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

Tunisia
in the investment of these facilities and, since 1996, has made bill payments. This last mode of
payment was introduced first in the university teaching hospitals. Since 1999, it has been gradually
extended to regional hospitals.
The continued growth of health care needs has pushed the social security funds to diversify
their interventions and coverage for some specialized services, under agreements with public or
private institutions: cardiology and cardiovascular surgery, kidney transplants, CAT scan, magnetic
resonance imaging, lithotripsy, bone marrow transplant, heart transplant, haemodialysis procedures,
spa treatment and functional rehabilitation, medical devices, prostheses, medicines and care abroad.
b) The State’s contribution to health coverage
Some segments of the population benefit either from free health care and hospitalization in
public facilities or from reduced fees. This is stipulated in the Health Organization Law and detailed
in decrees, orders and specific circulars for implementation. Ambulatory care and hospitalization
are entirely free of charge for any citizen considered destitute and for his/her family.
It concerns mainly individuals and families in need who benefit from permanent assistance
under the following programmes:
National Programme of Assistance to families in need, defined as those families with income below
the poverty line, equivalent to 8.3% of the population in 2002 (162 650 families).
Programme of assistance for deprived elderly people living in their families, which involves 3225
elderly people (2002).
Programme of assistance for disabled people, unable to work, which involves 3456 people.
The free health care scheme also concerns children without family support, including:
Children residing at the National Institute for the Protection of Childhood
Children living in units managed by other associations for the protection of children under agreement
with National Institute
Children living in foster families that cannot afford to provide them with health coverage.
The benefit of reduced costs for health care and hospitalization in public facilities is granted
to some categories of households with limited income. The criteria take into consideration both the
income level and the size of the family. Other categories of the population benefit from health care
and hospitalization in public facilities entirely free of charge. They are mainly:
persons covered within the framework of scientific research and prevention campaigns or those
suffering from epidemic diseases.
certain professional categories who benefit from the full health coverage in the institutions under the
supervision of the Ministry of Public Health or in facilities specific to them; they are the
personnel of the army, national security forces, customs, and health personnel and veterans.
c) Mutual insurance companies and group insurance
The mutual insurance companies provide optional health coverage and accompanies the legal
obligation of affiliation with the Social Security Fund. Mutual insurance companies are governed by
230