Summary
Highlights
Social security (dahmane estimé) is a crucial aspect of healthcare systems, covering financial risks related to health, accidents, retirement, unemployment, precariousness, and disability. Its primary goal is to improve citizens' living conditions by providing collective foresight mechanisms, as seen with organizations like CNAS (Caisse Nationale des Assurances Sociales) which manages contributions and redistributes funds to cover financial risks.
Social security began in the late 19th century with industrialization, driven by the need to protect workers from accidents, premature mortality, and other risks in factories. Initially, it covered only working individuals, but eventually expanded to include the entire population. This generalization of social security spread across Western Europe and led to international conventions.
Universal coverage is achieved when over 80% of the population is insured. Social security acts as a 'suction pump,' collecting contributions and redistributing them to cover risks. This system, like the Bismarck model in Germany, can operate at national or regional levels. Algeria's social security system, existing since the colonial era, initially only covered public sector workers but later unified to cover all employees.
Social security covers risks of non-professional origin (illness, maternity, old age, disability, death) and professional origin (work accidents, occupational diseases), as well as economic risks (unemployment). Beneficiaries include workers, students, trainees, and athletes. Dependents like non-working spouses, children under 18 (or 21 if not enrolled in school), unmarried adult daughters, disabled children, and dependent parents are also covered.
Social security covers healthcare costs, including curative, preventive, professional rehabilitation, thermal cures, and medical transportation. Reimbursement rates are typically at least 80% of regulated tariffs. For chronic illnesses, the reimbursement rate can be 100%. The 'third-party payment' system means that the insured person pays a fixed tariff (reference tariff), and the social security covers the remaining 80%. This system relies on conventions between social security and healthcare providers.
Maternity insurance requires medical follow-up during pregnancy and a medicalized delivery for reimbursement. Full reimbursement (100%) and 14 weeks of legal rest (three months of leave) are provided. Work accidents include incidents during work or on the commute (e.g., within 30 minutes of starting work). In such cases, social security provides benefits for temporary or permanent incapacity, or indemnities to the family in case of death. Additionally, social security pays a fixed annual fee for hospitalizations.
Social security is primarily funded by contributions from employers and employees. In Algeria, due to needs exceeding contributions, a portion of taxes also contributes to financing. The system is structured into several national funds: CNAS (for salaried workers' social insurance), CNR (National Retirement Fund), CNAC (National Unemployment Insurance Fund, which also finances micro-enterprises), and CASNOS (National Social Security Fund for non-salaried workers).
Social security faces challenges such as demographic growth (leading to increased demand), job loss (reducing contributions), the informal sector, and healthcare costs. The system also suffers from limited reimbursement due to an outdated general nomenclature of professional acts (NGAP), which does not reflect real prices, new medical acts, technologies, or diseases. The monetary value has not been updated since 1987, leading to hospitals not receiving correct reimbursement rates.
The main goal of social security is societal protection, enabling individuals to access healthcare services, including consultations, hospitalizations, and treatments. It also aims to provide replacement income in cases of inability to work due to illness, disability, maternity, or unemployment, regardless of the cause.