突尼斯的卫生融资：新冠肺炎后的最新情况和政策选择

A POST-COVID UPDATE AND POLICY OPTIONSPublic Disclosure Authorized Health Financing in Tunisia:A Post-COVID Update and Policy Options February 2026 CONTENTS AcknowledgmentsAcronyms Executive Summary Introduction3 1Health system context snapshot5 2OverviewofthehealthfinancingsysteminTunisia8 3GeneralgovernmenthealthspendinginTunisia12Snapshot of health insurance schemes and expenditures16 4Financialriskprotectionforhouseholdsandout-of-pocketspending:evidencefromhouseholdsurveys20Financial risk protection coverage20Health service utilization21Household out-of-pocket expenditures27 5Keyfindingsandpotentialpolicyoptions33 Annex 1: Overview of CNAM and AMG schemes36Annex 2: Methodology for ENV analyses37 LIST OF FIGURES Figure 1.1 Diabetes service coverage cascade5Figure 1.2 Hypertension service coverage cascade5Figure 1.3Evolution of UHC Service Coverage Index (SDG 3.8.1) performance intunisia and comparatorcountries, 2000–20216Figure 2.1 Flow of funds for public health facilities intunisia9Figure 2.2Composition of per capita health spending intunisia, USD, 2016–202110Figure 2.3Share of pooled health expenditures (government and health insurance) intunisia and other MENAcountries, 202110Figure 2.4 Current health expenditures as a share of GDP11Figure 2.5Government health expenditures as a share of general government expenditures11Figure 3.1Ministry of Health Expenditures (total and share of overall government spending), 2016–202312Figure 3.2Breakdown of general government spending on health, 2008–202213Figure 3.3Year-on-year in general government spending on health, 2015–2023 (budgeted)13Figure 3.4 Functional classification of MOH budget1414Figure 3.5Change in the share of the distribution of MOH budget14Figure 3.6trends in overall Ministry of Health budget execution, 2016–202214Figure 3.7Budget execution rates by expenditure type, 202114Figure 3.8Budget execution rates by level of care and functional classification, 2016–202215Figure 3.9Year-on-year growth rate of different salary categories15Figure 3.10Salary spending at health facility levels, in millions oftND15Figure 3.11Spending on goods and services at health facility levels15Figure 3.12Average total spending per facility, millions oftND16Figure 3.13Distribution of CNAM beneficiaries by type of scheme17Figure 3.14Per capita expenditures on CNAM schemes, intND17Figure 3.15Breakdown of government health expenditures across general government expenditures, CNAMhealth insurance schemes, and other CNAM schemes (in millionstND)17Figure 3.16 Financial snapshot of CNAM, in millions oftND18Figure 3.17Efficiency frontier, health expenditure per capita, and UHC SCI index18Figure 4.1Percentage of population with health insurance, by quintile, 2015 and 202120Figure 4.2Percentage of population enrolled in different health coverage schemes, 2015 and 2021, total (left)and by quintile (right)20Figure 4.3Percentage of population enrolled in different health coverage schemes, 2015 and 2021, total andby quintile21Figure 4.4Distribution of practitioners consulted among those who seek outpatient care, 2015 and 2021, byquintile (left) and health coverage scheme (right)22Figure 4.5Distribution of facilities consulted among those who seek outpatient care (all types of care,specialized and general care), 2015 and 2021, by quintile (left) and health coverage scheme (right)22Figure 4.6Distribution of facilities used for inpatient care, 2015 and 2021, by quintile (left) and coveragescheme (right)23Figure 4.7C-section rates across quintiles and coverage scheme, 2015 and 202125Figure 4.8 Foregone care by income quintiles and insurance coverage, 202126Figure 4.9 Concentration curves of key indicators of access to outpatient care26 Figure 4.10Composition of out-of-pocket spending on health, by quintile and health coverage scheme, 2015and 202129Figure 4.11Incidence of catastrophic health payments in 2010, 2015 and 202129Figure 4.12Incidence of catastrophic payments defined at different thresholds, by quintile (left) and healthcoverage scheme (right)30Figure 4.13Concentration curves for catastrophic payments at 10 percent of total household consumption(left), 25 percent of household consumption (middle) and at 40 percent of non-food householdconsumption (right)30Figure 4.14Pre- and post-health payments poverty headcount, by quintile and coverage status, 2015 and 202131Figure 4.15Pen’s parade illustrating the incidence of impoverishing expenditure, at the national poverty line,201531Figure 4.16Pen’s parade illustrating the incidence of impoverishing expenditure, at the national poverty line,202131Figure 4.17Composition of out-of-pocket spending on health, by health coverage scheme, 2015 and 2021among the overall population (left) and those affected by catastrophic payments at 10 percent oftotal household spending (right)32 LIST OF TABLES table 1.1tunisia’s UHC service coverage index (SCI) performance, 20216table 4.1Percentage of population seeking care with a general pract