Tunisia : Country Studies - What is GIS

Tunisia Role of contractual arrangements in improving health system performance
66% of the total expenditure of the two Funds in 1990 and 72.6% in 2001.
Haemodialysis accounts for more than 70% of the expenditures under agreements
made by the two Funds. In 1987, it accounted for 83%. Cardiovascular surgical
interventions are gaining increasing importance under the agreements both in terms of
beneficiaries and expenditures.
Resorting to health care abroad for the insured is gradually decreasing in both
Funds. The expenditures of the two Funds for health care abroad have been reduced by
more than half, as measured in current dinars (Table 9).
Table 9. Coverage of beneficiaries resorting to health care abroad in the two Funds, 1987–2001
Year 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
CNRPS BEN 395 292 230 259 171 206 207 160 125 89 74 72 52 34 63
EXP 4.88 2.523 3.205 3.306 2.046 3.565 2.751 2.698 2.840 2.514 2.405 2.095 1.672 1.235 1.760
CNSS BEN 692 598 495 314 198 222 224 259 141 113 123 138 81 48 66
EXP 5.904 5.890 5.526 6.784 3.957 4.2054.169 6.174 3.173 3.500 3.397 3.780 2.737 1.238 3.042
CSS BEN 1087 890 725 273 369 428 431 419 266 202 197 210 133 82 129
EXP 10.784 8.413 8.731 10.09 6 7.77 6.92 8.87 6.01 6.014 5.8 5.88 4.409 2.473 4.802
EVALUATION OF CONTRACTUAL ARRANGEMENTS
Advantages of contractual arrangements
The agreements have contributed to:
• The reduction of health care abroad, which represents a very high cost for the social
security funds and for the economy of the country.
• The development of public and private facilities which have become well-equipped
medical centres with advanced technology (Table 10). The expansion of the private
sector is also remarkable as it attracts a large number of patients from neighbouring
countries.
• Contributing to improve health care provision throughout the country. Equipment
such as scanners and lithotripters are now more available in the private sector in
most governorates of the country and have become accessible to the insured.
• The creation of new jobs in the medical field, contractual arrangements guarantee
potential clients and solvent demand for the private health facilities.
• De facto regulation of the private sector. The social security funds intervene
through agreements so as to ensure the best treatment conditions (role of medical
inspection of the CSS) on the basis of flat rates.
• A fundamental change in public hospital management (management of the system
of billing) and in budget preparation procedures, which have developed from
procedures based on a systematic annual increase to procedures linked to hospital
activity.
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