Tunisia : Country Studies - What is GIS

More documents

Recommendations

Info

Tunisia Role of contractual arrangements in improving health system performance INTRODUCTION The health insurance system in Tunisia includes a multitude of schemes. The legal schemes managed by social security funds cover about 2 200 000 socially insured people and their dependents (spouses ascendants and children). Health coverage varies from one year to another, with an average rate of 5.14% (2002). With the constant aim of improving health care provided to the socially insured, the social security funds have reached agreements with public, parapublic and private health care providers. Through these agreements, the socially insured can benefit from the services provided in public or private facilities. Growing openness towards the private sector is reflected in the agreements between the social security funds and private hospitals. Concern to improve the quality of health coverage has driven the funds to develop a system of health service contract based on lump sum settlement of fixed-cost packages covering the costs of thermal (spa) treatment, scans, laser treatment and lithotripsy. These agreements also cover the financing of some other, more extensive health care treatments or investigations: Cardiovascular surgery (in the public sector, and then extended to the private sector) Transplants (kidney, bone marrow) Magnetic Resonance Imaging (MRI) and other medical imaging procedures Severe burns (Military Hospital of Tunis) In this report, we describe the major agreements signed by the social security funds and the health care providers in Tunisia (public and private facilities). These agreements make it possible for those covered by the funds to benefit from extensive health care that was not included in earlier agreements. Of course, the agreements are based on the evolving demand for health care resulting from demographic, epidemiological and technological changes. The report provides a description of the terms of reference of these agreements as well as the expenditure of the funds in this area. It starts with a description of the Tunisian health system, then presents an evaluation of these agreements along with comments on the process. OVERVIEW OF THE TUNISIAN HEALTH SYSTEM Institutional and legal framework of the Tunisian health system The system of health care provision The current framework was defined by the Health Organization Law of 29 June 1991. This law set the general principles concerning the functioning of the health
Tunisia Role of contractual arrangements in improving health system performance system, the architecture of the public and private health care facilities and their objectives and the fundamental conditions of orientation of the health system by the authorities in charge and the advisory bodies that have been set up. Health care is provided by public, parapublic and private health care facilities. The public health facilities are usually classified according to three levels: primary, secondary and tertiary. Primary level comprises basic health centres and district hospitals. Basic health centres provide preventive care and curative health care services as well as health education for: Treatment of common diseases Mother and child care, including family planning Prevention and control of communicable and infectious diseases, particularly through immunization Pre-school, school and university medical services Dissemination of hygiene principles and practices and rules relating to environmental protection through health education Collection and use of epidemiological and statistical health data. At the end of 2000, there were 1981 basic health care centres throughout the country with a national average of 1 centre per 4826 population. District hospitals, beside the services similar to those of the basic health centres, also provide general, maternity and emergency services, and have hospital beds. At the end of 2002, there were 106 district and maternity hospitals with a total capacity of 2711 beds. The secondary level comprises regional hospitals that provide specialized medical and surgical care, in addition to those services mentioned for primary, or firstline, facilities. Every county town has one or two regional hospitals, which makes a total number of 32 hospitals and 5126 beds for Tunisia as a whole. The tertiary level comprises the university-oriented health facilities which, while sharing some attributes with first-line and second-line facilities, have as their primary objective to provide high specialized care, graduate and post-graduate education of health personnel as well as to develop research in the medical, pharmaceutical and dental areas. Almost all of these third-line institutions have the legal status of public health institutions, as specified in the Health Organization Law and defined in detail in a specific decree issued on 2 December 1991, granting autonomy to these facilities in their administrative and financial management, as with public facilities. They are 20 such institutions. The number of departments in these teaching hospitals is 177 with 40 specialties totalling 8305 beds (2002).
Page 1: Tunisia Draft The role of contractu
Page 5 and 6: Tunisia Role of contractual arrange

Tunisia : Country Studies - What is GIS

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?