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

Tunisia
to the private sector. The insured also find it to their best interest to go to the private sector
known for better quality services. Under the agreements, the patients can choose between the
public and the private sectors.
With regard to the behaviour of private hospitals the private hospitals charge: a fee per
hospital day which is supposed to cover accommodation and intermediate care; a fee for
service to be paid to medical practitioners, as doctors’ fees are not included in the private
hospital budget; and lump sums for expensive procedures such as scans.
This combined formula may lead to increasing the number of stays and reducing their
average duration so as to accelerate bed rotation and maximize the output of the technical
equipment and the volume of surgeon fees. It can prompt private hospitals to specialize in
routine surgery, maternity, medicine, or in dialyses and cancer treatment, all of which are costeffective
activities, taking into account the fee structure.
Private hospitals have also found it in their interest to acquire technical equipment, for
the purposes entering into an agreement. Table 10 shows the higher number of equipment in
the private sector compared with the public sector.
The influence of the fee structure appears, for example, in the choice of the treatment
formula in the case of a private hospital.
Table 10. Advanced technical equipment in hospital facilities, 2003
Equipment Public Private Total Density
Population per piece of equipment
MRI 3 5 8 1 236 000
Scanner 15 54 69 143 000
Lithotripter 3 12 15 660 000
Tele-cobalt 4 5 9 1 100 000
Digital vascular imaging machines 6 10 16 618 000
Catheter 9 10 19 520 000
CEC 6 12 18 550 000
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