Impact of Disparities in Reimbursement Rules Between Public and Private Sectors on Accessibility to Care in Moroccan Mandatory Health Insurance: A Cross-Sectional Study

• Published in: Value in health regional issues 2019-09, Vol.19, p.132-137
• Main Authors: Cheikh, Amine, Bouatia, Mustapha, Ajaja, Mohamed Rida, El Malhouf, Naoufel, Cherrah, Yahia, Abouqal, Redouane, El Hassani, Amine
• Format: Article
• Language: English
• Subjects: Adult; copayment; Cross-Sectional Studies; disparities; Female; Health Services; Health Services Accessibility; Healthcare Disparities; healthcare utilization rate; Humans; Male; mandatory health insurance; Middle Aged; Morocco; Patient Acceptance of Health Care - statistics & numerical data; Private Sector; Public Sector; Reimbursement Mechanisms; Socioeconomic Factors; Universal Health Insurance; Young Adult
• ISSN: 2212-1099; 2212-1102
• DOI: 10.1016/j.vhri.2019.07.008

Disparities in the reimbursement rules between the 2 funds that manage mandatory health insurance in Morocco could negatively affect the accessibility of insured persons to healthcare services and products. The objective is to analyze the impact of these disparities on access to care and to assess the insured’s copayment difference between the 2 funds. Healthcare utilization rates of the insured population in the 2 funds were analyzed by sector, sex, and age groups for 2014. We also looked at the percentage of copayment paid by the insured depending on the fund, methods of reimbursement, type of care, and nature of diseases. The analysis was based on data retrieved and aggregated at the National Agency for Health Insurance. The healthcare utilization rate differs significantly between the 2 funds. It is higher for the insured in the public sector (45%) compared with those in the private sector (18.5%) (P < .001). The healthcare utilization rate differs significantly according to the age groups in the 2 sectors (P < .001, respectively), and according to the sex of the insured in the 2 sectors (the healthcare utilization rate is higher for women than for men [P < .001, respectively]). The copayment percentage incurred by insured persons was 32.1% for employees in the public sector and 36.4% for employees in the private sector. Differences in reimbursement rules between the 2 funds may be the cause of inequity in access to care between insured persons. This situation can jeopardize the objectives of a universal and equitable health insurance scheme. •Universal medical coverage is one of the goals and priorities of all countries worldwide and of the World Health Organization. The implementation of this medical coverage is not easy, especially for the countries with limited income. Several constraints and obstacles can block a better implementation of this universal coverage.•The difference in healthcare baskets covered by health insurance funds and the reimbursement rates of different medical benefits could create significant disparities in access to care for the population.•Standardizing reimbursement rules for medical benefits is one of the top priorities of our health system to ensure fairness and equality among citizens.