Economic evaluation of the health insurance reform in Tunisia.

Summary Tunisia is experiencing a significant increase in health care spending and in the life expectancy of Tunisians. But these results go hand in hand with inequalities in access to care, motivating a health insurance reform implemented in 2007. The main changes aim at improving coverage for chronic diseases and generalizing insurance for private health care. This applied microeconometrics thesis examines the impact of the reform on access to care and out-of-pocket expenses. The evaluations are based on surveys of several thousand individuals in 2005 and 2010. The motivations for the reform are presented, before analyzing the choice of insurance and its influence on the use of public or private care providers in 2010, after the reform. An evaluation of the reform was analyzed using the difference-in-differences approach. Overall, the results show that this reform seems to have achieved several of its objectives: improved access to care for members of the National Social Security Fund (CNSS), better access to private care, and a reduction in out-of-pocket expenses and catastrophic expenses for people with chronic diseases.