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Social Welfare System in Tunisia - Coggle Diagram
Social Welfare System in Tunisia
General Principles
Based on:
•Solidarity
•Equity
•Access to care
•Established by law (2004 reform
Main Health Social Protection Schemes
A. Compulsory Health Insurance (CNAM)
•Covers workers + dependents
•About two-thirds of population
•Funded by social contributions (employer + employee)
3 Care Channels:
•Public sector
•care in public structures
•low co-payment
•Private sector
•via family doctor
•partial patient payment
•Reimbursement system
•patient pays first, then reimbursed
Free Medical Assistance (AMG)
•AMG1 (poor)
→ totally free care in public sector
•AMG2 (vulnerable)
→ reduced payment (co-payment system)
•Funded by taxes
•Covers around low-income population groups
Complementary Coverage
•Private insurance
•Mutual insurance → additional protection (optional)
Coverage Situation
•Majority covered (CNAM + AMG)
•Still some uncovered population
•High out-of-pocket payments
Benefits (Care Package)
•Wide coverage:
•consultations
•hospitalization
•drugs
•medical tests
•Includes chronic diseases (full coverage)
•Preventive care in public sector = free
Financing System
•Social contributions (CNAM)
•Taxes (AMG)
•Household payments
•Private insurance
Access to Care
Strong role of public sector
•Private sector accessible depending on insurance channel
•Transfers possible to private sector or abroad (special cases)
Main Issues
•Incomplete coverage
•High household spending
•Inequalities in access
•Complexity of system (multiple schemes)