This thesis presents a challenge to policy initiatives that presume that patient-centered care will reduce racial disparities in health. Data from the Medical Expenditure Panel Survey were used to test patient assessment of provider behavior defined as patient-centered care according to the National Health Disparities Report of the Agency for Healthcare Research and Quality of the Department of Health and Human Services. Results indicated patient-centered care improves self-rated health status, but blacks still report worse health status than whites experiencing comparable patient-centered care. Further, black-white differences in patient-centered care had no affect on health status. Rival theories of black-white differences in health, including social class and health literacy, provided better explanations of disparities than assessment of provider behaviors. These findings suggest that policies designed to financially incentivize patient-centered care practices by providers should be considered with caution. While patient-centered care is better quality care, financial incentives could have a negative effect on minority health if providers are deterred from practices that serve disproportionate numbers of poor and less literate patients and their families. Measurement of the concept of patient-centered care in future health disparities research was also discussed.

This thesis presents a challenge to policy initiatives that presume that patient-centered care will reduce racial disparities in health. Data from the Medical Expenditure Panel Survey were used to test patient assessment of provider behavior defined as patient-centered care according to the National Health Disparities Report of the Agency for Healthcare Research and Quality of the Department of Health and Human Services. Results indicated patient-centered care improves self-rated health status, but blacks still report worse health status than whites experiencing comparable patient-centered care. Further, black-white differences in patient-centered care had no affect on health status. Rival theories of black-white differences in health, including social class and health literacy, provided better explanations of disparities than assessment of provider behaviors. These findings suggest that policies designed to financially incentivize patient-centered care practices by providers should be considered with caution. While patient-centered care is better quality care, financial incentives could have a negative effect on minority health if providers are deterred from practices that serve disproportionate numbers of poor and less literate patients and their families. Measurement of the concept of patient-centered care in future health disparities research was also discussed.

La présente thèse tente de savoir s’il est opportun pour les pays en développement les moins avancés de s’engager davantage dans le processus de globalisation financière pour promouvoir leur croissance, et si ce processus influence les effets des instabilités, financière et monétaire, sur cette dernière. A cette fin, la thèse se déroule en trois parties. Avant d’examiner le cadre théorique de la globalisation financière, la première partie esquisse sa genèse avec en arrière-fond la recherche d’une réponse au problème de sa régulation. La deuxième partie s’intéresse à la littérature sur les effets de la globalisation financière sur la croissance, afin d’en tirer les enseignements pour une étude de 72 pays en développement à revenu bas de 1972 à 2011. La troisième partie se focalise sur les impacts de la globalisation financière et des deux instabilités considérées isolément, puis en interaction avec la globalisation sur la croissance à travers deux études empiriques basées sur le même cadre spatio-temporel que l’étude précédente. Ces dernières sont précédées par une revue des relations entre la globalisation financière, l’instabilité financière puis monétaire et la croissance, avec une analyse théorique de l’instabilité financière. Il en ressort que les instabilités, financière et monétaire, ont des effets négatifs sur la croissance, tandis que la globalisation financière, et en particulier la globalisation par l’investissement contrairement à celle par l’endettement, promeut les bienfaits des politiques économiques et du commerce extérieur, en plus de son effet positif direct sur la croissance même en présence des deux instabilités dont elle diminue les effets négatifs. / This thesis examines whether or not it is beneficial for least developed countries to engage more in the process of financial globalization in pursuit of their economic growth, and if this process influences the effects of financial and monetary instability on the latter. This thesis is divided into three parts. Before examining the theoretical framework of financial globalization, the first part sketches its genesis on a background of the research for an answer to the problem of its regulation. The second part focuses on the literature on the impact of financial globalization on growth. This is done in order to draw lessons for the establishment of a study covering 72 low-income developing countries over the period 1972-2011. The third part centers on the impact on economic growth of financial globalization and the two aforementioned types of instability, discussed both separately and in conjunction. Evidence is provided by two empirical studies based on the same spatio-temporal framework as the previous one. These studies are preceded by a review of the literature on the relationship between financial globalization, financial and then monetary instability and growth, in addition to a theoretical analysis of financial instability. This illustrates that financial and monetary instability have negative effects on growth, while financial globalization and in particular investment-globalization, unlike indebtedness-globalization, promotes the benefits of macroeconomic policies and international trade. This can be find in addition to its direct positive effect on growth, even in the presence of the two instabilities of which it reduces the negative effects.

The institutional quality concept, advanced by academic literature as a mean to enhance output growth, suffer from the absence of a clear implementation strategy. Considering that developing countries usually lack resources to be able to afford large-scale universal institutional reforms, the lack of roadmap puts substantial obstacles to practical application of the given concept. This thesis therefore goes beyond the simple statement of institutional primacy and sets an objective to differentiate the institutional effects relative to the level of development. To test it empirically, fixed effects model is chosen and interaction terms between the measures of institutional quality and the share of middle class are employed. Obtained coefficients indicate that institutions promote economic growth only when middle class share exceeds 25%. At the same time, different aspects of institutional quality exhibit contradictory dynamics. The control of corruption becomes growth enhancing only when middle class constitutes over one third of the population, while the relevance of government effectiveness for economic growth on the contrary decreases with the enlargement of middle class. These findings confirm the presence of conditionality and deny the existence of universal recipe for institutional reforms. Implementation of better institutions based on context-specific approach would therefore bring greater results in terms of economic growth than the direct adoption of best-practice institutions, so intensively advanced by the World Bank and the IMF.