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Tunisian Health Care Financing & Problems - Coggle Diagram
Tunisian Health Care Financing & Problems
Health Financing Mechanisms
A. Health Accounts
•Analyze:
•Amount of expenditure
•Sources of funding
•Use of funds
•Not regularly updated in Tunisia
B. Level of Expenditure
•Around 7% of GDP
•About 500 TND per capita/year
C. Financing Structure
•Public sector ≈ half of spending
•CNAM (insurance) ≈ one-third
•Households (direct payments) ≈ large share (~40%)
D. Key Characteristics
Important role of private sector
•More than half of spending in private services
•Rapid increase in private consultations and hospitalizations
Main Problems
High Household Payments
•High out-of-pocket expenses
•Causes:
•poverty
•inequalities (regions)
•Leads to:
•catastrophic spending
•foregoing care
Public Sector Difficulties
•Chronic underfunding
•Increased demand without resources
•CNAM payment ceilings limit activity
•Lack of compensation for free care
•Underuse of resources + management issues
Fragmentation of System (3 channels)
•Public / private / reimbursement systems
•Same contributions but different access conditions
•Results:
•inequality of access
•two-tier system (public vs private)
•weakening of solidarity
Low System Efficiency
•Weak prevention and health promotion
•Primary care (1st line) underdeveloped
•No clear care pathways
•Risk of overmedicalization
Strategic Directions (Reforms)
•Move toward universal health coverage (UHC)
•Increase public health spending
•Reduce household payments
•Improve efficiency and quality of care