Is informality an individual choice? Evidence from the field using a contingentvaluation survey in Tunisia

Authors

  • Khaled Makhlouf Aix-Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, IHU - Timone, 27 Bd Jean Moulin, 13385 Marseille Cedex 5, France
  • Christel Protière Aix-Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, IHU - Timone, 27 Bd Jean Moulin, 13385 Marseille Cedex 5, France
  • Bruno Ventelou ORS PACA, Observatoire Régional de la Santé, Provence Alpes Côte d’Azur, Faculty of Medicine - Timone, 27 Bd Jean Moulin, 13385 Marseille Cedex 5, France Correspondance : Khaled Makhloufi, INSERM-IRD-UMR912 – SESSTIM, Faculté de Médecine, 27 Bd Jean Moulin, 13385 Marseille cedex 5, France

Keywords:

Willingness-to-pay, Contingent valuation method, Social insurance, Health risk, Old-age risk, Informal workers

Abstract

In many developing countries and in the particular context of Middle East and North Africa (MENA) region, the challenge of informality is regarded as a fatality. This leads a large fraction of the population being deprived of any social security system. Following an original approach, a cross-sectional contingent valuation study was conducted in Tunisia, between August and September 2013, dealing with willingness to take-up two mandatory health and pension insurance schemes currently run by two national funds: ‘Caisse Nationale d’Assurance Maladie’ (CNAM) and ‘Caisse Nationale de Sécurité Sociale’ (CNSS), respectively. The sample size covers 456 respondents, all non-covered by any social security scheme (health or pension scheme) and recruited in all parts of the country (North, Central and South). The Willingnessto-pay (WTPs) of respondents are elicited in two sampling points: the informal markets (known as Souks) characterized by the high presence of informal workers and the public squares (known as Al-mydan) where peaceful demonstrations of unemployed people were commonplace following the so-called ‘Arab Spring’ that began in Tunisia at the end of 2010. Results support the hypotheses that the proposition of a voluntary affiliation to mandatory insurance schemes, referred to as social insurance schemes, can be accepted by the majority of non-covered and that the WTPs stated are substantial. Willingness-to-join the proposed schemes by informal workers and unemployed varies regarding the three health insurance plans described (the scheme run by the CNAM includes three plans) and risks covered (with an added pension scheme or not). The WTPs declared, for each insurance scheme, show preferences (utility) of Tunisian households to both mandatory health and pension insurance schemes. Accordingly, this suggests important implications for the Tunisian health insurance policy (with universal health coverage goal in mind) and the pension system. The message of this paper is to outline that informality is not an irrevocable choice and that control of social evasion in Tunisia is possible. Another strength of the paper is that it gives some data and information on a population generally difficult to reach, the demonstrators, although informal-workers (non-demonstrators) appear strongly interested by the insurance program.

Published

2022-11-30

How to Cite

Khaled Makhlouf, Christel Protière, & Bruno Ventelou. (2022). Is informality an individual choice? Evidence from the field using a contingentvaluation survey in Tunisia. Journal De Gestion Et D économie médicales, 35(04-05). Retrieved from https://journaleska.com/index.php/jdds/article/view/7624

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Section

Articles