2 August 2004: Reform of the Health Insurance [Law No. 2004-71 of 2 August 2004]

Before the 2004 Health Insurance Reform, the CNSS regime (private sector) only gave access to public health care facilities, as well as to a network of polyclinics created by the CNSS, while the CNRPS offered access to private healthcare services for civil servants in managerial positions. After an unsuccessful attempt to reform the health insurance regimes in 1986, the government launched a consultation with the social partners to reform it in 1996. The consultation led to the creation of the National Health Insurance Fund (Caisse Nationale d’Assurance Maladie – CNAM) for both the public and the private sectors. In the name of a “national solidarity” displayed in its first article, Law No. 2004-71 enshrines the unification of the health coverage system, the separation between a mandatory basic scheme, and a voluntary supplementary scheme, stating their non-superposition. Despite the principles of unity and equality adopted by Law No. 2004-71, CNAM’s affiliates still have access to unequal healthcare benefits. In fact, the CNAM compulsory system is diversified into three modes of management giving different rights to the workers: access to the public healthcare system, access to health care private sector (based on the third-party payer principle and linked with a complex care path), and the “repayment system” which concerns reimbursement of private health care services. Therefore, CNAM’s affiliates' access to the private sector healthcare depends on their ability to advance the costs for private healthcare services (CHAYATA 2013, 208-241), which reproduces and reinforces class-based boundaries.