CNAM Liquidity Crisis Highlights Need for Social Security Reform in Tunisia

Tunis: Tunisia's health insurance system, covering approximately 3.5 million members and known for its varied treatment schemes, is currently grappling with a severe liquidity crisis. This situation has led to an ongoing dispute between the National Health Insurance Fund (CNAM) and private healthcare providers, as highlighted by social protection expert Badr Smaoui.According to Agence Tunis Afrique Presse, Smaoui, in an interview at the TAP television studio, revealed the paradoxical nature of CNAM's financial status. While the fund records a surplus of nearly TND 900 million from an accounting standpoint, it faces a cash-flow deficit that hampers its ability to settle debts with pharmacists, doctors, and private healthcare providers.Smaoui emphasized that resolving CNAM's issues extends beyond technical adjustments, such as the smart card or payment deadlines. It requires a comprehensive overhaul of the social security system and its financial structures. He underscored the necessity of reform to ensure financial sustainability, noting that relying solely on contributions from employees and companies is no longer viable.He further highlighted the importance of the directions outlined in the 2026 Finance Law, aimed at diversifying funding sources. This includes the introduction of new taxes, which Smaoui believes would enhance the state's ability to intervene and correct the situation.The expert also recalled a 2017 law mandating the National Pension and Social Insurance Fund (CNRPS) and the National Social Security Fund (CNSS) to transfer contributions related to CNAM. However, CNSS has failed to comply due to its financial challenges.CNAM's membership is divided into three primary schemes: the public scheme, accounting for about 59%, where insured individuals receive treatment in public hospitals and social security clinics; the reimbursement scheme, covering 25%, where members initially pay the full cost and later recover about 70% of expenses; and the third-party payer scheme (family doctor), the le ast utilized at around 18%, which is currently mired in a crisis of confidence between the fund and healthcare providers.