[Perspectives of the Tunisian health system reform].

Perspectives of development of the Tunisian health system are presented, in reference to the conceptual framework recommended by the World Health Organization, while a project of health insurance reform of the social security regimes is submitted to a dialogue with the different concerned parts. Recommended orientations articulate around five axes: 1. The promotion of care provision by improving the accessibility to services, notably in zones under served, by introducing new modes of dispensation, organization and management of care provision in the framework of a continuous quality assurance strategy.

[Health care supply regulation].

In the current context of health systems' reforms, the regulation would have to occupy a major place in the new role of the State concerning health in order that the system could reach the essential objective to control the quantity and the distribution of health services and to insure an optimal, efficient and equitable coverage of the population's needs. Authors pass in review, in a first part, current regulation means of health care supply, public and private, put in place in Tunisia and suggest their development in areas not covered yet; notably these in relation with the quality and the cost-containment of health care. The current regulation is interested especially in areas of the infrastructure, equipment, medicines and pharmaceutical products and financial and human resources of the sector.

[Sickness risk coverage of the poor and low income population].

Among regimes of sickness risk coverage, those who are managed by the government to the profit of the poor and low income population offer advantages in nature, in the form of total exempt from payment or a strong subsidy of care in public sanitary structures of the ministry of public health. These two regimes, known as "Gratuitous Medical Assistance", existed under other names since the 1950's and has undergone various modifications that had all for objective to adapt the benefit of the gratuitous of care to the economic conditions and financial of the targeted population.

[Hospital reform project, objectives, implementation, results and training].

Face to structural adjustments of the economy, the Tunisian public system of health, confronted with internal inefficiencies and to an inadequate financing, makes the object of a reform targeting teaching hospitals. Its objectives are to institute an autonomy of management and to exploit an integrated system of information that, associated to economic studies, will allow the Government to revise modes of financing of the health sector. This reform has modified the legal structure of university hospitals ending to a management of performances, based on the participation of the intervening, in an environment demarcated by the Government, by contracting multi-annual programs.