The role of contractual arrangements in improving health sector ...

INTRODUCTION
Tunisia
The health insurance system in Tunisia includes a multitude of schemes. The legal schemes
managed by social security funds cover about 2 200 000 socially insured people and their
dependents (spouses ascendants and children). Health coverage varies from one year to another,
with an average rate of 5.14% (2002).
With the constant aim of improving health care provided to the socially insured, the social
security funds have reached agreements with public, parapublic and private health care providers.
Through these agreements, the socially insured can benefit from the services provided in public or
private facilities. Growing openness towards the private sector is reflected in the agreements
between the social security funds and private hospitals.
Concern to improve the quality of health coverage has driven the funds to develop a system of
health service contract based on lump sum settlement of fixed-cost packages covering the costs of
thermal (spa) treatment, scans, laser treatment and lithotripsy.
These agreements also cover the financing of some other, more extensive health care
treatments or investigations:
Cardiovascular surgery (in the public sector, and then extended to the private sector)
Transplants (kidney, bone marrow)
Magnetic Resonance Imaging (MRI) and other medical imaging procedures
Severe burns (Military Hospital of Tunis)
In this report, we describe the major agreements signed by the social security funds and the
health care providers in Tunisia (public and private facilities). These agreements make it possible
for those covered by the funds to benefit from extensive health care that was not included in earlier
agreements. Of course, the agreements are based on the evolving demand for health care resulting
from demographic, epidemiological and technological changes.
The report provides a description of the terms of reference of these agreements as well as the
expenditure of the funds in this area. It starts with a description of the Tunisian health system, then
presents an evaluation of these agreements along with comments on the process.
OVERVIEW OF THE TUNISIAN HEALTH SYSTEM
Institutional and legal framework of the Tunisian health system
The system of health care provision
The current framework was defined by the Health Organization Law of 29 June 1991. This
law set the general principles concerning the functioning of the health system, the architecture of
the public and private health care facilities and their objectives and the fundamental conditions of
orientation of the health system by the authorities in charge and the advisory bodies that have been
set up.
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