Morocco aims to achieve universal healthcare through integrating all healthcare programs (2022–present)

Over the past few decades, the Moroccan government has sought to expand access to health insurance for its citizens through two complementary programs, Assurance Maladie Obligatoire (AMO) and Régime d’Assistance Médicale (RAMED), which cover the formal and informal sectors respectively. In 2022, AMO and RAMED were merged into the unified AMO-Tadamon program, which enables all beneficiaries to receive healthcare from both public and private clinics. This new reform is designed to reduce the burden on public health facilities and ensure equal access to healthcare resources.

In 2002, just 17 percent of Morocco’s population was covered by health insurance.¹ That year, the government began its healthcare reform process with the aim to achieve universal healthcare. Morocco’s contributory health insurance scheme, Assurance Maladie Obligatoire (AMO), was launched in 2005 to provide healthcare only for formal public- and private-sector employees. The Régime d’Assistance Médicale (RAMED),² launched the same year, aimed to cover those in the informal sector. In 2022, the RAMED program was ended and all beneficiaries were transferred to the new AMO-Tadamon program, as the government sought to achieve universal healthcare under a single system. The unified system was created to reduce the burden on public hospitals and allow all beneficiaries to access the same level of care.

Implementation

In 2002, the Law N° 65-00 established the right to health for all, and assigned tasks to key stakeholders to achieve that goal. It entered into force in August 2005, establishing AMO and RAMED. The government also set up a new administrative structure, l’Agence Nationale d’Assurance Maladie (ANAM) to ensure the regulation and oversight of the national health insurance system and provide technical supervision of RAMED and AMO, and ensure that the programs met their objectives. The organization is run by a council, chaired by the Prime Minister, and populated by representatives from the government, employers, policyholders, and organizations managing the health insurance programs. They handle negotiations between RAMED and AMO and care providers and medical suppliers, and evaluate the success of the programs in reaching the targeted beneficiaries. To set up the financing mechanism, the government established a Committee of Experts, chaired by the Prime Minister, to formulate recommendations and a financing approach.

Originally, AMO provided comprehensive healthcare coverage for those in the formal sector, covering, among other things—childbirth, hospitalization, and medications. In private clinics, beneficiaries could be reimbursed for 70 percent of the national reference price for their care; in public clinics and hospitals, beneficiaries could be reimbursed for 90 percent of the price of services provided.³ 

The RAMED program was designed to provide health insurance for those outside of formal employment, especially the poor, those with disabilities, and the elderly. Under the program, households with incomes less than MAD 300 (USD 34) per person per month (including those with no incomes at all), were eligible for free health insurance. Those with monthly per-person incomes of MAD 300–600 (USD 34–68) were eligible to purchase health insurance in accordance based on their income. Individuals who receive subsidized or free healthcare were not subject to caps on coverage but were only eligible to receive healthcare at public hospitals.⁴ In its early years, this had raised concerns about the existence of a two-tier healthcare system.⁵ Additionally, the expansion of the program, without a corresponding increase in public healthcare resources, resulted in an overburdening of public hospitals.⁶ 

In 2022, to reduce some of the burdens on public health facilities, the government launched the AMO-Tadamon program, a new platform that merges the existing RAMED and AMO programs into one. The 11 million beneficiaries of RAMED were transferred to the newly consolidated scheme and now benefit from the same health coverage as those in the formal sector, but are not required to contribute towards it.^7,8 Importantly, this new program allows patients to receive care from private healthcare institutions, instead of only being allowed to use public facilities. AMO-Tadamon is managed by the National Social Security Fund, known as Caisse Nationale de Sécurité Sociale. Under the new system, employed individuals make contributions via a single unified payment, which covers tax, social security, and healthcare obligations, and is called the “contribution professionnelle unique.” Contribution amounts are based on income, and range from MAD 300 to 3,600 (USD 29 to 352).⁹ 

Cost

Morocco’s health insurance system is financed by a combination of employee and employer contributions and government financing. Employees in the formal sector contribute one to four percent of their incomes, depending on whether they already have private health insurance coverage.¹⁰ In 2022, the government budgeted USD 2.3 billion for healthcare.¹¹ 

Assessment

Within its first six months of existence in 2006, AMO enabled 3.5 million Moroccans to access health insurance for the first time.¹² Since the establishment of these programs, Morocco has witnessed a significant increase in healthcare coverage. The percentage of citizens with coverage grew from 15 percent in 2005¹³ to 78 percent in 2022.¹⁴ However, because there was not a correlated improvement in healthcare resources, particularly in rural areas, the impact of these reforms has been somewhat limited.¹⁵ Many beneficiaries reported challenges accessing hospital care and high rates of out-of-pocket payments.¹⁶ It remains to be seen if consolidating AMO and RAMED, thereby allowing all beneficiaries to access private health resources, in addition to the public clinics, will alleviate some of these challenges. 

Figuring the cost of healthcare. ©Adobe Stock/Christian Delbert

Tags

• Health
• Income & Wealth
• Middle East & North Africa
• Middle-Income Country
• Morocco
• Social Protection
• Universal