I / The health insurance reforms of the 2000s:
In
order to improve the performance and the quality of services provided by the
social security system, a major reform program has been tee developed and
implemented from the 2000s.
1- improving the quality of services, in particular with:
•
the extension of the network of local structures,
•
the extension of the third-party payment system (drugs and health care),
•
the development of health actions through the creation of regional medical
imaging centers and specialized clinics,
•
measures to improve the purchasing power of retirees.
2- modernization, in particular through:
•
the rehabilitation of existing infrastructure,
•
the generalization of the IT tool,
•
human resources development,
•
the introduction of the electronic card of the social insured
"CHIFA".
3- preserving the financial balance of social security organizations, in particular through:
•
reform of the instruments for collecting contributions,
•
reform of social security financing,
•
the implementation of a new drug reimbursement policy through the promotion of
generic drugs, the reference price and the encouragement of national
production.
I-1 Reforms of the legislative and regulatory system:
The
social security reform program was initiated by the adaptation of certain
legislative and regulatory texts.
In this context, it is worth mentioning in particular:
-
Law n ° 04-17 of November 10, 2004 modifying and supplementing law 83-14 of
July 2, 1983 relating to the subjection to social security which allowed the
widening of the prerogatives of the agents of control of social security and
empowering labor inspectors to identify breaches of social security
legislation;
-
the supervision of the procedures for approving social security supervisors and
the conditions for their exercise through Executive Decree No. 05-130 of April
24, 2005;
-
Law n ° 08-01 of January 23, 2008 modifying and supplementing law n ° 83-11 of
July 2, 1983 relating to social insurance and its implementing decree, which
constitutes the legal anchor of the electronic card of the “Chifa” social
insured;
-
Law No. 08-08 of February 21, 2008 on social security litigation which
introduced new measures aimed, on the one hand, at facilitating the forced
collection of contributions, measures applicable against taxable persons not
fulfilling their legal obligations in terms of social security and, on the
other hand, promoting the regularization of the situations of bona fide
employers experiencing financial difficulties;
-
Law n ° 11-08 modifying and supplementing law n ° 83-11 relating to social
insurance, which provides for the possibility of extending social coverage to
new specific categories of the population, improving social coverage of women,
improving the quality of services by integrating the specific features of the
great south and the highlands, widening the scope of new information and
communication technologies and confirming the reform of the financing of the
system social security;
-
The 2010 finance law (article 67) which enshrined the reform of the financing
of the social security system by the creation of the national social security
fund, fed by the proceeds from the tobacco tax, from the tax to purchase of
pleasure boats and levy on the net profits from the importation of medicines.
II-Achievements under the 1st objective of the reforms:
Improving
the quality of services.
II.1 – extension of the network of local social security structures:
In
order to bring the social security services closer to the insured, an action
plan aimed at developing local structures has been implemented by all social
security funds. The evolution was remarkable, the number of structures went
from 852 in 1999 to 1431 in 2011, that is to say 579 new structures created
during the last decade. II.2 – The development and generalization of the third-party payment system:
The
third-party payment system established by social security legislation prevents
the insured person from paying health care costs directly when he contacts a
care structure or services linked to care, to a healthcare professional. health
or a pharmacist approved by the social security organization.
The
social insurance organization settles the amounts of the prestations to the
establishment or to the approved health professional, the insured only pays the
costs remaining at his expense, namely 20%. He is exempt from any payment when
he is 100% covered in accordance with the regulations in force, this is
particularly the case for the chronically ill.
II.3- The development and generalization of the third-party payment system concerned:
•
Pharmaceutical products:
After
the implementation of the third-party drug payment system for the benefit of
the chronically ill, retired, disabled and low-income insured persons and their
dependents, a new measure was applied as of August 1, 2011, it this is its
extension to all holders of the "Chifa" card and their dependents.
•
Consultations and medical procedures:
The
extension of the third-party payment system for consultations and essential
medical procedures through the agreement system of the attending physician was
introduced for the first time in our country in 2009, in accordance with the
provisions of Executive Decree No. 09-116 of 7 April 2009 fixing the standard
conventions concluded between the social security organizations and the medical
practitioners practicing in a private capacity.
