@article{PAR00012155,
  title = {{F}airness in healthcare finance and delivery : what about {T}unisia ?},
  author = {{A}bu-{Z}aineh, {M}. and {A}rfa, {C}. and {V}entelou, {B}. and {B}en {R}omdhane, {H}. and {M}oatti, {J}ean-{P}aul},
  editor = {},
  language = {{ENG}},
  abstract = {{A}necdotal evidence on hidden inequity in health care in {N}orth {A}frican countries abounds. {Y}et firm empirical evidence has been harder to come by. {T}his article fills the gap. {I}t presents the first analysis of equity in the healthcare system using the particular case of {T}unisia. {A}nalyses are based on an unusually rich source of data taken from the {T}unisian {H}ealth{C}are {U}tilization and {M}orbidity {S}urvey. {P}ayments for health care are derived from the total amount of healthcare spending which was incurred by households over the last year. {U}tilization of health care is measured by the number of physical units of two types of services: outpatient and inpatient. {T}he measurement of need for health care is apprehended through a rich set of ill-health indicators and demographics. {F}indings 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. {T}he 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. {I}nterestingly, however, when statistical testing is applied at the disaggregate level progressivity is retained over the top half of the distribution. {F}urther 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. {S}everal policy relevant factors are discussed, and some recommendations are advanced for future reforms of the health care in {T}unisia.},
  keywords = {{H}ealthcare finance ; healthcare delivery ; progressivity ; horizontal ; equity ; {T}unisia ; {TUNISIE}},
  booktitle = {},
  journal = {{H}ealth {P}olicy and {P}lanning},
  volume = {29},
  numero = {4},
  pages = {433--442},
  ISSN = {0268-1080},
  year = {2014},
  DOI = {10.1093/heapol/czt029},
  URL = {https://www.documentation.ird.fr/hor/{PAR}00012155},
}