Have health insurance reforms in Tunisia attained their intended objectives?

Khaled Makhloufi (), Bruno Ventelou () and Mohammad Abu-Zaineh ()
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Khaled Makhloufi: SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD - Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale - IRD - Institut de Recherche pour le Développement - AMU - Aix Marseille Université - INSERM - Institut National de la Santé et de la Recherche Médicale
Bruno Ventelou: ORS PACA, GREQAM - Groupement de Recherche en Économie Quantitative d'Aix-Marseille - EHESS - École des hautes études en sciences sociales - AMU - Aix Marseille Université - ECM - École Centrale de Marseille - CNRS - Centre National de la Recherche Scientifique
Mohammad Abu-Zaineh: AMSE - Aix-Marseille Sciences Economiques - EHESS - École des hautes études en sciences sociales - AMU - Aix Marseille Université - ECM - École Centrale de Marseille - CNRS - Centre National de la Recherche Scientifique

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Abstract: A growing number of developing countries are currently promoting health system reforms with the aim of attaining ' universal health coverage' (UHC). In Tunisia, several reforms have been undertaken over the last two decades to attain UHC with the goals of ensuring financial protection in health and enhancing access to healthcare. The first of these goals has recently been addressed in a companion paper by Abu-Zaineh et alš (Int J Health Care Financ Econ 13(l): 73-93, 2013). The present paper seeks to assess whether these reforms have in fact enhanced access to healthcare. The average treatment effects of two insurance schemes, formal-mandatory (MHI) and state -subsidized (MAS) insurance, on the utilization of outpatient and inpatient healthcare are estimated using propensity score matching. Results support the hypothesis that both schemes (MHI and MAS) increase the utilization of healthcare. However, significant variations in the average effect of these schemes are observed across services and areas. For all the matching methods used and compared with those the excluded from cover, the increase in outpatient and inpatient services for the MHI enrollees was at least 19 and 26 %, respectively, in urban areas, while for MAS beneficiaries this increase was even more pronounced (28 and 75 % in the urban areas compared with 27 and 46 % in the rural areas for outpatient and inpatient services, respectively). One important conclusion that emerges is that the current health insurance schemes, despite improving accessibility to healthcare services, are nevertheless incapable of achieving effective coverage of the whole population for all services. Attaining the latter goal requires a strategy that targetsthe "trees" not the "forest".

Keywords: Universal health coverage State-subsidized insurance Healthcare utilization Propensity score matching Developing countries Tunisia; Universal health coverage; State-subsidized insurance; Healthcare utilization; Propensity score matching; Developing countries; Tunisia (search for similar items in EconPapers)
Date: 2014-12-03
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Published in International Journal of Health Economics and Management, 2014, 15, pp.29 - 51. ⟨10.1007/s10754-014-9157-6⟩

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Persistent link: https://EconPapers.repec.org/RePEc:hal:journl:hal-05717695

DOI: 10.1007/s10754-014-9157-6

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