The Tunisian organization to inform the consumer (OTIC) sounded the alarm on Monday September 22, 2025, on the major dysfunctions of the social security system in Tunisia. Excessive reimbursement deadlines, unsuitable ceilings and lack of transparency in medical pricing weigh heavily on insured and threaten fair access to care.
Social policyholders strangled
According to OTIC, Tunisian insureders directly support between 38% and 40% of health spending, well beyond the 25% threshold recommended by the World Health Organization (WHO). The minimum wage guaranteed in the industry, set at 566.512 dinars per month, makes the current ceiling for “unfair” reimbursement in the face of the continuous increase in the price of treatment.
Reimbursement times exceed in many cases five months, while more than 3 million requests are filed each year, the majority of which concerns more than a million chronic patients. These administrative slowness, qualified as “unjustified”, aggravate the deterioration of the health state of patients forced to report or abandon their care.
Unsuitable ceilings and opaque pricing
The OTIC notes that the cover ceilings do not evolve at the rate of inflation, which obliges the insured to assume heavy expenses after only a few months of treatment.
In addition, the organization denounces a lack of transparency in the pricing of private clinics and firms, which do not publish their prices despite the legal obligation, thus exposing patients to “surprise invoices”. Some establishments would not even respect the reference rates of the National Health Insurance Fund (CNAM).
Abuse revealed by the Court of Auditors
The 32ᵉ Annual report of the Court of Auditors highlighted serious abuse: excessive beneficiary margins sometimes reaching 300% on certain medical products, and illegal increases in drug prices with margins ranging from 26% to 160%, instead of the 10% authorized.
For the OTIC, these practices constitute a “blatant violation” of constitutional law for health, guaranteed by article 38 of the Tunisian Constitution.
The reforms claimed by the OTIC
Faced with this situation, the organization calls for a maximum period of 15 days for the processing and reimbursement of files; To regularly revise the annual coverage ceiling according to the minimum wage, purchasing power and inflation; to broaden the list of serious and chronic diseases supported; And to accelerate the generalization of the electronic card “Labess”, intended to fluidify the procedures.
