidence, develop data-driven policies, and translate them into actions.<p><p>Beyond this, we have demonstrated that controlling tuberculosis was much more complex than providing free services. The socio-economic context in which people affected by this disease live cannot be dissociated from health policy. The implications of microeconomic research on the households’ costs and responses to tuberculosis may have a larger scope than informing implementation and adaptation of national disease-specific strategies. They can be of great interest to support the definition of guiding principles for further research on social protection schemes, and to produce evidence-based targets and indicators for the reduction and the monitoring of economic burden of illness. In this thesis, we have build on prevailing debates in the field and formulated different assumptions and proposals to inform the WHO Global Strategy and Targets for Tuberculosis Prevention, Care and Control After 2015. For us, to reflect poor populations’ needs and experiences, global stakeholders should endorse bottom-up and systemic policy-making approaches towards sustainable people-centered health systems.<p><p>The findings of the thesis and the various global and national challenges that have emerged from case studies are crucial as the problems we have seen for tuberculosis in West Africa are not limited to this illness, and far outweigh the geographical context of developing countries.<p><p><p>Keywords: Catastrophic health expenditure, Coping strategies, Cost-of-illness studies, Direct, indirect and intangible costs, Evidence-based Public health, Financial and Social protection for health, Health Economics, Health Policy and Systems, Informed Decision-making, Knowledge translation, People-centered policy-making, Systemic approach, Universal Health Coverage<p> / Doctorat en Sciences de la santé publique / info:eu-repo/semantics/nonPublished