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

Tunisia
control interventions are provided with specific systems for permanent data collection to allow for
epidemiological surveillance of diseases such as malaria, schistosomiasis, HIV/AIDS, rabies,
tuberculosis, leishmaniasis and leprosy.
CONTRACTUAL ARRANGEMENTS
History
The Tunisian health system has made extensive use of contractual arrangements since 1970,
when the social security funds and the public health care providers agreed upon the payment of a
lump sum to the Treasury for health care provided to their affiliate members and their dependents.
This process of contracting has greatly developed in the past decade, with the objective of managing
the relationships between the health insurance (social security) and the health care providers (both
public and private) and to bring together the often conflicting interests of these two actors.
Several extensive health care and specialized services are not provided for in the initial
agreements made between the social security funds and the Ministry of Public Health. Most of these
services are the subject of later agreements and memoranda of understanding with the Ministry of
Public Health and are adhered to by some private specialized care institutions and the Military
Hospital. These agreements are useful as there is no act or decree allowing the socially insured to
receive health care in private health facilities.
Legal foundations
Generally, the Ministry of Social Affairs and Solidarity (MASS) establishes the agreement
with the Ministry of Public Health or the Military Hospital attached to the Ministry of Defence. The
private facilities are only adherents to the agreement. The legal foundations of these agreements are
shown in Table 2.
Table 2. Distribution of agreements
Subject of the agreement Service providers concerned by the agreement Year of signature
Cardiovascular intervention 1- MASS, MSP (2002) and the Military Hospital of Tunis 1995
- Taoufik Private Hospital 1991
- Bergé du Lac Private Hospital 2000
- Cardiovascular Surgery Private Hospital 1995
- Social Security Private Hospital, Sousse 1997
- El Basatine Private Hospital 2000
- El Manar Private Hospital 1997
- Chams Private Hospital, Sfax 2000
- Ibn El Neffis Private Hospital, Sfax 2000
- El Korniche Private Hospital, Sousse 2003
2- MASS, MSP : Public Facilities only 2001
Heart transplant MASS and Tunis Military Hospital 1998
Services of myocardial
MASS and Tunis Military Hospital 2000
scintigraphy Mejdi El Mahrsi Radiology and Nuclear Medicine Centre 2002
Kidney transplant MASS, MSP and the Tunis Military Hospital 2002
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