@article{PAR00010226,
  title = {{A}ppraising financial protection in health : the case of {T}unisia},
  author = {{A}bu-{Z}aineh, {M}. and {B}en {R}omdhane, {H}. and {V}entelou, {B}. and {M}oatti, {J}ean-{P}aul and {C}hokri, {A}.},
  editor = {},
  language = {{ENG}},
  abstract = {{D}espite the remarkable progress in expanding the coverage of social protection mechanisms in health, the {T}unisian healthcare system is still largely funded through direct out-of-pocket payments. {T}his paper seeks to assess financial protection in health in the particular policy and epidemiological transition of {T}unisia using nationally representative survey data on healthcare expenditure, utilization and morbidity. {T}he extent to which the healthcare system protects people against the financial repercussions of ill-health is assessed using the catastrophic and impoverishing payment approaches. {T}he characteristics associated with the likelihood of vulnerability to catastrophic health expenditure ({CHE}) are examined using multivariate logistic regression technique. {R}esults revealed that non-negligible proportions of the {T}unisian 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}. {I}n terms of impoverishment, results showed that health expenditure can be held responsible for about 18 % of the rise in the poverty gap. {T}hese results appeared to be relatively higher when compared with those obtained for other countries with similar level of development. {N}onetheless, 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. {A}mongst the correlates of {CHE}, health insurance coverage was significantly related to {CHE} regardless of the threshold used. {S}ome implications and policy recommendations, which might also be useful for other similar countries, are advanced to enhance the financial protection capacity of the {T}unisian healthcare system.},
  keywords = {{TUNISIE}},
  booktitle = {},
  journal = {{I}nternational {J}ournal of {H}ealth {C}are {F}inance and {E}conomics},
  volume = {13},
  numero = {1},
  pages = {73--93},
  ISSN = {1389-6563},
  year = {2013},
  DOI = {10.1007/s10754-013-9123-8},
  URL = {https://www.documentation.ird.fr/hor/{PAR}00010226},
}