At the end of September 2024, more than 31.8 million people were registered with a medical coverage plan. Nearly a quarter of the population does not yet have medical coverage, according to a report from the Economic, Social and Environmental Council (CESE) presented on Wednesday. The details.
The Economic, Social and Environmental Council (CESE) organized, Wednesday, November 20 at its headquarters in Rabat, a meeting to present the conclusions of its opinion entitled “Generalization of the AMO, progress report: a social advance to be consolidated , challenges to be taken up. This opinion concerns the situation and prospects of AMO following its generalization by framework law no. 09-21 relating to social protection. Two major findings emerge. The first observation is that the legislative and regulatory framework as well as the managerial and technical infrastructure for generalization have progressed. At the end of September 2024, more than 31.8 million people were registered with a medical coverage scheme, or 86.48% of the total population (estimated at 36.8 million inhabitants), this means that 13, 55% of the population is not yet registered with a health insurance scheme. As for the second observation, the CESE points out that almost a quarter of Moroccans, or 8.54 million people, do not yet access AMO services, either due to lack of registration (4.97 million people, i.e. almost 13.51% of the total population) or, even when it concerns registered persons, due to an administrative situation of “closed rights” due to insufficient duration of declaration or non-payment, voluntary or involuntary, of contributions due to their coverage plans. This situation of closed rights concerns more than 11% of the total registered population, or more than 3.56 million people. The situation of “closure of rights” concerns nearly 25% of people registered with private sector contributory schemes under management of the CNSS. In its opinion, the CESE notes that registration has proven to be complex for the so-called “TNS” regime initially intended to cover some 11 million workers in the categories of professionals, self-employed workers and self-employed persons practicing a liberal activity. At the beginning of October 2024, if the population registered with this scheme was a little more than 3.5 million people (insured and entitled), two thirds of this number were in a situation of closed rights (i.e. 2.3 million people).
The main recommendations
The CESE notes that the question of forgoing care for financial reasons is one of the main challenges highlighted by its survey on the perception of the AMO, which reveals that among the people surveyed, 60% of those who are not registered and 36 % of insured people give up care for economic reasons. The CESE considers that an overhaul of the architecture and general governance of the national health insurance system is necessary to bring the schemes that make it up into convergence and ensure effective coverage for the entire population, without leaving no one on the sidelines. This implies a refocusing of the AMO, its financing, its services and its management on the health needs of people and on the quality and availability of the care offered. The CESE recommends five areas of recommendations. The first axis concerns the establishment of a unified national regime with compulsory registration for all. Within the framework of the powers assigned to the High Authority for Health, this involves carrying out actuarial and medico-socio-economic impact studies for all variables linked to the generalization of the AMO, based on hypotheses , a clear methodology and objectives shared with all stakeholders in the health insurance and health system. Based on the results of this study, clearly define the basket of care, update the list of reimbursable medicines and medical devices, the national reference rate, contribution and reimbursement rates and rigorously establish a national “third-party payment” system. defined. The EESC recommends strengthening the link between the financing of health insurance and the development of the national health care offer. In this context, it is a question of extending third-party payment for all AMO policyholders. It is also a question of harmonizing pricing and pooling the risks of work accidents and illness. Furthermore, the CESE recommends ensuring the financial sustainability of the AMO. To do this, it is essential to revise the AMO contribution rate by removing the contribution cap established at the public sector level. The Council suggests strengthening medical control of AMO expenditure through the establishment of a national medicines policy, prioritizing the reduction of the costs of innovative medicines and biosimilars. It also involves adopting a unified and transparent process for eligibility for reimbursement and obtaining Marketing Authorization (MA), based on a rigorous medico-economic evaluation of the medical benefit provided. The CESE suggests mobilizing additional funding for the AMO through the establishment of a generalized social contribution (CSG) by direct deduction from all income; the allocation of VAT points to the financing of social protection and in particular solidarity medical coverage for people, active or not, unable to pay AMO contributions. Also included is the mobilization of additional financial resources through specific levies on movable income, financial transactions, on a dedicated share of revenue from the domestic consumption tax (TIC), on revenue from taxes on tobacco, alcohol and games. . In a fourth area, the CESE recommends improving the quality of healthcare services by consolidating the public sector and putting it back at the center of national healthcare provision. It is also important to develop the third sector and establish its public health and social utility character. Finally, the EESC suggests establishing inclusive, participatory and responsible governance. Thus, it is a question of making investment in priority health sectors more attractive, while improving the business climate: introducing measures to prevent speculative operations and strengthening the capacity of public authorities to effectively regulate the sector.
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A complex system
The CESE investigation, which was carried out as part of the preparation of this opinion, reveals that the health insurance system, despite its notable progress, appears to be faced with the need to improve public information on its structures and its access mechanisms. The level of citizen satisfaction appears “moderate” on the part of people with insurance and critical on the part of people without coverage. The health insurance system is mostly perceived as complex, lacking in protection, including on the part of insured persons, and insufficiently clear on the services covered, their costs, their conditions of access and their reimbursement methods. This survey reveals the persistence of the financial barrier: renunciation of care by 60% of the uncovered population and 36% of the insured population. It is also necessary to note the unequal accessibility to care and treatments: specialized treatments “are expensive and are not reimbursed quickly” implying the need for the insured to advance significant costs and wait for partial reimbursement, which represents a heavy financial burden, especially for low-income families.
