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

Tunisia
and the attending physician, and the administrative documents of the beneficiary concerning the
coverage. The latter must not be affiliated with another social security or social welfare scheme.
This application should be submitted to the regional centre that is nearest to the affiliate member’s
residence. The coverage can only be granted upon the advice of the CNRPS medical committee.
• Lithotripsy. Coverage is provided for any treatment for kidney stones that does not require a
surgical procedure.
• Computerized axial tomography. The CNRPS covers the expenses of computerized axial
tomography (CT) scan procedures performed for the socially insured in public health facilities
on a lump sum basis covering all the operations related to this procedure. Coverage includes
expenses for CT scans of the skull and of other parts of the body.
• Bone marrow transplant. Coverage by the CNRPS is provided for bone marrow transplant
performed at the National Centre for Bone Marrow Transplant of the Ministry of Public Health.
Coverage for bone marrow transplant requires the constitution of a file including: an application
for prior approval on a special form provided by the National Centre for Bone Marrow
Transplant, filled by the affiliate member and the attending physician.
• Kidney transplant interventions. Coverage includes the medical procedures related to the
clinical, biological and radiological preparations of the donor and the recipient, the surgical
procedures of removal and transplant as well as the clinical, biological and radiological followup,
length of stay and post-surgical care. Coverage can only be granted upon the advice of the
CNRPS medical committee.
• Cardiovascular surgical interventions. Coverage includes cardiovascular surgical procedures
performed in public health facilities and hospitals, in Tunis Military Hospital as well as in the
private facilities that adhere to the memorandum of agreement made between the Ministry of
Social Affairs and the Ministry of Public Health. Specific procedures covered are:
Open-heart interventions
Vascular interventions of arterial restoration with or without prosthesis
Open-heart interventions requiring cardiopulmonary bypass, instrumental dilatation, arterial
dilatation, insertion of intracardiac or intravascular material, costs of pre-surgical
investigations and post-surgical care, upon the advice of the CNRPS medical
committee.
• Thermal (spa) treatment. Coverage includes medical procedures relating to thermal cures
(rheumatology and otorhinolaryngology), medical visits and accommodation expenses in hotels.
Coverage is provided to a limit of 85% of care expenses, plus a ceiling of TND 8.5 per
overnight stay. The thermal treatment centres are:
thermal centre of Hamman Bourguiba
thermal centre of Korbous
health complex of Djebel Oust
thermal centre of Djerba
Coverage for thermal care requires the submission of an application made on a special “ST”
form, filled by the affiliate member and the attending physician.
• Magnetic Resonance Imaging (MRI). Coverage is provided for MRI procedures performed in
the following facilities:
Centre of Bab Sâadoun (Tunis)
Tunis Military Hospital
Habib Bourguiba Hospital (Sfax)
Sahloul Hospital ( Sousse)
238