Pays
Tunisie
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The burden of disease (2012) attributable to communicable diseases is 10.8%, noncommunicable diseases 82.3% and injuries 7.0%. The share of out-of-pocket expenditure is 35.3% (2013) and health workforce density is 12.2 physicians per 10 000 population (2010).
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"Health indicators registered substantial progress to achieve the health and nutritionrelated Millennium Development Goals. Life expectancy at birth has reached 73.1 years, reflecting the epidemiological transition during the past decades. The decline of the infant mortality rate is the most important progress accomplished, decreasing from 41 (1990) to 21 (2002). During the last 44 years, Tunisia has the highest life expectancy at birth when compared to MENA region countries and the gap continues to increase, approaching OECD countries. The epidemiological profile of Tunisia is not the same, as observed at the end of 1980 decade. We currently observe a net recession of communicable diseases and the eradication, a dominance of non communicable diseases and recrudescence of injuries and accidents".
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The Wold Bank Health Equity and Financial Protection datasheets provide a picture of equity and financial protection in the health sectors of low- and middle-income countries. Topics covered include: inequalities in health outcomes, health behavior and health care utilization; benefit incidence analysis; financial protection; and the progressivity of health care financing. Data are drawn from the Demographic and Health Surveys (DHS), World Health Surveys (WHS), Multiple Indicator Cluster Surveys (MICS), Living Standards and Measurement Surveys (LSMS), as well as other household surveys where available. The datasheets use a common set of health indicators for all countries. All analyses are conducted using the health modules of the ADePT software.
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"Depuis leur indépendance, les pays du Maghreb central ont connu des transformations considérables dans le domaine de la santé. Tout d’abord, ils doivent faire face à une transition démographique qui s’opère presque en même temps que la transition épidémiologique, alors que les pays du Nord de la Méditerranée ont pu affronter ces deux évolutions à des périodes différentes. Ensuite, le Maroc, la Tunisie et l’Algérie se sont engagés dans des reconstructions et des réformes qui doivent être poursuivies et approfondies aujourd’hui afin de faire face aux nouveaux défis identifiés dans le rapport et aux attentes grandissantes de leurs populations".
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A growing number of developing countries are currently promoting health system reforms with the aim of attaining ‘ universal health coverage’ (UHC). In Tunisia, several reforms have been undertaken over the last two decades to attain UHC with the goals of ensuring financial protection in health and enhancing access to healthcare. The first of these goals has recently been addressed in a companion paper by Abu-Zaineh et al. (Int J Health Care Financ Econ 13(1):73–93, 2013). The present paper seeks to assess whether these reforms have in fact enhanced access to healthcare. The average treatment effects of two insurance schemes, formal-mandatory (MHI) and state-subsidized (MAS) insurance, on the utilization of outpatient and inpatient healthcare are estimated using propensity score matching +++
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Despite the remarkable progress in expanding the coverage of social protection mechanisms in health, the Tunisian healthcare system is still largely funded through direct out-of-pocket payments. This paper seeks to assess financial protection in health in the particular policy and epidemiological transition of Tunisia using nationally representative survey data on healthcare expenditure, utilization and morbidity. The extent to which the healthcare system protects people against the financial repercussions of ill-health is assessed using the catastrophic and impoverishing payment approaches. The characteristics associated with the likelihood of vulnerability to catastrophic health expenditure (CHE) are examined using multivariate logistic regression technique +++
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Anecdotal evidence on hidden inequity in health care in North African countries abounds. Yet firm empirical evidence has been harder to come by. This article fills the gap. It presents the first analysis of equity in the healthcare system using the particular case of Tunisia. Analyses are based on an unusually rich source of data taken from the Tunisian HealthCare Utilization and Morbidity Survey. Payments for health care are derived from the total amount of healthcare spending which was incurred by households over the last year. Utilization of health care is measured by the number of physical units of two types of services: outpatient and inpatient. The measurement of need for health care is apprehended through a rich set of ill-health indicators and demographics. +++
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"This report focuses on the available evidence on inequities in health and inequities in socioeconomic determinants that exist both within and across countries in the WHO Eastern Mediterranean Region. It uses data from the Pan-Arab Project for Child Development (PAPCHILD) and Pan-Arab Project Family Health Survey (PAPFAM). The report aims to assess the extent of health inequality in the Region and identify what contributed to the changing levels of inequalities in the 1990s. The study analyses the role of changing socioeconomic and behavioural characteristics of the population and the changes in health system in contributing to widening or narrowing health inequalities. The analysis is limited to six countries in the Region for which we have data on health outcomes in two points in time (early 1990s and early 2000)."
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