Ambulatory Surgery as a Population Health Strategy: Health System Reorganization and Policy Implications
1
Ecole Supérieure de Commerce de Tunis, La Manouba, Tunisia
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
The transition from conventional inpatient surgery to ambulatory surgery has been widely promoted as a strategy to improve hospital efficiency and optimize resource use.¹˒² In many middle-income countries, including Tunisia, health systems face increasing surgical demand, persistent hospital congestion, and financial constraints.³˒⁴ While ambulatory surgery has expanded in high-income settings,⁵ evidence on its population-level implications in health systems undergoing organizational transitions remains limited.⁶ This study examines ambulatory surgery as a health service delivery reform and explores its potential effects on access, efficiency, quality of care, and equity within the Tunisian health system.
METHODS:
We adopted a health systems and population-based analytical framework. The study combined (i) a review of national regulatory and strategic documents related to hospital organization and surgical care in Tunisia,⁷ (ii) secondary analysis of administrative and hospital data on surgical activity and length of stay,⁸ and (iii) a narrative synthesis of international evidence contextualized to Tunisia.⁵˒⁶ The analysis was structured using the WHO health systems building blocks and access-to-care frameworks, focusing on population coverage and equity.⁹˒¹⁰
RESULTS:
Scaling up ambulatory surgery in Tunisia could increase surgical throughput, reduce hospital length of stay, and alleviate inpatient congestion.²˒⁵ However, implementation remains uneven across regions and specialties, constrained by limited organizational readiness, weak coordination between hospital and outpatient services, and insufficient post-operative follow-up.⁶˒⁸ While ambulatory surgery may improve access to care, it also risks exacerbating inequities for patients facing geographic or social barriers to follow-up.¹⁰˒¹¹
CONCLUSIONS:
Ambulatory surgery in Tunisia represents a population-level health service reform with significant implications for access, equity, and system performance.³˒⁹ Effective implementation requires integrated care pathways, aligned provider incentives, and policies addressing social and territorial disparities.⁶˒¹⁰ Strengthened governance and monitoring are essential to ensure equitable and sustainable gains in surgical care.⁹˒¹¹ If you want, I can also provide:
The transition from conventional inpatient surgery to ambulatory surgery has been widely promoted as a strategy to improve hospital efficiency and optimize resource use.¹˒² In many middle-income countries, including Tunisia, health systems face increasing surgical demand, persistent hospital congestion, and financial constraints.³˒⁴ While ambulatory surgery has expanded in high-income settings,⁵ evidence on its population-level implications in health systems undergoing organizational transitions remains limited.⁶ This study examines ambulatory surgery as a health service delivery reform and explores its potential effects on access, efficiency, quality of care, and equity within the Tunisian health system.
METHODS:
We adopted a health systems and population-based analytical framework. The study combined (i) a review of national regulatory and strategic documents related to hospital organization and surgical care in Tunisia,⁷ (ii) secondary analysis of administrative and hospital data on surgical activity and length of stay,⁸ and (iii) a narrative synthesis of international evidence contextualized to Tunisia.⁵˒⁶ The analysis was structured using the WHO health systems building blocks and access-to-care frameworks, focusing on population coverage and equity.⁹˒¹⁰
RESULTS:
Scaling up ambulatory surgery in Tunisia could increase surgical throughput, reduce hospital length of stay, and alleviate inpatient congestion.²˒⁵ However, implementation remains uneven across regions and specialties, constrained by limited organizational readiness, weak coordination between hospital and outpatient services, and insufficient post-operative follow-up.⁶˒⁸ While ambulatory surgery may improve access to care, it also risks exacerbating inequities for patients facing geographic or social barriers to follow-up.¹⁰˒¹¹
CONCLUSIONS:
Ambulatory surgery in Tunisia represents a population-level health service reform with significant implications for access, equity, and system performance.³˒⁹ Effective implementation requires integrated care pathways, aligned provider incentives, and policies addressing social and territorial disparities.⁶˒¹⁰ Strengthened governance and monitoring are essential to ensure equitable and sustainable gains in surgical care.⁹˒¹¹ If you want, I can also provide:
| eISSN: | 2654-1459 |
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