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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Fairness in healthcare finance and delivery: What about Tunisia?
Health Policy and Planning, Volume 29, No. 4, Year 2014
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Description
Anecdotal evidence on hidden inequity in health care in North African countries abounds. Yet firm empirical evidence has been harder to come by. This article fills the gap. It presents the first analysis of equity in the healthcare system using the particular case of Tunisia. Analyses are based on an unusually rich source of data taken from the Tunisian HealthCare Utilization and Morbidity Survey. Payments for health care are derived from the total amount of healthcare spending which was incurred by households over the last year. Utilization of health care is measured by the number of physical units of two types of services: outpatient and inpatient. The measurement of need for health care is apprehended through a rich set of ill-health indicators and demographics. Findings are presented and compared at both the aggregate level, using the general summary index approach, and the disaggregate level, using the distribution-free stochastic dominance approach. The overall picture is that direct out-of-pocket payments, which constitute a sizeable share in the current financing mix, emerge to be a progressive means of financing health care overall. Interestingly, however, when statistical testing is applied at the disaggregate level progressivity is retained over the top half of the distribution. Further analyses of the distributions of need for - and utilization of - two types of health care - outpatient and inpatient - reveal that the observed progressivity is rather an outcome of the heavy use, but not need, for health care at the higher income levels. Several policy relevant factors are discussed, and some recommendations are advanced for future reforms of the health care in Tunisia. © The Author 2013; all rights reserved.
Authors & Co-Authors
Abu-Zaineh, M.
France, Marseille
Aix Marseille Université
Arfa, Chokri
Tunisia, Tunis
Institut National du Travail et Des Etudes Sociales
Ventelou, Bruno
France, Paris
Inserm
Ben Romdhane, Habiba
Tunisia, Tunis
Faculté de Médecine de Tunis
Moatti, Jean Paul
France, Marseille
Aix Marseille Université
Statistics
Citations: 16
Authors: 5
Affiliations: 4
Identifiers
Doi:
10.1093/heapol/czt029
e-ISSN:
14602237
Research Areas
Health System And Policy
Study Design
Cross Sectional Study
Study Approach
Quantitative
Study Locations
Tunisia