Blel S
Tunis Med. 2001 May;79(5):278-84.
The Tunisian health system, notably in its health insurance component, has allowed to record a satisfactory evolution of health indicators. Nevertheless, socio-economic, demographic and epidemiological transitions impose a global reform of the system, notably of its financing. The present article, leaving from the presentation of the current system of coverage of the social security insured, analyses observed insufficiencies that have brought public authorities to commit the health insurance reform. The main observed insufficiencies refer to the multiplicity of regimes and their heterogeneity, generating iniquities between insured and a strong growth of care expenses financed directly by households. In addition, relationships of social security bodies with public and private providers of health care are little transparent, marked by a preferential processing of public structures, despite an important development of the private sector. In a second part, the author analyzes successively objectives of the health insurance reform of the social security regimes, its founder principles, characteristics of the proposed regime (a mandatory basic regime and an optional complementary regime) and sketches of providers payment methods.
突尼斯卫生系统，尤其是其医疗保险部分，已使健康指标取得了令人满意的进展。然而，社会经济、人口和流行病学转型要求对该系统进行全面改革，尤其是其融资方面。本文从介绍当前社会保障参保人员覆盖体系入手，分析了所观察到的不足之处，正是这些不足促使公共当局进行医疗保险改革。所观察到的主要不足涉及制度的多样性及其异质性，这在参保人员之间造成了不公平，并且由家庭直接支付的医疗费用大幅增长。此外，社会保障机构与公共和私人医疗服务提供者之间的关系透明度很低，其特点是尽管私营部门有了重要发展，但仍对公共机构给予优先待遇。在第二部分，作者依次分析了社会保障制度医疗保险改革的目标、其基本原则、拟议制度的特点（一个强制性基本制度和一个自愿补充制度）以及医疗服务提供者支付方式的概述。
