Critical Situation in Tunisia's Healthcare Sector
The Tunisian Organization for Consumer Guidance (OTOC) has issued a statement warning of the critical situation in the country's healthcare sector. According to the organization, this situation heavily affects citizens, including those with social insurance, which constitutes a blatant violation of the constitutional right to healthcare as stated in Article 38 of the Tunisian Constitution.
Socially Insured Citizens are the Most Penalized
The organization explains that socially insured individuals are the most penalized by excessively long reimbursement delays for healthcare services and the increasing cost of these services. Thousands of families often have to wait up to five months to receive the sums they are owed. This wait, according to OTOC, exacerbates financial pressure and forces some individuals to postpone their treatments or go into debt, further eroding their purchasing power.
Objective: Protecting the Constitutional Right to Healthcare
The goal of highlighting this issue is to protect the constitutional right to fair and rapid access to healthcare while ensuring the continuity of social protection.
High Healthcare Costs for Tunisians
The OTOC statement emphasizes that consumers directly bear between 38% and 40% of healthcare expenses, whereas the World Health Organization (WHO) recommends not exceeding 25%. The organization recalls that the guaranteed minimum wage (SMIG) is 566.512 dinars per month, making the health coverage ceiling inequitable in the face of increasing treatment costs. This major imbalance, according to OTOC, requires urgent reform to rebalance the contribution of socially insured individuals and the cost of care.
Urgent Need for Reform
OTOC stresses that despite the financial contribution of insured individuals to the National Health Insurance Fund (CNAM) under Law No. 71 of 2004, the processing time for reimbursement files often exceeds five months. This unjustified administrative and technical delay undermines the principle of equal access to healthcare services. The organization specifies that more than three million reimbursement requests are filed each year, with the majority concerning patients with severe or chronic diseases (over one million members), which worsens their health situation.
Demands for Reforms and Controls
The organization calls for a revision of the list of severe and chronic diseases, which no longer corresponds to the evolution of health conditions and pathologies. It also deplores that the health coverage ceiling does not follow the increase in drug and medical service prices, forcing insured individuals to bear additional costs after just a few months.
Generic Medications and Price Transparency
The statement notes that despite a 2004 law favoring reimbursement based on generic drugs, commercial prescription remains dominant. This practice forces consumers to buy expensive, non-fully reimbursed medications, serving the interests of international laboratories.
OTOC points out that many private clinics and offices do not publish their rates, violating the Consumer Protection Code, and thus exposing patients to unexpected bills. The 32nd report of the Court of Auditors also revealed overruns, with profit margins reaching up to 300% on certain medical products and illegal price increases on certain medications.
Solutions Proposed by OTOC
In the face of these problems, OTOC demands a maximum delay of 15 days for the processing and reimbursement of files. It also calls for an urgent and regular revision of the annual coverage ceiling, linking it to the SMIG and medical inflation indicators. The organization demands that scientific (generic) prescription and the publication of service prices in all private clinics be made mandatory, in accordance with CNAM's reimbursement rates.
Need for Reinvestment in Public Healthcare
OTOC emphasizes the need to reinvest CNAM's resources in public health establishments to guarantee social justice and the constitutional right to healthcare. The organization concludes that subjecting the healthcare sector to market logic alone is a grave violation of the Constitution and current laws, and that legislative and structural reform is necessary to give the public healthcare system its deserved place.
