Abhatoo - Centre Nationale de Documentation

In Morocco, a reform process to establish universal health coverage through nonsubsidized and subsidized social health insurance (SHI) was launched in 2002. The government that year adopted the law on basic medical coverage, which launched a series of health financing reforms to establish universal health coverage through a subsidized SHI scheme (Régime d’assistance Médicale, RAMED), under which the poor would make no contributions, the vulnerable would make small contributions, and all others would be covered by nonsubsidized mandatory health insurance schemes (Assurance Maladie Obligatoire, AMO).
This case study focuses on the subsidized social health insurance scheme, RAMED. This program, which is Morocco’s flagship social protection and health program and which had the support of the King Mohamed VI, was piloted in 2008 and scaled up to the national level in 2012. As of November 2016, 6.35 million people—19 percent of the population—had valid RAMED identification cards. RAMED relies on a sophisticated methodology to target poor and vulnerable households, combining proxy means testing and community targeting methods. However, the reform is yet to be fully implemented, particularly in three areas: actual management of contributions to RAMED by an SHI fund; definition of an explicit benefits package that would be similar to the nonsubsidized SHI schemes; and establishment of monitoring and evaluation mechanisms that would allow for actual monitoring of the services and benefits delivered under the program.
This case study reviews RAMED’s achievements and identifies potential reforms to address the challenges RAMED is facing. After presenting details of the health financing and delivery systems and an overview of public health care, the case study reviews RAMED’s institutional arrangements, poverty targeting, enrolment and identification mechanisms, benefits package, and information environment system. The study concludes with a discussion of potential areas of improvements.