Tunisia : Country Studies - What is GIS

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Tunisia Role of contractual arrangements in improving health system performance TABLE 5. BENEFICIARIES (BEN) AND EXPENSES (EXP) UNDER CNSS AGREEMENTS, 1987–2001T (million dinars) Agreements Year 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 Cardiovascular BEN 24 35 35 62 513 735 819 966 1396 1331 1585 1930 2057 2528 surgery EXP 0.100 0.250 0.422 1.012 2.009 3.054 3.224 3.929 6.022 6.147 7.132 8.732 9.296 10.793 Kidney transplant BEN 13 5 12 4 9 15 9 21 27 9 25 46 20 8 EXP 0.060 0.084 0.060 0.152 0.126 0.210 0.126 0.323 0.491 0.164 0.455 0.649 0.534 0.316 Bone marrow transplant BEN 15 34 25 30 EXP 0.720 1.913 1.595 1.815 Scanner BEN 171 113 388 2067 2176 3470 3927 3009 3255 4731 6744 6935 8931 12183 EXP 0.013 0.009 0.01 0.061 0.13 0.208 0.236 0.215 0.234 0.342 0.483 0.493 0.635 0.882 Lithotripsy BEN 709 571 695 824 971 1118 EXP 0.280 0.221 0.267 0.317 0.375 0.432 MRI BEN 1418 2042 2870 3376 3923 4570 EXP 0.425 0.613 0.861 1.013 1.177 1.371 Haemodialysis BEN 268 361 385 492 717 891 1047 1258 1369 1552 1747 2081 2224 2385 2703 EXP 2.338 3.334 3.866 6.183 7.422 9.640 13.993 16.681 18.935 18.793 22.132 26.850 29.408 33.951 35.035 Thermal cure BEN 968 1210 1465 1650 1958 2702 3635 3295 3795 2820 2046 1640 1634 1776 1699 EXP 0.151 0.249 0.223 0.368 0.494 0.741 0.988 0.857 0.948 0.675 0.474 0.374 0.390 0.434 0.716 Military Hospital EXP 0 0 0.178 0.889 0.804 0.926 0.815 0.600 0.000 0.026 0.028 0.079 0.031 0.746 0.834
Tunisia Role of contractual arrangements in improving health system performance Figure 1 shows the distribution of expenses for health care provided under CNSS agreements. In 2001, 66% of the CNSS expenses under agreements were for haemodialysis sessions, 21% for cardiovascular interventions and 13% for remaining items or procedures covered by the agreements (thermal treatment, bone marrow transplant, kidney transplant, scanning, MRI, lithotripsy and the Military Hospital). CTH 1% HEM 66% HMI 2% CCV 21% HEM: Haemodialysis; CTM: Thermal Cure; HMI: Military Hospital; CCV: Cardiovascular interventions; GR: Kidney transplant; GMO: Bone marrow transplant; SCA: Scanner; LIT: Lithotripsy; IRM: MRI Figure 2. Distribution of health care expenses under the CNSS agreements (2001) The resources of all the schemes managed by the CNSS are steadily increasing, they increased threefold between 1990 and 2000 alone. The Fund resources have increased by 10.8%, from 383.5 million dinars in 1990 to 1075.2 million dinars in 2000. The Fund expenditures on medical care under health insurance (health and social actions), in comparison with the global expenditures, represented 20% in 1991 and 31% in 2000. Table 6 shows an increase in the CNSS contractual arrangements. Indeed, the CNSS devoted only 2.7% in 1990 and then 5.4% in 2001 of its total expenditures to agreements. The share of the expenditures under contractual arrangements in comparison with health insurance expenditures increased twofold during the 1990s, from 15.4% to 30.0%. Table 6. Share of CNSS expenditure allocated to health care provided under contractual agreements (parties under contract) in comparison with health insurance expenditure (health and social actions) Expenditure 1990 2001 Health insurance expenditures(1) 51.7 173.0 Expenditures under contractural 7.9 52.2 GR 1% IRM 3% GM 3% SCA 2% LIT 1%
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