Provision of Health Care

Health care is provided by a range of actors, including governments, civil society, and the for-profit private sector.[1] In some countries, certain forms of care are provided free of charge to citizens as a matter of right or charity. Otherwise, access is contingent upon ability to pay directly (so-called out of pocket spending) or upon having health insurance, which exists in different forms. So-called social health insurance (SHI) is provided on the same basis as social insurance, meaning that it is largely limited to formal sector workers and their dependants.[2] Sometimes social insurance and SHI are even provided through a single scheme, such as Algeria’s Caisse Nationale d’Assurances Sociales. There is also private health insurance which, unlike SHI, typically is not linked to employment or earnings.[3]

In the Arab region, persons with disabilities are often formally entitled to free health care coverage. The precise means through which this right is supposed to be realized vary. In some countries, such as Lebanon, persons with disabilities are theoretically eligible for free health care at hospitals run or contracted by the government simply by presenting their disability card.[4] In other countries, persons with disabilities are legally entitled to be enrolled for free in SHI schemes. Notably, such provisions exist in Algeria,[5] Sudan [6] and Jordan,[7] and in Egypt for children with disabilities.[8] Although gaining access to free health care and to free health insurance might seem, effectively, to be the same thing, it appears that the choice of administrative mechanisms sometimes impacts upon whether the right to access health care is fulfilled in practice, as will be discussed later. SHI coverage is also sometimes extended for free to all beneficiaries of certain social assistance programmes, as is the case in the State of Palestine and again in Sudan[9] and Jordan.[10]

Non-contributory health insurance may also be granted through separate schemes set up specifically for this purpose. Conceptually, such schemes are similar to social assistance schemes, since they are funded by general revenue, and since access is based on need rather than on past contributions. Morocco’s Régime d’Assistance Médical (RAMED) and Tunisia’s Assistance Médicale Gratuite (AMG) are two examples. Each of these two schemes is graded, such that insurance is provided entirely for free to those deemed most in need, and on the basis of a small contribution for those considered to be vulnerable but not among the poorest.[11] In Tunisia, the totally non-contributory part is called AMGI, and the one requiring a small contribution AMGII. However, persons with disabilities covered by AMGII are by law entitled to free health care on the same basis as AMGI beneficiaries.[12] As will be elaborated further below, the eligibility criteria and targeting mechanism for AMGI are the same as for the CT scheme PNAFN, meaning that coverage of one programme implies coverage of the other.