The unique identifier as one of the essential tools for steering universal health coverage: The case of Morocco / L'identifiant unique comme un des instruments indispensables au pilotage de la couverture sanitaire universelle, le cas du Maroc.

INTRODUCTION: Morocco is carrying out several actions to generalize basic compulsory health insurance (CHI). Managing this project requires coordination, information sharing, and the commitment of all actors to the goal of covering an additional 22 million people. One of the key factors for achieving this objective is the implementation of a unified registration system. PURPOSE OF THE RESEARCH: The aim is to analyze the existing situation and the feasibility of implementing a unified registration system, and to describe the potential positive impact of the latter on the extension of CHI. RESULTS: This work is based on a diagnosis of the current situation. It draws on the legal framework, all available documents and figures, and on an analytical reading supported by existing literature. It reveals that due to the inadequacy or even the absence of an appropriate legal basis, each managing body has its own registration system. The lack of a unified system has given rise to a number of constraints. These concern, among other things: (i) mobility between or within schemes, which does not operate smoothly because it leads to re-registration (ii) inadequate monitoring of double benefit claims, which is the case for more than one scheme, due to insufficient and hesitant anti-fraud action (iii) the sharing and use of reliable data, which hinders decision making, evaluation, and monitoring. CONCLUSIONS: It is essential to adopt legal texts that will provide the basis for a unified system with regulations enabling the participation of all stakeholders, with the aim of steering the roll-out of CHI effectively and efficiently.

Introduction: Le Maroc mène, depuis quelques années, plusieurs actions permettant de généraliser l'assurance maladie obligatoire (AMO). Le pilotage de ce chantier nécessite la coordination, le partage d'informations et l'engagement de tous les acteurs afin de couvrir 22 millions de personnes supplémentaires. L'un des éléments clés pour optimiser la réalisation de cet objectif consiste à mettre en place un système unifié d'immatriculation. But de l'étude: Analyser l'existant et la faisabilité de la mise en place d'un système unifié d'immatriculation, tout en précisant ses retombées positives sur l'extension de l'AMO. Résultats: Ce travail, fondé sur un diagnostic, appuyé par l'arsenal juridique, des documents et des chiffres disponibles ainsi qu'une lecture analytique renforcée par la littérature existante, a permis de constater que, du fait de l'insuffisance voire l'absence d'un soubassement juridique adapté, chaque organisme gestionnaire a son propre système d'immatriculation. L'absence d'un système unifié gêne notamment : 1) la mobilité entre régimes ou intra-régimes, étant donné qu'elle ne se fait pas de manière fluide car elle génère la ré-immatriculation ; 2) le contrôle du double bénéfice d'un régime insuffisamment organisé et incapable de lutter contre la fraude ; 3) le partage et l'exploitation de données fiables empêchant d'assurer de manière appropriée le suivi, l'évaluation et la prise de décision. Conclusion: Il est indispensable d'adopter des textes juridiques pour fonder un système unifié qui permettra l'encadrement et l'engagement de toutes les parties prenantes dans l'objectif de piloter la généralisation de l'AMO avec efficacité et efficience.

[Medical assistance in middle-income countries needs regulation to ensure its sustainability: Case of Morocco]. / Réguler l'aide médicale des pays à revenu intermédiaire : le cas du Maroc.

INTRODUCTION: The sustainability of medical assistance, considered necessary in middle-income countries, requires permanent regulation. In Morocco, the medical assistance scheme (MAS) is confronted with the lack of regulation tools and the difficulty of affixing these tools effectively in the absence of a regulator. In this sense, the shortcomings of the current practice of its regulation should be identified in order to recommend actions and tools to improve its implementation and guarantee its continuity. METHODS: The analysis and the proposed recommendations are based on the review of the available literature, the review of the legal texts framing the basic medical coverage and the analysis of the current practice of regulation of the MAS. RESULTS: The regulation of the MAS was not treated in the same way as the compulsory health insurance. There is no proper regulator as the case of the compulsory health insurance. In substance, the planned measures remain very insufficient and scattered between several actors and sometimes difficult to apply. Based on a reference framework designed along four axes (resources, expenditures, health care offer and population), the analysis identified fifteen actions and tools to correct deficiencies and support its sustainability. CONCLUSION: The proposed recommendations need a durable commitment from all the actors who must trigger as quickly as possible urgent actions to optimize the implementation of the medical assistance scheme and improve its perception in the citizen.

[For sustainable financing of the Medical Assistance scheme in Morocco]. / Pour un financement pérenne du Régime d'assistance médicale au Maroc

INTRODUCTION: Five years after its implementation, the Medical Assistance scheme (Ramed) has been able to cover more than eleven million people. Nevertheless, its financing remains the main challenge. Its initial financial structure was exceeded after its implementation. A reconfiguration of the financial package has become a necessity in order to guarantee sustainable financing. METHODS: A review of the literature and a situational analysis through disseminated reports and documents made it possible to identify the initial financial package and its limits in order to design a new financial package. RESULTS: The current financing is out of step with the regulations, which has a negative impact on it. Funds are insufficient to cover needs and do not even exceed half of the planned funding, set at three billion dirhams, due to a partial collection of resources. In order to meet the needs of the beneficiaries and follow their growing rhythm, at least 4 billion dirhams annually must be collected. This amount can only be ensured with a revision of the contributions of the State and local authorities. CONCLUSION: The current funds do not meet the needs, which undermines the social acceptability of the regime and threatens its sustainability. It is essential to improve its funding through a diversity of resources and more commitment from stakeholders to ensure sustainable funding managed according to the principles of good governance.