The next stage of Morocco's gradual rollout of universal health insurance involves university students being provided with health insurance. Up next is the scheme's greatest challenge, the enrolment of informal-sector workers, a process that will place stress on the cracks already appearing in the scheme.
IHS Life Sciences perspective | |
Significance | Students are to be covered under the government's universal health insurance plans, which already cover formal-sector workers and low-income families. |
Implications | As students are typically young and healthy, their enrolment is likely to have a minor impact on the scheme. |
Outlook | The next stage of the rollout, the enrolment of informal-sector workers, is more difficult and risky, as it can be challenging to drive enrolment in these groups. Such an eventuality would lead to financial instability and raises the risk of sudden attempts to reign in healthcare expenditure. |
New health insurance provisions are due to come into effect in Morocco. According to the source, Moroccan World News, the provisions, approved by the Moroccan government in July, will have university students and those enrolled in vocational training enrolled in the country's universal health insurance scheme. Over 260,000 students are set to receive cover in the latest stage of the rollout of insurance. By 2020, the government envisions that up to 460,000 students will be enrolled in the scheme.
Under the provisions, those attending public facilities will have their premiums covered by the government, while those attending private institutes will be required to pay a premium of MAD400 (USD41.26). To assist in the rollout of insurance to students, the government has set aside MAD110 million (USD11 million). The exact level of cover and the benefits afforded by membership remain unclear.
Morocco's universal health insurance program, known as Assurance Maladie Obligatoire (AMO), was introduced in 2005 and its rollout has been staggered, with full implementation remaining some way off. Following the initial rollout of the insurance to those working in the formal sector, the government launched in 2009 insurance provisions, known as the Régime d'Assistance Médicale (RAMED), for low-income families.
Outlook and implications
As of March, 62% of the Moroccan population had enrolled in universal health insurance schemes, of whom 34% had done so through the AMO scheme and 28% through RAMED. The remaining 38% are students, those working in the informal sector (private-sector freelance workers), and the unemployed. The next stage of the rollout, which is expected to be launched later this year, will see those working in the informal sector provided with insurance.
To date, the rollout of the insurance scheme has however not been plain sailing, with the Moroccan health minister, Hossine El Ouardi, suggesting in March that the health insurance system faced challenges, including a lack of management and governance, funding shortages, poor infrastructure, and a lack of human resources. The enrolment of students is likely to place a low strain on resources and finances, as students are typically young and therefore healthier than other groups.
The next stage of the rollout, to those in the informal sector, is arguably the most difficult. This is mainly because the collection of premiums may be challenging given that many informal-sector workers do not hold bank accounts or pay tax. This means that it is challenging for the government to collect premiums in a mandatory way, and therefore informal-sector workers would need to be enrolling in the scheme in a voluntary fashion. This creates challenges, as healthy informal-sector workers may not feel the need to enrol in the scheme, leaving enrolment primarily to those with chronic health conditions. Without healthy populations, who are less likely to use cover, paying into the scheme, the expenditure of the insurance scheme can rapidly become more than income. This in turn increases the financial instability of the scheme, necessitating government cash injections or heightened premiums. In theory, the government could punish those who do not pay premiums, but this is extremely challenging to enforce. The enrolment of informal-sector workers in universal health insurance schemes in the developing world remains a serious conundrum for countries attempting to roll out insurance provision. Rwanda is one of the few developing countries that have been successful in driving enrolment levels, through high levels of coverage at low premiums, making the benefits far outweigh the negatives. Rwanda's scheme has however only been successful because premiums are kept artificially low and benefits artificially high through a large amount of foreign aid.
For pharmaceutical companies operating in Morocco, the financial fragility of the scheme should cause some concern. Should the scheme face challenges, there remains the very real risk that the government may attempt to reign in expenditure. Indeed, the government has already sought to reduce expenditure on medicines through a series of drug price cuts (see Morocco: 14 April 2014: Morocco announces price cuts on 5,001 drugs).