National Health Insurance Fund

Direct collection of public sector health insurance contributions: A financial exercise to promote social security schemes’ financial autonomy

Implementation year

Tunisia’s National Health Insurance Fund (Caisse nationale d’assurance maladie – CNAM) was founded in 2004 as part of the country’s health insurance reforms. The collection of compulsory health insurance scheme contributions from public sector workers fell to the National Pension and Social Insurance Fund (Caisse nationale de retraite et de prévoyance sociale – CNRPS). The methods and procedures by which these contributions were then transferred to the CNAM were set out in an agreement between the two funds. In the wake of some structural issues, and owing to the depletion of its financial reserves and insufficient advances coming from the state budget, the CNRPS began paying out civil servant pensions using contributions intended for the CNAM. To remedy this financial imbalance, Law no. 47/2017 of 15 June 2017 gave the CNAM direct responsibility for collecting health insurance contributions from public sector workers. To fulfil this new remit, the CNAM had to establish, with some urgency, the requisite operational processes and logistical mechanisms through which employers could meet their legal obligation to declare and pay health insurance contributions. With reference to relevant good practices and ISSA Guidelines, the CNAM successfully established its own collection system that enabled it to vastly improve its cash flow and therefore to pay healthcare providers more quickly.

Governance and administration
Contribution collection and compliance
Error, evasion and fraud