UNIVERSAL HEALTH COVERAGE AND DIAGONALIZATION OF SOCIAL HEALTH INSURANCE: LESSON FROM A CONTINGENT VALUATION IN TUNISIA

Abstract

Tunisia, like many countries of the Middle East and North Africa region, has implemented several health sector reforms to extend coverage of the whole population towards the goal of Universal Health Coverage (UHC). Nevertheless, due to the structural barriers of informality and unemployment, social health insurance coverage of formal groups and poorer people with a state-subsidized scheme remains unable to reach UHC. Thus informal workers and unemployed are left behind. Achieving the UHC goal involves the consistent participation of the non-covered who are the most concerned to address their preferences and they know better their utility. It is mainly based on this principle that is proposed the idea of diagonalization of the enrollment of non-formal groups to social health insurance. Results from a contingent valuation study in Tunisia dealing with a sample of informal workers and unemployed people support the hypotheses that informality is not an irrevocable choice of the non-covered and that is possible to diagonalize enrollment to national health insurance fund beyond the sphere of formal groups. The diagonalization of health insurance means bending the opportunity to enrol formal health insurance to non covered groups without the prerequisite condition of declared activity. The diagonalization of social health insurance enrollment to non-formal groups may improve their access to the health care services and the whole health system financing.