Tunisia: CNAM Crisis Driven By Liquidity Crunch, Calls for Sweeping Social Security Reform - - Expert

Tunis, Jan. 4 — Tunisia's health insurance system, which covers about 3.5 million members and is characterised by a diversity of treatment schemes, is facing a severe liquidity crisis that has led to the current dispute between the National Health Insurance Fund (CNAM) and private healthcare providers, according to social protection expert Badr Smaoui.

In an interview at the TAP television studio, Smaoui said the paradox lies in the fact that, from an accounting perspective, CNAM records a surplus of nearly TND 900 million, yet in reality it suffers from a cash-flow deficit that prevents it from settling its debts to pharmacists, doctors and private healthcare providers.

He stressed that rescuing CNAM is not merely a technical issue related to the smart card or payment deadlines, but rather depends on a deep and comprehensive reform of the social security system and its financial balances.

Smaoui pointed to the need for reform aimed at ensuring financial sustainability, saying that "it is no longer possible to continue relying solely on contributions from employees and companies."

In this context, he highlighted the importance of the orientations set out in the 2026 Finance Law toward diversifying funding sources, including the introduction of new taxes, which he believes would give the state broader scope for corrective intervention.

The expert recalled that, under a 2017 law, the two funds, the National Pension and Social Insurance Fund (CNRPS) and the National Social Security Fund (CNSS), are required to transfer contributions related to CNAM. However, CNSS has not complied due to its own financial difficulties.

CNAM's membership base is divided into three main schemes. The public scheme, which accounts for the largest share at about 59%, under which insured persons receive treatment in public hospitals and social security clinics.

The reimbursement scheme comes second with 25%, where members initially pay 100% of their treatment costs and later recover about 70% of the expenses.

The third is the third-party payer scheme (family doctor), the least used at around 18%. Although it allows members to pay only about 30% of the cost, it is facing a serious crisis of confidence between the fund and healthcare providers.

Read the original article on Tunis Afrique Presse.