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Consolidation and Transparency : Transforming Tunisia’s Health Care for the Poor

access to health services access to services accountability mechanisms administrative efficiency Adult mortality Adult mortality rate affordable health care aged ambulatory care beds Beneficiaries capital investments central government cities Citizen citizens Civil Society Organizations clinics communicable diseases contraception Contraceptive prevalence costs of health care deaths delivery mechanisms delivery system demand for health demand for health care demand for services Dental care Dependency ratio dependent children developing countries disability disparities in health dissemination Doctors economic transition epidemic Expenditures Families fee-for-service fertility fertility rate financial management financial protection financial risks General Health System gross domestic product Health Care health care consumption health care coverage health care delivery health care providers health care provision health care services health care system health centers health conditions Health Coverage Health Economics health expenditure health facilities health financing health information health information system health infrastructure health insurance health insurance coverage Health Ministry Health Organization health outcomes health professionals health sector health service health service delivery health services health status Health System health system performance health systems health workers health-system healthcare services Home care Hospital beds Hospital budgets hospital pharmacies hospital services hospitalization hospitals Household Expenditure household size household surveys human capital ill health immunization immunizations income income countries income groups inequities infant infant health infant mortality Infant mortality rate informal payments information systems insurance coverage insurance premiums lab tests Labor Force Life expectancy Life expectancy at birth live births living conditions local authorities mandates maternal mortality Maternal mortality rate maternal mortality ratio medical services medicines midwives Ministry of Health morbidity mortality national health national health insurance national health insurance fund Neonatal mortality Nurses nursing nursing care outpatient services patient patients pensions pharmacists Physician Physicians pocket payments postnatal care pregnant women prenatal care preventive health services primary care primary health care private care private clinics private insurance Private Insurers Private Pharmacies private sector private services private spending programs provision of care public expenditure Public Funds Public Health public health care public health care services Public health expenditure public health expenditures Public health services public health spending Public Health Surveillance public hospital public hospital services public hospitals public perceptions Public Providers public provision public service public services Public spending Quality assurance quality of health quality of services quality services rate of growth referral system regulatory framework respect rural areas safety net safety nets sanitation sanitation facilities Skilled birth attendance skilled personnel skills development Social Affairs Social exclusion social health insurance social safety nets Social Security social workers socioeconomic status specific incentives spouse spouses technical capacity Transparency Tuberculosis unemployment universal access urban areas urban development user fees Vulnerability woman working-age population World Health Organization
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World Bank, Washington DC
Middle East and North Africa | Tunisia
2013-05-06T17:01:27Z | 2013-05-06T17:01:27Z | 2013-01

Since the 2011 popular revolution in Tunisia, calls for a new social contract have been made to improve social inclusion, including addressing gaps in health care coverage for the vulnerable households. This paper evaluates Tunisia's Free Medical Assistance for the Poor (FMAP) and seeks to identify opportunities to improve universal coverage in Tunisia. The study focuses on the structural and institutional framework of health care coverage for the poor in Tunisia in terms of strengths, weaknesses, and recommendations for achieving universal coverage. The paper reviews Tunisia's health financing and delivery system with a special emphasis on FMAP, and analyzes the main structural and targeting challenges the program faces. The distinctive characteristic of this paper is the focus on institutional design and organizational practice of FMAP. The legal and regulatory framework is assessed in terms of management, beneficiary targeting methods, benefits package, and the information environment. Section 2 provides an overview of health financing and service delivery in Tunisia, including the relationship between the FMAP and the main financing schemes. Section 3 describes key supply-side issues in terms of primary health care provision for the poor. Section 4 assesses the institutional framework of the FMAP in greater detail and its linkages to the health care delivery system. Section 5 focuses on beneficiary selection and targeting methods under the FMAP. Section 6 examines public financial management under the FMAP, which is followed by a discussion in Section 7 of the benefits package. Sections 8 and 9 describe the information environment of the FMAP and how this links to the special focus of future financing reforms. The concluding section discusses the pending agenda and priorities for the FMAP moving forward.

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