La recherche économique considère le médecin généraliste comme un agent offrant à l’échange information et services intellectuels en santé à des principaux. L’imparfaite convergence entre leurs objectifs, comme la présence d’incertitudes et d’asymétries d’information, conduisent le médecin à « fixer » les quantités, l’effort fourni et la qualité des soins et services rendus. Cette thèse vise à identifier le rôle des caractéristiques des généralistes, de leur mode d’exercice ou d’organisation, sur la performance de leur activité, en s’appuyant sur trois articles. Le premier analyse les déterminants de la variabilité de prescription d’antibiotiques pour rhinopharyngite aiguë, le second évalue l’impact du travail en équipe avec des infirmières sur la qualité et l’efficience des soins pour les patients diabétiques, et le troisième évalue l’impact de l’exercice regroupé pluriprofessionnel sur l’activité et l’efficience productive des généralistes et l’efficience des recours aux soins ambulatoires de leurs patients. Ces travaux de recherche permettent d’interroger la faiblesse relative de la régulation de l’offre de soins ambulatoire en France en matière de politique de maîtrise de l’évolution des dépenses de santé en comparaison de celle portant sur la demande. / According to economic research, the general practitioner is considered as an agent that offered information and intellectual services in health to principals. Imperfect convergence between their objectives, like the presence of uncertainties and information asymmetries, lead the physician “to fix” the quantities, the effort and the quality of the care and services delivered. Based on three articles, this thesis aims at identifying the role of the characteristics of the general practitioners and of their practice organization, on activity performance. The first articles analyzes the determinants of the antibiotic prescription for acute rhinopharyngitis variability, the second evaluates the impact of team working with nurses on the quality and the efficiency of the care for diabetic patients, and the third evaluates the impact of multi-professional group practices on the activity and the productive efficiency of GPs and on the utilization of ambulatory health care and by their patients. These researches question the relative weakness of the ambulatory health care regulation in France in terms of health care expenditure containment policies in comparison with that bearing on demand.

This thesis explores the entire cycle of education, from initial access to schooling, over degree completion, to returns to education. Despite recent gains in increasing access, an tens of millions of children worldwide are still out of school. Abolishing school fees has increased enrollment rates in several countries where enrollments were low and fees were high. However, such policies may be less effective, or even have negative consequences, when supply-side responses are weak. The first part of the thesis evaluates the impacts of a tuition waiver program in Haiti, which provided public financing to nonpublic schools conditional on not charging tuition. The chapter concludes that school's participation in the program results in more students enrolled, more staff, and slightly higher student-teacher ratios. The program also reduces grade repetition and the share of overage students. While the increase in students does not directly equate to a reduction in the number of children out of school, it does demonstrate strong demand from families for the program and a correspondingly strong supply response from the nonpublic sector.Pertaining degree completion, it is well established that natural disasters can have a negative effect on human capital accumulation. However, a comparison of the differential impacts of distinct disaster classes is missing. Using census data and information from DesInventar and EMDAT, two large disaster databases, the second part of the thesis assesses how geological disasters and climatic shocks affect the upper secondary degree attainment of adolescents. The chapter focuses on Mexico, given its diverse disaster landscape and lack of obligatory upper secondary education over the observed time period. While all disaster types are found to impede attainment, climatic disasters that are not infrastructure-destructive (e.g. droughts) have the strongest negative effect, decreasing educational expansion by over 40%. The effects seem largely driven by demand-side changes such as increases in school dropouts and fertility, especially for young women. The results may also be influenced by deteriorated parental labor market outcomes. Supply-side effects appear to be solely driven by infrastructure-destructive climatic shocks (e.g. floods). These findings thus call for differential public measures according to specific disaster types and an enhanced attention to climatic events given their potentially stronger impact on younger generations.It is also widely appreciated that natural disasters can have negative impacts on local labor market outcomes. However, the study of differential types of negative capital shocks, the underlying labor market mechanisms, and the context of the poorest countries have been neglected. Following testable predictions of economic theory, the third part of the thesis exploits the exogenous variation of destruction of human and physical capital caused by the 2010 Haiti earthquake to disentangle the differential impact on local individual monetary returns to education. Employing individual-level survey data from before and after the earthquake the chapter finds that the returns decreased on average by 37%, especially in equipment-capital intensive industry. Higher educated individuals adjust into low-paying self-employment or agriculture. The returns are particularly shock-sensitive for urban residents, migrants, males, and people over age 25. / Doctorat en Sciences économiques et de gestion / info:eu-repo/semantics/nonPublished