Tunis/Tunisia — 17.2% of the estimated Tunisian population of 11.295,787 people in 2016 are without any social coverage against the disease, according to the results of feasibility studies of the guarantees of the social protection floor, carried out by the Centre for Social Research and Studies, and made public on Thursday at a national seminar held in Tunis.
This population, which has no social security coverage against disease, consists of those not registered with the National Social Security Fund (CNSS) (8.9%), the unemployed (5.6%, or 632 500 unemployed) from categories belonging to poor families who do not benefit from medical assistance and workers in the informal sector representing 2.6% of the total population (297, 916 persons).
The diagnosis of health coverage also showed that 58% of the total population benefits from health insurance coverage, 7.3% from free "AMG1" medical assistance (824,482 people) and 17.5% from reduced-rate medical assistance "AMG2" (1.975,459 people). According to these same results, public expenditure on AMG1 amounts to 276 MD and 242 MD on AMG2, i.e. a total amount of 518 MD.
On the other hand, the health system in Tunisia guarantees a relatively large supply of care in terms of infrastructure and human resources. However, regional inequalities (infrastructure and resources) and the deterioration in the quality of services provided by public health structures greatly limit the effectiveness of health care provision, particularly for the poorest people.
The establishment of a universal health coverage scheme in Tunisia, according to the technical proposals of the experts who contributed to the preparation of the studies carried out, must be based on the principles of universality, free of charge, equity, national solidarity, effective coverage of the necessary care and the upgrading of public health structures.
The guarantee of access to universal care should target, according to experts, persons not subject to a compulsory health insurance scheme and who do not have sufficient resources to meet the costs of medical benefits, their spouse(s), dependent children of poor families aged 2 years or over and not covered by basic compulsory health insurance and disabled children of any age who are totally and permanently unable to engage in a paid activity as a result of physical or mental disability.
Once implemented, this guarantee will facilitate access to public health facilities and basic care for the poor and low-income population, provide a quality and community-based care (ambulatory care, hospitalisation, testing and imaging and medicines), strengthen the ability of poor populations to meet their health service needs and invest in human capital through preventive medicine, particularly for children.
Projections show that the future regime requires financing of 0.9% of GDP from 2020 onwards for a first proposed scenario that groups two populations according to their incomes P1 and P2. The second scenario sets financing at 1.31% of GDP. The latter includes beneficiaries of AMG1, AMG2, the unemployed and other categories of people.
The financing can be ensured by the budgetary credits currently allocated to the financing of the AMG (estimated at 518 MD), 1 and a half points of social VAT and possibly one point of Social Solidarity Contribution and a contribution of 4% levied on the other guarantees or an equivalent personal contribution. It is also possible to provide for other tax sources in the form of taxes on certain products and transactions.