The social security reforms in algeria

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.

The objectives of this program are:

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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