Santé, Analyses économiques, Données, Analyse économiques, Handicaps, Santé primaire 

Disability is multifactorial. All its components are potential sources of barriers and disadvantages. The originality of this thesis is to take into account the complexity of disability definition to analyze the use of primary health care. The ultimate goal of primary health care is better health for all, reducing exclusion and social inequalities in access to the health care system. We approach disability in different ways, ending with a model that includes the three dimensions of a “disability situation” (functional dimension, environmental dimension and social participation). First we analyze the functional dimension considering people with disabilities as physically limited. Then, we investigate the environmental dimension through analysis among adults living in institutions. Finally, we adopt a global vision of disability that integrates all the dimensions simultaneously through the measures of latent capabilities. The estimated model approximates a fundamental inter-individual comparability and reveals all things being equal, the levels on which to act to overcome inequalities. The analyses suggest that favorable environment, societal and/or socioeconomic could offset the negative impact of the limitations and cognitive and physical restrictions. We conclude on several possible waysto improve the use of primary care: acting on the environmental dimension and acting on social participation.