FINANCIALIZATION OF HEALTHCARE AND THE ECONOMIC VULNERABILIZATION OF HOUSEHOLDS IN MALI: A Systemic Reading of Inequalities[FINANCIARISATION DE LA SANTE ET VULNERABILISATION ECONOMIQUE DES MENAGES AU MALI : Une lecture systémique des inégalités]

This study examines the impact of the financialization of the health system on household economic vulnerability in Mali, in a context of progressive state disengagement and cost transfer to individuals. Combining an econometric modeling over the period 1990–2022 (ARDL) with a qualitative survey of 50 health system actors (patients, professionals, and managers), the study uncovers a structural asymmetry: public health expenditure fosters growth through the strengthening of human capital, while the rise in private health spending constrains household consumption and investment capacities, thereby worsening inequalities in access to care. Testimonies reveal circumvention strategies, destructive budgetary trade-offs, and a loss of trust in public institutions. Far from being residual, this financialization reshapes the logics of social protection and undermines the conditions for inclusive growth. The article argues for a reconfiguration of health financing based on redistributive solidarity, public regulation of costs, and the effective expansion of universal health coverage.