Recent revelations, during a parliamentary session of oral questions, exposed questionable practices in certain private clinics, “accused of using intermediaries to attract patients under the pretext of free medical campaigns.” These campaigns, presented as humanitarian actions, “include expensive procedures like heart surgery or cataract surgery.” Once the operations have been carried out, reimbursements are claimed from the National Social Security Fund (CNSS), part of which would be diverted to the benefit of the intermediaries involved.
Worrying practices in a sector in crisis
According to precise information that Barlamane.com was able to verify, intermediaries convince dozens of beneficiaries of compulsory health insurance to participate in these campaigns by promising them free care. However, these interventions, fully reimbursed by health insurance, are sometimes performed on patients who do not really require an operation, thus increasing the health system’s expenses. The clinics concerned, located particularly in large cities, would pay commissions to intermediaries – between 400 and 600 dirhams per patient – while receiving much higher amounts for each intervention, sometimes five times higher than the costs charged in public establishments.
Governance still ineffective
These abuses find their origin in the lack of effective implementation of the High Health Authority (HAS), although created by a recent law. Although its president has been appointed, the regulatory texts necessary for its operation have not yet been adopted, which delays its role of control and effective regulation. This institutional void allows the private sector to largely dominate health insurance reimbursements to the detriment of public establishments, a situation mentioned in the reports of the Kingdom’s Mediator. The public service, faced with delays in paying reimbursements – often lasting several years – is struggling to meet the growing needs of the population, according to operators in the sector.
Parliamentarians react
Voices have been raised to demand an in-depth audit of these practices and a temporary halt to suspicious reimbursements, pending the conclusion of investigations. “The urgency of strict regulations associated with effective governance is necessary to prevent these abuses from compromising the strategic project of generalization of medical coverage, initiated under the aegis of the country’s high authorities”urged deputies from Istiqlal (PI, majority) and the Party of Progress and Socialism (PPS, opposition).
The rapid adoption of the implementing texts necessary for the operationalization of the high health authority is considered crucial. “This body must play a central role in controlling practices, regulating costs and guaranteeing equitable coverage for all citizens”underlined MP Rachid Hamouni.
