The Moroccan health system is confronted with a myriad of problems related mainly to the demographic and sanitary transition, subsidies insufficiency and iniquity in care financing. The collective financing of health represents 41 % only of the global spending on health. Only 5 million Moroccans benefit from medical cover while the rest of the population falls back on a certificate of indigence in spite of a social coverage system set up for 40 years. To overcome these dysfunctions, improve the health conditions of citizens and assure equality in the access to the care, the authorities have carried out a great reform project concerning medical cover and health financing..

Objectives of the reform

The reform process began in October, 2002 with the adoption of the code of the basic medical cover. The publication of the decree relating to the National Agency of Health Insurance in October, 2003 and that relating to the National Fund Administration Council of the Provident Fund Bodies in June, 2004 came to strengthen this reform.

The code of the basic medical cover tends to cover in a progressive the whole Moroccan population progressively. It institutes:

• A compulsory basic health insurance (AMO) based on the principles and techniques of the national insurance on behalf of the persons practicing a lucrative activity, holders of pension, former Resistance members and members of the Liberation Army and students.

• A medical care system (RAMED) based on the principles of social aid and national solidarity on behalf of the deprived population. The social "charter" foreseeing the implementation of the AMO was signed on January 4, 2004 in Agadir by the government and social partners, namely the main associations of labour unions and employers.

This charter which determines the implementation modalities of the code of the AMO will at first allow increasing from 17 % to 35 % the proportion of Moroccans benefiting from health insurance.

As far as the public sector is concerned, about 700.000 civil servants who have no health insurance so far are going to be able to subscribe to the AMO. Therefore, it will raise to 4,5 millions the number of members in the National Fund of the of the Social Provident Bodies, ( CNOPS).

Concerning the private sector employees, the regime of the AMO will allow to cover more than 4,5 % beneficiaries, (active, retired and persons and rightful persons. It is through the CNSS that this regime is going to allow to more than 1.350.000 employees to subscribe to the AMO and thus join the 300.000 current beneficiaries. On the other hand, the case of liberal professions, tradesmen and craftsmen, who represent about 20 % of the population, is not settled yet. It is still considered by the government which is studying at present the possibility of integrating these categories into the reform program through the creation of an optional product adapted to the specificities of this third group by the launching of the RAMED announced for 2006.

Administrative Bodies

The CNOPS and CNSS, the administrative bodies of the AMO, detain modern management tools in order to carry out their task successfully. The technical supervision of the AMO and the installation of regulation tools of the system fall within the competences of the National Agency of Health Insurance (ANAM). This state-owned institution attached to the Prime Minister has to make sure that the provisions of the law are respected and that basic medical cover system functions appropriately.

Inventory of fixtures 

At present, the implementation of the AMO makes good progress. Eight application decrees were the object of a meeting held on February 17, 2005 between the parties concerned, namely ministries of employment and Health and social partners. The various decrees which were discussed within the cabinet give a larger idea about the conditions and modalities in which the various measures should be taken and applied.

Moreover, the government council held on March, 2005, adopted several draft decrees related to the implementation of the medical cover system.

These decrees concern the application of the basic cover code, the fixing of the cover rates for medical services provided by CNOPS and CNSS and the fixing of the amount to be paid to these two funds.

For its part, the technical committee in charge of the follow-up of the AMO validated two draft decrees of execution. The first fixes the conditions of membership and registration in the basic regime of the AMO, whereas the second determines the rate of contribution for the CNSS and the CNOPS. On July 6, 2005, the project of the AMO witnessed a new turning point with the adoption by the Cabinet of decrees allowing the coming into force of the medical cover system. These decrees come into effect in the first month following their publication in the official bulletin. Therefore, the ANAM (the National Agency of Health insurance) will be able to call for contribution. However, no member will benefit from medical cover until six months of contribution has passed and the first repayments will take place after January 2006. If the final architecture of the project assuring the basic cover is known during 2005, it is untill 2008 that the operational connections AMO / RAMED will be established.

For further information:

The site of the Ministry of Health

http://www.sante.gov.ma/

The site of the national Fund of Social Security

http://www.damancom.ma