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Appraising financial protection in health: the case of Tunisia

Mohammad Abu-Zaineh (), Habiba Ben Romdhane, Bruno Ventelou, Jean-Paul Moatti and Arfa Chokri
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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, ORS PACA, AMU - Aix Marseille Université

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Abstract: Despite the remarkable progress in expanding the coverage of social protection mechanisms in health, the Tunisian healthcare system is still largely funded through direct out-of-pocket payments. This paper seeks to assess financial protection in health in the particular policy and epidemiological transition of Tunisia using nationally representative survey data on healthcare expenditure, utilization and morbidity. The extent to which the healthcare system protects people against the financial repercussions of ill-health is assessed using the catastrophic and impoverishing payment approaches. The characteristics associated with the likelihood of vulnerability to catastrophic health expenditure (CHE) are examined using multivariate logistic regression technique. Results revealed that non-negligible proportions of the Tunisian population (ranging from 4.5 % at the conservative 40 % threshold of discretionary nonfood expenditure to 12 % at the 10 % threshold of total expenditure) incurred CHE. In terms of impoverishment, results showed that health expenditure can be held responsible for about 18 % of the rise in the poverty gap. These results appeared to be relatively higher when compared with those obtained for other countries with similar level of development. Nonetheless, although households belonging to richer quintiles reported more illness episodes and received more treatment than the poor households, the latter households were more likely to incur CHE at any threshold. Amongst the correlates of CHE, health insurance coverage was significantly related to CHE regardless of the threshold used. Some implications and policy recommendations, which might also be useful for other similar countries, are advanced to enhance the financial protection capacity of the Tunisian healthcare system.

Keywords: Economic Policy; Health Informatics; Public Finance & Economics; Public Health; Statistics for Business/Economics/Mathematical Finance/Insurance; Statistics for Life Sciences; Medicine; Health Sciences (search for similar items in EconPapers)
Date: 2013
Note: View the original document on HAL open archive server: https://hal-amu.archives-ouvertes.fr/hal-01498257
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Published in International Journal of Health Care Finance and Economics, Springer Verlag, 2013, 13 (1), pp.73--93. ⟨10.1007/s10754-013-9123-8⟩

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Persistent link: https://EconPapers.repec.org/RePEc:hal:journl:hal-01498257

DOI: 10.1007/s10754-013-9123-8

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