Health Insurance in the Maghreb: The Payer Nobody Pitches
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Health Insurance in the Maghreb: The Payer Nobody Pitches
Tunisian private health insurance collected 400 million dinars in the first half of 2026, up 16.9 percent. It paid out 293.7 million over the same period. Health is now the fastest growing branch after life. This article asks what health insurance in the Maghreb would actually buy from a digital health company.
HealthCare Innovation is the HealthTech cluster based in Monastir, Tunisia. We publish this because founders pitch patients and ministries, and skip the payer sitting between them.
What the Tunisian numbers show
The figures come from the General Insurance Committee, relayed on 31 August 2026 . Direct insurance revenue reached 2,529.2 million dinars for the half year, up 13 percent.
| Branch | Premiums, first half 2026 | Change |
| Life | 774.2 million dinars | up 19.4 percent |
| Motor | 943.1 million dinars | up 9.3 percent |
| Health | 400 million dinars | up 16.9 percent |
| Fire | 190.9 million dinars | up 5.1 percent |
Health sits third by size and second by growth. Now read the other side of the ledger. Claims paid on health reached 293.7 million dinars, up 16.4 percent.
Divide one by the other. The branch returns around 73 dinars in claims for every 100 dinars of premium. That division is our own arithmetic on two published figures, and the committee publishes no such ratio.
Two things follow. The branch is profitable enough to keep growing. It is also indexed on the cost of care, because premiums and claims rose within half a point of each other.
An insurer in that position has three options. Raise premiums, reimburse less, or reduce the volume of care claimed. Only the third option leaves the customer better off.
Coverage is rising across the Maghreb
Morocco moved faster than its neighbours. The generalisation of mandatory health insurance reached more than 32 million beneficiaries in 2025 → . That is 88 percent of the population, against 42 percent before the reform.
| Country | Population covered | Recent change |
| Morocco | 88 percent in 2025 | Up from 42 percent before generalisation |
| Tunisia | 81 percent at the 2024 census | Between 2 and 2.3 million people uncovered |
The Moroccan figure breaks down into schemes. The Tadamon scheme covers close to 11 million people, the scheme for self-employed workers around 4 million, and a voluntary scheme registers 313,000 more.
Morocco is also revising its national reference tariff and making therapeutic protocols enforceable. Those two files decide what a payer reimburses and at what price. They matter more to a digital health company than any coverage headline.
Coverage and financial protection remain different questions. Tunisian households still pay between 38 and 40 percent of health spending directly, depending on the source and the year. We treat that figure in Tunisia’s health financing gap .
Prevention is the only lever an insurer controls
The Tunisian Federation of Insurance Companies has taken a public position on this. Its president, Mondher Khabcheche, argued in April 2026 that private cover should act as a partner to the public scheme .« Private insurance should not be a luxury. It should be a regulator, a partner able to support the public scheme within a logic of lasting balance and universal health coverage. » Mondher Khabcheche, President, Tunisian Federation of Insurance Companies
The federation puts the household share at 40 percent, against 24.3 percent in 2016 and 12 percent in 2005. It places the international reference between 10 and 15 percent.
The driver is chronic disease. The federation attributes 82 percent of Tunisian deaths to noncommunicable diseases. Cardiovascular conditions alone account for more than 30 percent. One Tunisian in three has hypertension and one in six has diabetes. World Health Organization country data puts the noncommunicable share nearer 86 percent. Treat both as an order of magnitude.
The federation also relays return on investment ratios for prevention.
| Prevention area | Return relayed by the federation |
| Healthier diet | 14 to 1 |
| Alcohol harm reduction | 9 to 1 |
| Cardiovascular disease management | 8 to 1 |
| Tobacco reduction | 7 to 1 |
| Cancer screening and treatment | 6 to 1 |
| Physical activity | 4 to 1 |
These ratios are relayed by the federation rather than taken from a document we consulted line by line. The underlying framework is public. The World Health Assembly adopted an expanded list of 28 best buy interventions in May 2023. WHO publishes them as best buys .
Prevention is where the insurer and the digital health company want the same outcome. Both gain when a complication does not happen.
Where the InsurTech money is going
Capital for this sector is being organised at continental level. FSD Africa announced a pan-African venture fund of 25 to 30 million dollars on 26 November 2025 . It targets early stage insurance startups, with health named among its three priorities.
The accelerator behind it has scale. BimaLab reports more than 135 startups supported in 28 African countries since 2020. It counts 150 insurance solutions reaching over 6 million customers. It has worked with 15 regulators on 7 regulatory sandboxes.
The announcement names 28 countries without listing them. We could not establish from public sources whether Tunisian companies have taken part. That is a limit of what is published, not a finding about the sector.
Insurance penetration stays below 3 percent across most of Africa. A market at that level grows by reaching new customers rather than by taking share.
What an insurer would actually buy
A pitch that promises better health will lose. A pitch that names a claims line will get a meeting. Four conditions decide the outcome.
- A named population. Not all policyholders. The diabetic members of one corporate scheme, counted.
- A measured baseline. What that group costs the insurer today, in claims, over twelve months.
- An agreed endpoint. Fewer hospital admissions, fewer repeat tests, better treatment adherence. One number, agreed before the pilot starts.
- A contract that shares the result. Payment linked to the measured effect rather than to the number of licences.
Those four items are also what a public scheme needs. The reimbursement pathways that exist elsewhere are built on the same evidence, as we show in Who pays for digital therapeutics .
One technical condition sits underneath all of it. Measuring a baseline means reading claims and clinical data in a usable form.
That is an interoperability question, treated in FHIR, Sahetna.tn and the interoperability gap .
Companies working on this can start with our Startup programmes . Insurers and mutual funds can reach the cluster through the Community page
Frequently Asked Questions
Q: How large is private health insurance in Tunisia?
A: Premiums reached 400 million dinars in the first half of 2026, up 16.9 percent, according to General Insurance Committee figures. It is the second fastest growing branch after life.
Q: How much does that branch pay out?
A: Claims on health reached 293.7 million dinars over the same six months. That is around 73 dinars paid for every 100 collected, on our own calculation from the two published figures.
Q: How does Moroccan coverage compare?
A: Morocco reports 88 percent of the population covered in 2025, against 42 percent before generalisation. Tunisia reports 81 percent at the 2024 census.
Q: Why should an insurer buy a digital health tool?
A: Because premiums and claims are rising at almost the same rate. Reducing the volume of care claimed is the only lever that leaves the customer better off.
Q: What makes a pitch to an insurer credible?
A: A named population, a measured baseline in claims, one agreed endpoint, and a contract that pays on the measured effect.
HCI Resources
Accelerating Innovation in HealthTech
Pharma & Medical Device Regulatory Services
External Citations
La Presse de Tunisie – insurance sector indicators, first half 2026
Web Manager Center – Tunisian Federation of Insurance Companies on private cover and the public scheme (2026)
Portail national du Maroc – generalisation of mandatory health insurance (2025)
World Health Organization – Tackling NCDs, best buys and other recommended interventions, 2nd edition (2024)
World Health Organization – expanded list of NCD best buys adopted by the World Health Assembly (2023)
FSD Africa – Inclusive Insurtech Investment Fund (2025)
