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

Tunisia
There has been a significant increase in the number of persons benefiting from health care
provided under the agreements. The number of beneficiaries for cardiovascular interventions has
increased from 24 to 14 016 (1988–2001). For the scanner, this number reached 58 100 in 2001
compared with 171 in 1988.
According to Table 5, the policy of reducing the need for care abroad, which was the reason
for adopting contractual arrangements, has been successful. In 15 years, the number of beneficiaries
receiving health care abroad has been reduced about ninefold. The CNSS expenses have been
reduced by 3.5 million dinars, without adjusting for international inflation but with coverage
maintained at a high level.
Since 1987 the largest share of expenses for health care provided under agreements for
haemodialysis sessions. Haemodialysis expenses exceed 60% of total expenditure during the period
1987–2001. The gradual increase of cardiovascular surgery expenses, from 2.7% in 1988 to 20.7%
in 2001, is also noted.
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