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

Tunisia
Table 8 shows an increase in CNRPS expenditures under contractual arrangements.
Indeed, the CNRPS devoted only 3.1% in 1992, and 3.4% in 2001, of its total expenditures to
agreements. The share of expenditures under contractual arrangements in comparison with
health insurance expenditures increased by 1.6% during the 1990s, from 25.7% to 27.3%.
Table 8. Share of CNRPS expenditures allocated to health care provided under
contractual arrangements in comparison with health insurance expenditures
(compulsory scheme)
Year 1992 2001
Health insurance expenditures (1) 29.7 89.2
Expenditures under agreements (2) 7.6 24.4
Ratio: (2)/(1) 25.7% 27.3%
Importance of contractual arrangements for the CNSS and CNRPS
During the period 1990–2001, the agreements have gradually taken a major place in the
coverage activity of the two Funds. The number of beneficiaries increased from 5878 to
39 791, i.e. an increase of 6.7%. Expenditures also increased significantly, from 12. to
MD 71.9 million dinars, equivalent to an average annual increase rate of 17.7%.
Figure 2 shows the trend of expenditures of the two Funds under agreements. The
CNSS spends more than the CNRPS. The share of the CNSS expenditure represented 66% of
the total expenditure of the two Funds in 1990 and 72.6% in 2001.
EXP (in million dinars)
60
50
40
30
20
10
0
CNSS CNRPS
1987 1989 1991 1993 1995 1997 1999 2001
Year
Figure 2. Trend of expenditures on health care provided
under agreements, 1987–2001