Tunisia's National Health Insurance Fund Under Pressure
Two ultimatums have been issued to the Caisse Nationale d'Assurance Maladie (CNAM) this summer, putting the organization under significant pressure. The first ultimatum, issued by the Syndicat des Pharmaciens d'Officine de Tunisie (SPOT), expired on July 1, while the second, presented by medical device suppliers, is set to expire on August 31.
Two Fronts, One Common Anger
On June 24, SPOT threatened to suspend coverage for insured individuals, citing approximately 80 million dinars in unpaid claims and payment delays of three to four months. A protocol agreement signed in January between the two parties is now considered "stillborn" by the former president of the syndicate, Naoufel Amira. A crisis cell was established on June 30, and a meeting chaired by the Minister of Social Affairs is scheduled for mid-July.
Medical Equipment Suppliers Join the Fray
The Chambre Syndicale des Dispositifs Médicaux de l'UTICA is denouncing unpaid debts dating back to 2020, affecting over 600 companies. This is an unprecedented liquidity crisis, which may lead these companies to suspend all delivery and maintenance activities.
A Surplus That Only Exists on Paper
The CNAM's situation is all the more paradoxical given that its latest public accounts, which date back to 2022, show a net result exceeding one billion dinars for two consecutive years. However, this surplus is virtual and only exists in the accounting records. The majority of it comes from claims from the CNSS and CNRPS, which collect contributions on behalf of the CNAM. These claims represent 82% of the balance sheet and are growing faster than the result itself.
A Lack of Liquid Assets
In reality, the CNAM is counting on claims that it cannot collect, rather than actual cash. The real treasury is limited to 75.5 million dinars at the end of 2022, barely enough to cover the debt owed to pharmacists. This phenomenon is spreading, and the debt owed to hospitals and clinics has increased by 44% over two years. Furthermore, no accounts have been published since 2022, depriving parliamentarians and creditors of any visibility into the current situation.
A Brake on the Entire Sector
Beyond the immediate liquidity crisis, these chronic unpaid debts are discouraging investment in the medical sector. Medical device companies, forced to finance the CNAM with their own funds, are freezing their expansion projects and, in some cases, stopping imports altogether.
A Degraded Customer Base
This also affects their access to bank credit, as banks are naturally more cautious when dealing with claims that have been pending for up to four years. The lack of published accounts since 2022 only exacerbates the problem, making the counterparty risk of the fund illegible to any foreign investor or distributor who wants to enter the Tunisian health market.
