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

under the agreements, 1995–2004
Tunisia
Scheme 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Contribution to CNSS 43.5 43.5 43.5 43.5 43.5 43.5 43.5 43.5 43.5 43.5
the State budget CNRPS 11.0 11.0 11.0 11.0 11.0 11.00 11.0 11.0 11.0 11.0
Direct
contribution to
the budgets of
Regional
Hospitals
Billing system
Total 54.5 54.5 54.5 54.5 54.5 54.5 54.5 54.5 54.5 54.5
CNSS 0.5 0.5 0.5 0.5 3.6 8.3 21.1 30.1 41.6 47.660
CNRPS 0.3 0.3 0.3 0.3 1.2 2.7 6.9 9.9 12.4 14.340
Total 0.8 0.8 0.8 0.8 4.8 11.0 28.0 40.0 54.0 62.000
CNSS 2.6 10.7 18.8 26.5 33.3 37.3 48.5 62.3 75.0 81.200
CNRPS 1.7 3.6 5.4 7.8 9.0 10.7 13.5 17.7 21.0 21.800
Total 4.3 14.3 24.3 34.3 42.3 48.0 62.0 80.0 96.0 103.0
Table 4. Trend of social security fund total contributions, 1995-2004
Year 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
CNSS 46.5 54.6 62.8 70.4 103.9 102.4 113.1 135.9 160.1 172.3
CNRPS 13.0 14.9 16.7 19.1 27.1 27.7 31.4 38.6 44.4 47.1
Total 59.5 69.5 79.5 89.5 130.9 130.1 144.5 174.5 204.5 219.4
The strengthening of public health institutions has taken place since 1990, following an
agreement made between the Ministry of Social Affairs and Solidarity and the Ministry of Public
Health. This agreement aims at improving hospital care and reducing the need for health care
abroad.
Two types of interventions have been implemented. They help ensure financing of the
infrastructure and purchase of medical equipment and new technology. The first intervention is a
contribution of 55 million dinars for the period 1990–1994, distributed annually: 20 million for
1990–1991, 24 million for 1992–1993 and 11 million for 1993–1994. The second intervention
coincided with the Ninth Development Plan. The two funds have contributed 50 million dinars, 40
million of which are supported by the CNSS for strengthening public health institutions.
In total, the contribution of the social security funds has increased at an average annual rate of
30%.
The National Social Security Fund (CNSS)
For the period 1987–2001, the CNSS spent 345.8 million dinars for all the health care
provided under agreements; 72% of this expenditure was for coverage of haemodialysis sessions.
Haemodialysis expenses increased at an average annual rate of 21%.
Cardiovascular interventions have accounted for 18% of total expenditure by the CNSS on
health care provided under the agreements. During the period 1988–2001, cardiovascular surgery
expenses increased at an average annual rate of 43.3%.
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