Abstract
Health is a fundamental human right and is central to development challenges. Health is also at the heart of the Sustainable Development Goals (SDGs). In order to meet the health needs of the population and to participate in the achievement of the SDGs, efficient health systems are necessary. Therefore, the efficiency and regulation of health systems are essential to achieve better health results given the resources used. However, measuring health performance is not always easy, and there are many ways to do so. Moreover, the health challenges that countries are facing differ according to geographic and socio-economic contexts. This thesis seeks to provide insights into the topic of efficiency of health systems by investigating various ways to improve it.In the context of increasing healthcare expenditures, health technology assessment has become crucial to optimize resources’ utilization in high-income countries. The first chapter exploits the introduction of medico-economic evaluation of innovative drugs in France since 2014 to create a unique database with the objective of revealing ex post the market access criteria used by the regulator. Firstly, the analysis focuses on the criteria associated with the clinical value (SMR - Service Service Médical Rendu), which determines the reimbursement rate of drugs in France, and on the criteria associated with the improvement of the clinical added value (ASMR - Amélioration du Service Médical Rendu), which constitutes a basis for price negotiation. Among official criteria, not all seem to be actually considered in the evaluation of these two criteria. Secondly, the Incremental Cost-Utility Ratios (ICURs) calculated by pharmaceutical firms are studied. These ratios appear to be lower for drugs with a large target population and higher for drugs with a pediatric indication or with no therapeutic alternative.Health challenges differ from one country to another, and primary health care is of crucial importance in low-income countries. The second chapter of this thesis provides an analysis of the technical efficiency of advanced medical centers (AMC), which correspond to district hospitals, in Burkina Faso. The efficiency of AMCs is assessed using a bootstrapped non-parametric data envelopment analysis (DEA) method. Efficiency scores calculated for AMCs are relatively low, indicating the potential for increased healthcare production without additional costs. Moreover, the size, education level, and health status of the covered population and the density of the healthcare supply in the district appeared as the main driving factors of AMCs’ efficiency.In a broader vision, all policies that enable the improvement of the population's health might be considered when assessing health systems’ efficiency. The third part of this thesis chapter focuses on how access to information on the internet can influence preventive healthcare behaviors. Indeed, various studies have established a link between the provision of health information and health behaviors. More precisely, this study aims at investigating whether internet access impacts the use of antenatal visits, the use of mosquito nets, and children’s vaccinations in Senegal. Using a double-difference methodology, our results show that internet access increases the use of bed nets for children under five but has undetermined or no effect on children’s vaccinations and antenatal visits.