The Moroccan health care system contains a combination of public and private financing and delivery. In this regard, it is similar to health systems in other developing countries in which the government assumes responsibility primarily for basic public health activities and for management and organization of the health sector. The Moroccan government, largely through the Ministry of Health (MOH), is a main provider of services.
Despite this, access to care remains difficult, mainly for Moroccans with low income. To improve the well-being of the population, access to high-quality care and reduce disparities in access and financing between income groups and poor people. The Moroccan government has launched RAMED Medical Assistance Regimen in 2012. It is a healthcare system based on the principle of social assistance and national solidarity in favor of poor individuals, who do not benefit from any other health insurance. It allows those people to have free health care services in public hospitals as well as state-provided health services. (Ministry of health, 2013).
Regardless of the effort made by the government, to facilitate health access for the poor population but, is still a group of poor people having no social safety yet. In respect of, some problems and challenges facing the health system particularly in term of medical frames, infrastructure, management, and governance.The writer chooses this topic because access to health, plays a significant role in the well-being of the individual and it contributes to the reduction of poverty. Focusing on the RAMED system as public health insurance for poor people. We will define RAMED system, discuss the reasons that prevent the entire Moroccan population to benefit from this type of health coverage and give the suitable solutions to overcome these obstacles.
To achieve universal health coverage in order to guarantee better access to health care services has been a permanent challenge the country has tries to overcome in the previous decade. It has nonetheless made a significant advance in covering a majority of the population under the RAMED system.
RAMED was first launched in 2009 in the region of Beni Mellal, before being prolonged to the rest of the country in 2012. The system, which targets the low-income population, with the objective of facilitating health care coverage to 8.5 million people, Through this 28% of Morocco’s inhabitants, an estimated group of 4 million people experiencing an extreme poverty . To benefit from this system those people must confirm that they do not own any other health insurance and have the following criteria: for the residents of urban areas, having an annual income less than 3,767 dirhams per individual assessed after weight the reported income. But an individual with annual income of 5650 dirhams is considered vulnerable. For people living in rural areas, to determine if they belong to vulnerable or poor by owning (an agriculture land, cattle, any type of personal transportation or farm equipment).The RAMED system allows to those people to benefit from totally free care, whereas 4.5 million who are vulnerable will be required to pay 120 dirhams as an annual fee, provided at 600 dirhams per year and per family. But in December 2015, the number of RAMED beneficiaries increased to 9.2 million people, exceeding its initial goal. While this proposes that more beneficiaries than primarily planned are able to get health services at affordable rates. Even if the effort made by the government to cover poor and vulnerable but, would not overtake 50% of the 33 million Moroccan citizens, that means approximately half of the Moroccans pay directly from their pockets for health services or they do not benefit to avoid financial problems. Morocco Ministry of Health, (2016).People under RAMED system benefit from a wide range of care such as
Medical and surgical hospitalization, medical consultation, mother and baby care, physical therapy, functional rehabilitation.
As an example of Morocco by the RAMED have selected this system that specifically target poor and vulnerable populations, such as in Egypt the Social Pension Health Care Programme, whereas others have chosen a universal program, eventually a national system whose purpose is to register the entire population, containing the poor similar to Ghana with the National Health Insurance Scheme and PhilHealth in the Philippines. In the case of the Indian state of Andrah Pradesh, there is the Aarogyasri Community Health Insurance Scheme, where the poverty’s status determines those who are eligible to benefit from the system based on the criteria. Thus, the target is to make the 70% of the population living under the poverty line. (Joël. A,et al.2015)
The estimated budget for RAMED is 2.7 billion dirhams where 75% is financed by the government, 19%of annual fees from beneficiaries and the residual 6% from the local authorities. Categories are determined while the heads of families filled out a form which must contain information on the number of subordinates, the family structure, the income and their property. Based on the applications filed an appropriate decision will be taken from the dedicated committee, to give eligible people a three-year family card allowing for free care.
In addition to being able to facilitate access to health care for poor people, RAMED’s principle advantage is the qualityof services offered. This program effectively presents the same kind of care is given to people covered by AMO (compulsory Health Insurance). This is a unique aspect of the program as, in most countries where two such systems remain; the advantages offered to taxpayers are more expanded than those present to the poor population.Although, the RAMED system is succeeded to cover the target population. However, certain limitations face the system few months after its implementation.
One of the measurement challenges is governance; the Ministry of Health is the only decision-making form which assigns discretionary resources. The regional health agencies rely on the localize decisions made in the capital city of Rabat. Communities do not take part in system implementation.
More than that, the procedure of identifying the poor remains ambiguous; the lack of coordination between the registration system and the resolution of the Local Permanent Commission that means some people in vulnerable status is not properly determine; moreover the administrative complication of the documentation that has to be submitted in order to benefit from RAMED system obviously excludes some group of people such as the illiterate and those in more outlying areas. Furthermore, the registration system applied to target poor people is not yet able to precisely determine the eligible population. Errors of exclusion and inclusion persist and the inducement to join RAMED seems limited.
Additionally, the unequal distribution of medical public services between cities; the elevated rate of bed and physician per 1 000 people and some medical services are located only in big cities like Casablanca and Rabat. Well, the problem is the RAMED will not be effective if a poor have to bear the travel and the expenditure to get cured also, the lack of financial supplies to finance the system. Therefore, access to medical care provided by public and university hospitals remains reliant on the contribution of the vulnerable. (HYPERLINK “https://www.moroccoworldnews.com/author/youssef-sourgogmail-com/”Youssef sourgo,2014)
The health information system in Morocco is directed by a national plan developed in 2005 to enhance information literacy; introduce a modern mode of data collection, and rationalize the community and management of quality information. However, equivalent systems of data collection continue to exist and the transferring of information from the circumference to the center remains to be a challenge. A recent assessment of civil registration and vital statistics declare that several gaps and areas require an improvement.
According to Mohammed Hamouiyi, former head of the emergency department at the MS told OBG. , the issue now is the increased workload that follows the expanded coverage by RAMED, taking on to consider the shortage of medical frames, and its influence and impact on the quality of care being delivered.
To overcome all these challenges the Moroccan government should ensure that care services covered by RAMED are accessible, especially in rural areas where there is lack of framework and medical professional.
The Moroccan government should increase the number of public resources devoted to health care to spread coverage, meet the population’s care demands, and develop the field of the benefits package. The government will also need to modify the division of public resources through regions, providers and provide a pledge for financial commitments to local authorities, particularly in rural areas.
Refine and justify the process for beneficiaries from RAMED cards, as well as enhance the process of eligibility to cover the entire target population, determine the difficulties of renewing eligibility and the cause that pushes for the beneficiaries not to renew RAMED cards.
To conclude, Morocco established RAMED insurance to enable access to health care services for the majority of the poor and vulnerable population and protect them from financial hardships. The system proved its effectiveness by achieving the eventual goal to cover 8.5 million population, despite that a large part of the population is still not covered because of many challenges.
To achieve universal health coverage for the vulnerable and poor population; RAMED system must still be consolidated to achieve more improvements.