This device ensures:
-
better organization of the use of the healthcare system,
-
an improvement in the medical follow-up of insured persons and their
dependents;
-
the development of a doctor-social security partnership to promote the quality
of care, prevention and the rationalization of health spending.
•
Hemodialysis through the agreement of private local hemodialysis centers:
This
agreement which intervenes in support of the services of hemodialysis services
of public health structures, has greatly contributed to the approximation of
dialysis of renal insufficiency, who must undergo 3 sessions of 3 to 4 hours
per week.
The
number of approved hemodialysis centers increased from 5 centers in 2002 to 125
in March 2012.
In
2012, almost 7,500 insured persons and beneficiaries of social security
measures with renal insufficiency were taken care of in this context.
•
Medical transport through the agreement of medical transport companies.
In
2007, a standard agreement between social security organizations and medical
transport companies was enshrined in the provisions of Executive Decree No.
07-218 of July 10, 2007.
This
agreement made it possible to organize contractual relations between social
security and medical transport companies and to establish a third-party payment
system for the benefit of social insured persons, in particular those suffering
from kidney disease on dialysis.
In
2011, 161 medical transport companies were contracted with social security
organizations.
II.4. Development of the CNAS health insurance structures:
As
part of the implementation of the social and health action program, emphasis
was placed on:
-
the specific development programs of the specialized clinics under the CNAS and
in particular the infantile cardiac surgery clinic of Bou Ismail which
constitutes a high-level national reference structure, which has been the
subject of a specific development program through the modernization of its
technical platform and the highly specialized training of its personnel within
the framework of agreements signed with specialized foreign establishments with
the same vocation.
In
addition, this clinic was equipped in 2009 with a reception center for parents
of children.
-
The development of medical services (medical consultations, biological analysis
laboratories, dental care) at the level of the 35 diagnostic and care centers
under the CNAS, located in 15 wilayas of the country.
-
The completion in 2008 of 04 regional medical imaging centers under the CNAS
and located in Jijel, Constantine, Maghnia and Laghouat
-Inauguration
by His Excellency the President of the Republic of the Laghouat Regional Center
for Medical Imaging equipment of Regional Medical Imaging Centers.
These medical imaging centers have as
essential missions the contribution to the development of the early detection
of heavy and expensive pathologies and the improvement of the accessibility of
the insured persons to the expensive radiology examinations.
In
January 2010, a free breast cancer screening operation for women with social
security and dependents aged 40 and over was launched at the four regional
medical imaging centers.
This
action benefited from a specific organization, with the development **ement of
software allowing to automatically generate the summons of the women insured
social aged 40 years and more from the file of the insured.
III- Achievements under the 2nd objective of the reforms relating to social insurance modernization:
Within
the framework of the social insurance modernization program, work tools have
been modernized thanks to the possibilities offered by new information and
communication technologies and training and retraining of human resources.
These
actions were accompanied by the modernization of infrastructure.
-
With regard to the development of human resources:
The
staff of social security organizations has grown significantly since
independence, their number increased from 2,000 agents in 1963 to 27,791 agents
in 2000 and to 34,864 agents in 2011.
A
vast training plan for these personnel has been implemented and has concerned
in recent years nearly 17,000 agents from the various social security
organizations.
Training
in recent years has focused on the use of new technologies.
In
addition, four executives from social security organizations received
post-graduate actuarial training at the University of Lausanne (Switzerland).
This
training will allow the realization of prospective studies in the field of
social security.
-
Modernization of infrastructure:
Since
2000, almost 1,000 structures belonging to the various social security
organizations have been redeveloped and modernized.
-
Generalization of the IT tool and implementation of computer networks:
-
The number of centers for calculating social security funds increased from 17
centers in 2000 to 89 centers in 2011.
-
The number of social security structures linked by computer networks increased
from 300 structures in 2000 to more than 815 in 2012.
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