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Appraising financial protection in health: the case of Tunisia

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  • Mohammad Abu-Zaineh

    (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)

  • Habiba Ben Romdhane
  • Bruno Ventelou

    (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 - AMU - Aix Marseille Université - INSERM - Institut National de la Santé et de la Recherche Médicale, 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)

  • 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 - AMU - Aix Marseille Université - INSERM - Institut National de la Santé et de la Recherche Médicale, ORS PACA, AMU - Aix Marseille Université)

  • Arfa Chokri

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.

Suggested Citation

  • Mohammad Abu-Zaineh & Habiba Ben Romdhane & Bruno Ventelou & Jean-Paul Moatti & Arfa Chokri, 2013. "Appraising financial protection in health: the case of Tunisia," Post-Print hal-01498257, HAL.
  • Handle: RePEc:hal:journl:hal-01498257
    DOI: 10.1007/s10754-013-9123-8
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    Cited by:

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    2. Ismaïl, Safa, 2021. "Déterminants de l'accès aux soins et des dépenses de santé en Tunisie [Determinants of health care consumption in Tunisia]," MPRA Paper 111223, University Library of Munich, Germany.
    3. Khaled Makhloufi & Bruno Ventelou & Mohammad Abu-Zaineh, 2015. "Have health insurance reforms in Tunisia attained their intended objectives?," International Journal of Health Economics and Management, Springer, vol. 15(1), pages 29-51, March.
    4. Ahcène Zehnati & Marwân-al-Qays Bousmah & Mohammad Abu-Zaineh, 2021. "Public–private differentials in health care delivery: the case of cesarean deliveries in Algeria," International Journal of Health Economics and Management, Springer, vol. 21(3), pages 367-385, September.
    5. Olivier Chanel & Khaled Makhloufi & Mohammad Abu-Zaineh, 2017. "Can a Circular Payment Card Format Effectively Elicit Preferences? Evidence From a Survey on a Mandatory Health Insurance Scheme in Tunisia," Applied Health Economics and Health Policy, Springer, vol. 15(3), pages 385-398, June.
    6. Champonnois, Victor & Chanel, Olivier & Makhloufi, Khaled, 2018. "Reducing the anchoring bias in multiple question CV surveys," Journal of choice modelling, Elsevier, vol. 28(C), pages 1-9.
    7. Meriem Oudmane & Fouzi Mourji & Abdeljaouad Ezzrari, 2019. "The impact of out‐of‐pocket health expenditure on household impoverishment: Evidence from Morocco," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(4), pages 1569-1585, October.
    8. Hyacinthe Tchewonpi Kankeu & Sylvie Boyer & Raoul Fodjo Toukam & Mohammad Abu-Zaineh, 2016. "How do supply-side factors influence informal payments for healthcare? The case of HIV patients in Cameroon," International Journal of Health Planning and Management, Wiley Blackwell, vol. 31(1), pages 41-57, January.
    9. Ismaïl, Safa, 2021. "Healthcare expenditure progress in Tunisia: a qualitative analysis," MPRA Paper 111493, University Library of Munich, Germany.
    10. Abdur Razzaque Sarker & Marufa Sultana & Khorshed Alam & Nausad Ali & Nurnabi Sheikh & Raisul Akram & Alec Morton, 2021. "Households' out‐of‐pocket expenditure for healthcare in Bangladesh: A health financing incidence analysis," International Journal of Health Planning and Management, Wiley Blackwell, vol. 36(6), pages 2106-2117, November.
    11. Chantzaras, Athanasios E. & Yfantopoulos, John N., 2018. "Financial protection of households against health shocks in Greece during the economic crisis," Social Science & Medicine, Elsevier, vol. 211(C), pages 338-351.

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