Ben Abdelaziz Ahmed, Haj Amor Sina, Ayadi Ines, Khelil Mohamed, Zoghlami Chokri, Ben Abdelfattah Sami
Tunis Med. 2018 Oct-Nov;96(10-11):789-807.
As part of its strategy of Universal Health Coverage (UHC), Tunisia has calculated, after its revolution, its Health Accounts (HA), in a standardized and interdepartmental way.
Describe the current structure of care financing in Tunisia, through the HA reports, from 2012 to 2014, and assess its compliance with the principles of socialization of health insurance.
Crude data on health care expenditures were collected by a multi-departmental group that is responsible for calculating health accounts, using a methodology developed by WHO. On the basis of these data, a dozen of indicators that serve to monitor the financing of care, were determined, especially the proportion of public care expenditure (state and insurance), the proportion of direct payments of households in total care expenditure. and the share of expenses of the National Diseases Insurance Fund (CNAM) in the private sector.
During the 2012-2014 trienniums, the total health expenditure represented 7% of GDP. Public expenditure on health care did not exceed 57% of the total health expenditure, which is 4% of GDP. Households paid directly, from their pockets, 39% of current care expenditures. About half of the expenses of the CNAM, was released for the reimbursement of consultations, explorations and hospitalizations in private clinics and medical needs (drugs and medical material) in private pharmacies.
The financing of the post-revolution care system in Tunisia was characterized by a dangerous triad for its survival, performance and equity: excessive spending compared to the country's growth, a very high contribution of households exceeding the cutoff of "catastrophic" spending, and a marked shift in the social policy of the CNAM, in favor of the private sector. This profile, proof of low socialization of healthcare financing, would be a limiting factor in the implementation of the CSU strategy in Tunisia.
作为全民健康覆盖（UHC）战略的一部分，突尼斯在革命后以标准化和跨部门的方式计算了其卫生账户（HA）。
通过2012年至2014年的卫生账户报告描述突尼斯当前的医疗保健融资结构，并评估其是否符合医疗保险社会化原则。
负责计算卫生账户的多部门小组采用世界卫生组织制定的方法收集了医疗保健支出的原始数据。基于这些数据，确定了一系列用于监测医疗保健融资的指标，特别是公共医疗保健支出（国家和保险）的比例、家庭直接支付在总医疗保健支出中的比例，以及国家疾病保险基金（CNAM）在私营部门的支出份额。
在2012 - 2014年的三年期间，卫生总支出占国内生产总值的7%。公共医疗保健支出不超过卫生总支出的57%，即国内生产总值的4%。家庭直接自掏腰包支付了当前医疗保健支出的39%。CNAM约一半的支出用于报销私立诊所的咨询、检查和住院费用以及私立药店的医疗需求（药品和医疗材料）。
突尼斯革命后医疗保健系统的融资具有对其生存、绩效和公平性构成危险的三重特征：与国家经济增长相比支出过高、家庭贡献过高超过“灾难性”支出临界值，以及CNAM社会政策明显向私营部门倾斜。这种情况证明了医疗保健融资社会化程度较低，将成为突尼斯实施全民健康覆盖战略的一个限制因素。
