Tunisia : Country Studies - What is GIS

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Tunisia Role of contractual arrangements in improving health system performance Table 2. Distribution of agreements Subject of the agreement Service providers concerned by the agreement - Djerbal Thermal Centre Year signature of Functional rehabilitation CSS and the Djebel Oust Professional Rehabilitation Centre 1993 and 1997 Haemodialysis MASS and MSP 2001 Details of implementation of the agreements Every agreement covers specific health care services, whether for the CNSS or the CNRPS. The affiliate members of both funds are eligible for coverage for all health care services provided in the terms of the agreements. The conditions for benefits vary according to several criteria, as detailed below. The CNRPS agreements Whatever the scheme of the health care coverage (health cards or reimbursement), the affiliate is entitled to direct coverage for certain services such as lithotripsy, scanning, bone marrow transplant, kidney transplant, cardiovascular interventions, thermal treatments, Magnetic Resonance Imaging, heart transplant and haemodialysis. Most of these services have been the subject of memoranda of agreement with the Ministry of Public Health, to which some private specialized health care facilities have been party. Except where otherwise noted,coverage for the procedures listed below requires a file including an application for prior approval filled by the affiliate member 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
Tunisia Role of contractual arrangements in improving health system performance recipient, the surgical procedures of removal and transplant as well as the clinical, biological and radiological follow-up, 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) Coverage of MRI procedures requires the submission of an application made on a special form available in the above-mentioned facilities. • Heart transplant. Coverage of heart transplant expenses is provided to the socially insured undergoing treatment in Tunis Military Hospital. This coverage includes: the cost of clinical, biological and radiological preparations of the donor and recipient; the surgical procedures (removal and transplant); and the clinical, biological and radiological follow-up as well as the treatment of possible complications during the first year and the immunosuppressive treatment during the first year. Coverage of heart transplant requires: an application for prior approval submitted on a special form provided by Tunis Military Hospital. • Haemodialysis. In order to get coverage for haemodialysis sessions, the affiliate member hould submit to the CNRPS. An application for prior approval made on a special form available in one of the following hospitals: Charles Nicole Hospital The Military Hospital (Tunis) Fattouma Bourguiba Hospital (Monastir)
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Tunisia : Country Studies - What is GIS

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