Tunisia : Country Studies - What is GIS

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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%.
Tunisia Role of contractual arrangements in improving health system performance Cardiovascular interventions have accounted for 18% of total expenditure by the CNSS on health care provided under the agreements. During the period 1988–2001, cardiovascular surgery expenses increased at an average annual rate of 43.3%. 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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Tunisia : Country Studies - What is GIS

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