Fairness in healthcare finance and delivery: what about Tunisia?
Mohammad Abu-Zaineh (),
Habiba Ben Romdhane and
Additional contact information
Jean-Paul Moatti: SESSTIM - U912 INSERM - Aix Marseille Univ - IRD - Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale - IRD - Institut de Recherche pour le Développement - INSERM - Institut National de la Santé et de la Recherche Médicale - AMU - Aix Marseille Université
Post-Print from HAL
Anecdotal evidence on hidden inequity in health care in North African countries abounds. Yet firm empirical evidence has been harder to come by. This article fills the gap. It presents the first analysis of equity in the healthcare system using the particular case of Tunisia. Analyses are based on an unusually rich source of data taken from the Tunisian HealthCare Utilization and Morbidity Survey. Payments for health care are derived from the total amount of healthcare spending which was incurred by households over the last year. Utilization of health care is measured by the number of physical units of two types of services: outpatient and inpatient. The measurement of need for health care is apprehended through a rich set of ill-health indicators and demographics. Findings are presented and compared at both the aggregate level, using the general summary index approach, and the disaggregate level, using the distribution-free stochastic dominance approach. The overall picture is that direct out-of-pocket payments, which constitute a sizeable share in the current financing mix, emerge to be a progressive means of financing health care overall. Interestingly, however, when statistical testing is applied at the disaggregate level progressivity is retained over the top half of the distribution. Further analyses of the distributions of need for—and utilization of—two types of health care—outpatient and inpatient—reveal that the observed progressivity is rather an outcome of the heavy use, but not need, for health care at the higher income levels. Several policy relevant factors are discussed, and some recommendations are advanced for future reforms of the health care in Tunisia.
Keywords: healthcare delivery; Healthcare finance; horizontal equity; progressivity; Tunisia (search for similar items in EconPapers)
Note: View the original document on HAL open archive server: https://hal-amu.archives-ouvertes.fr/hal-01463931
References: Add references at CitEc
Citations: View citations in EconPapers (5) Track citations by RSS feed
Published in Health Policy and Planning, 2014, 29 (4), pp.433--442. ⟨10.1093/heapol/czt029⟩
There are no downloads for this item, see the EconPapers FAQ for hints about obtaining it.
This item may be available elsewhere in EconPapers: Search for items with the same title.
Export reference: BibTeX
RIS (EndNote, ProCite, RefMan)
Persistent link: https://EconPapers.repec.org/RePEc:hal:journl:hal-01463931
Access Statistics for this paper
More papers in Post-Print from HAL
Bibliographic data for series maintained by CCSD ().