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The Aim of the Study: Medication noncompliance is one of the daily problems of the physician. Improving the medication adherence allows better management of hypertension. The aim of this work was to determine the level of compliance for patients with hypertension and to identify factors that determine compliance., Methods: A cross-sectional study was carried out among a sample of hypertensive patients attending general and specialist practitioners in public or private clinics of Sfax. Two hundred and seventy-three participants had accepted to be interviewed. Patients were identified as noncompliants using a questionnaire developed by the Comité de lutte contre l'hypertension artérielle (CFLHTA)., Results: Non-compliance rate was 63.4%. The low level of education was associated with a lower adherence. The monotherapy, the once-daily regimen with fewer number of tablets were associated with a better adherence (p<10(-6)). The welcome and the availability of drugs in the public clinic affect positively the adherence of patients (p<0.0002). A patient very satisfied with his consultation and the explanation given by the doctor about his illness and its treatment had a better adherence (p<0.00003)., Conclusion: Our study had demonstrated a low compliance with antihypertensive drug therapy. Tunisian health care system should elaborate a management plan which takes into account our particular predictors of compliance to improve adherence to antihypertensive medication., (Copyright 2010 Elsevier Masson SAS. All rights reserved.)

Authors expose in the first part of this article practical modes to implement the health insurance reform under the angle of the mastery of care expenses, at the micro and the macroeconomic levels. Thus they pass in review the different possibilities to master expenses, at the supply and the demand sides, by identifying advantages and risks of each of they and by specifying orientations of the health insurance reform in this area: the moderating ticket, contractual payment methods of hospitals and health professionals, the path of care, the refund of care expenses, the rationalization of consumption of medicines and complementary examinations and the harmonious development of care supply by a better public and private mix. A particular accent is put on preliminaries and implementation conditions of the prospective payment of providers and organizational conditions of care provision, from general practitioner that would become the main entry of the care system. In a second part, authors pass in review organization and management conditions of social security bodies, needed for the health insurance reform implementation. On the basis of decentralization and a three levels organization (local, regional and central), social security bodies will put in place the most appropriate organization to insure a steady efficient implementation of the health insurance reform, in dialogue with stakeholders. Consultative committees at regional and central levels, regrouping all the intervening in the health insurance, will be instituted. The sought-after objective through this organization is to administer the health insurance, at the strategic, decisional and operational levels, with suppleness, as a changing and dynamic project, in function of flexibility imperatives necessary for the reform implementation.

The direct costs were determined by conducting a retrospective study on the files of 100 diabetics (selected at random) who had attended the clinic at least once in 1991. Another study was conducted simultaneously under the same conditions on 100 non-diabetic patients. Diabetic patients attend on average 8 times a year, twice as often as nondiabetics, generally at the department of general medicine (6 times). They undergo more biological tests and receive more care procedures than nondiabetics. Drug prescriptions cost on average US$ 62 per year for the diabetic, 3 times as much as for the non-diabetic (US$ 20/year). The total direct cost of outpatient care is US$ 117 per year for the diabetic, as against only US$ 48 for the nondiabetic. The cost is much higher for diabetics with degenerative complications (US$ 144 as against US$ 92). Reduction of the cost of care requires early detection of diabetes and education of the diabetic, so as to ensure better control of blood sugar levels and freedom from complications that lead to a sharp increase in consultations and treatment procedures.