Appraising financial protection in health: the case of Tunisia
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. Copyright Springer Science+Business Media New York 2013
Volume (Year): 13 (2013)
Issue (Month): 1 (March)
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- Wagstaff, Adam & Lindelow, Magnus, 2008.
"Can insurance increase financial risk?: The curious case of health insurance in China,"
Journal of Health Economics,
Elsevier, vol. 27(4), pages 990-1005, July.
- Wagstaff, Adam & Lindelow, Magnus, 2005. "Can insurance increase financial risk ? The curious case of health insurance in China," Policy Research Working Paper Series 3741, The World Bank.
- Christophe Muller, 2007.
"Anti-Poverty Transfers without Riots in Tunisia,"
DT/2007/08, DIAL (Développement, Institutions et Mondialisation).
- Christophe Muller, 2008. "Anti-Poverty Transfers without Riots in Tunisia," Working Papers. Serie AD 2008-08, Instituto Valenciano de Investigaciones Económicas, S.A. (Ivie).
- Christophe Muller, 2008. "Anti-Poverty Transfers without Riots in Tunisia," THEMA Working Papers 2008-15, THEMA (THéorie Economique, Modélisation et Applications), Université de Cergy-Pontoise.
- Christophe Muller, 2008. "Anti-Poverty Transfers without Riots in Tunisia," IDEP Working Papers 0801, Institut d'economie publique (IDEP), Marseille, France, revised Mar 2008.
- Christophe Muller, . "Anti-Poverty Transfers without Riots in Tunisia," Discussion Papers 07/06, University of Nottingham, CREDIT.
- Awad Mataria & Firas Raad & Mohammad Abu-Zaineh & Cam Donaldson, 2010. "Catastrophic healthcare payments and impoverishment in the occupied Palestinian territory," Applied Health Economics and Health Policy, Springer, vol. 8(6), pages 393-405, November.
- Owen O'Donnell & Eddy van Doorslaer & Adam Wagstaff & Magnus Lindelow, 2008. "Analyzing Health Equity Using Household Survey Data : A Guide to Techniques and Their Implementation," World Bank Publications, The World Bank, number 6896, August.
- Adam Wagstaff & Marcel Bilger & Zurab Sajaia & Michael Lokshin, 2011. "Health Equity and Financial Protection : Streamlined Analysis with ADePT Software," World Bank Publications, The World Bank, number 2306, August.
- Mohammad Hajizadeh & Hong Nghiem, 2011. "Out-of-pocket expenditures for hospital care in Iran: who is at risk of incurring catastrophic payments?," International Journal of Health Care Finance and Economics, Springer, vol. 11(4), pages 267-285, December.
- Adam Wagstaff & Eddy van Doorslaer, 2003. "Catastrophe and impoverishment in paying for health care: with applications to Vietnam 1993-1998," Health Economics, John Wiley & Sons, Ltd., vol. 12(11), pages 921-933.
- Yardim, Mahmut Saadi & Cilingiroglu, Nesrin & Yardim, Nazan, 2010. "Catastrophic health expenditure and impoverishment in Turkey," Health Policy, Elsevier, vol. 94(1), pages 26-33, January.
- Adam Wagstaff & Naoko Watanabe, 2003. "What difference does the choice of SES make in health inequality measurement?," Health Economics, John Wiley & Sons, Ltd., vol. 12(10), pages 885-890.
- Alexander S. Preker & Guy Carrin, 2004. "Health Financing for Poor People : Resource Mobilization and Risk Sharing," World Bank Publications, The World Bank, number 15019, August.
- Jane Goudge & Steve Russell & Lucy Gilson & Catherine Molyneux & Kara Hanson, 2009. "Household experiences of ill-health and risk protection mechanisms," Journal of International Development, John Wiley & Sons, Ltd., vol. 21(2), pages 159-168.
- Wagstaff, Adam, 2007. "The economic consequences of health shocks: Evidence from Vietnam," Journal of Health Economics, Elsevier, vol. 26(1), pages 82-100, January.
- Abu-Zaineh, Mohammad & Mataria, Awad & Luchini, Stéphane & Moatti, Jean-Paul, 2008. "Equity in health care financing in Palestine: The value-added of the disaggregate approach," Social Science & Medicine, Elsevier, vol. 66(11), pages 2308-2320, June.
- Abu-Zaineh, Mohammad & Mataria, Awad & Luchini, Stéphane & Moatti, Jean-Paul, 2009. "Equity in health care finance in Palestine: The triple effects revealed," Journal of Health Economics, Elsevier, vol. 28(6), pages 1071-1080, December.
- Grossman, Michael, 1972. "On the Concept of Health Capital and the Demand for Health," Journal of Political Economy, University of Chicago Press, vol. 80(2), pages 223-55, March-Apr.
- Pablo Gottret & George J. Schieber & Hugh R. Waters, 2008. "Good Practices in Health Financing : Lessons from Reforms in Low and Middle-Income Countries," World Bank Publications, The World Bank, number 6442, August.
- Kutzin, Joseph, 2001. "A descriptive framework for country-level analysis of health care financing arrangements," Health Policy, Elsevier, vol. 56(3), pages 171-204, June.
- Eddy van Doorslaer & Owen O'Donnell & Ravindra P. Rannan-Eliya & Aparnaa Somanathan & Shiva Raj Adhikari & Charu C. Garg & Deni Harbianto & Alejandro N. Herrin & Mohammed Nazmul Huq & Shamsia Ibragimo, 2007. "Catastrophic payments for health care in Asia," Health Economics, John Wiley & Sons, Ltd., vol. 16(11), pages 1159-1184.
- Ekman, Bjorn, 2007. "Catastrophic health payments and health insurance: Some counterintuitive evidence from one low-income country," Health Policy, Elsevier, vol. 83(2-3), pages 304-313, October.
- Alexander S. Preker & John C. Langenbrunner, 2005. "Spending Wisely : Buying Health Services for the Poor," World Bank Publications, The World Bank, number 7449, August.
- Menno Pradhan & Nicholas Prescott, 2002. "Social risk management options for medical care in Indonesia," Health Economics, John Wiley & Sons, Ltd., vol. 11(5), pages 431-446.
- Jeannette Amaya Lara & Fernando Ruiz Gómez, 2011. "Determining factors of catastrophic health spending in Bogota, Colombia," International Journal of Health Care Finance and Economics, Springer, vol. 11(2), pages 83-100, June.
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