Tunisia : Country Studies - What is GIS

Tunisia Role of contractual arrangements in improving health system performance
Table 3. Trend of social security fund contributions to the financing of public health facilities
under the agreements, 1995–2004
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%.