Health Financing in Tunisia: A Post-COVID Update and Policy Options

World Bank

Health Financing in Tunisia: A Post-COVID Update and Policy Options

Autores

World Bank

Editor

Washington, DC: World Bank

Descripción

This note updates the comprehensive health financing diagnostic conducted in 2016–2017, reflecting significant demographic, epidemiological, and systemic changes in Tunisia’s health sector. Over the past seven years, the system has faced accelerated population aging and a rising burden of non communicable diseases, particularly hypertension and diabetes, alongside the substantial impacts of the COVID 19 pandemic. Drawing on new household survey data and detailed budget information, the analysis highlights key trends in health financing, spending, and equity. In 2021, health expenditure reached US$269 per capita, with government spending accounting for 36 percent and out of pocket expenditure remaining high at 34 percent, largely driven by private sector utilization and pharmaceutical purchases. Although insurance coverage extends to nearly 90 percent of the population, financial protection remains limited, with catastrophic health expenditures increasing to 11 percent of households. Public spending is heavily skewed toward salaries and curative services, leaving limited resources for preventive care and primary health facilities. Persistent inefficiencies, inequities across income groups, and weaknesses in targeting assistance schemes further constrain system performance. Given fiscal space limitations and sustainability concerns in insurance systems, the note emphasizes the need for reforms to improve efficiency, equity, and sustainability. Priorities include strengthening public financial management, revising benefit packages, reforming provider payment mechanisms, improving targeting of financial protection schemes, and enhancing quality and coordination of care delivery.