AMO in Morocco: Financial Imbalances in Social Security Funds
Analysis of AMO’s financial imbalances in Morocco, from CNOPS deficits and pressure on the CNSS to governance, medicine prices and cost control.
“For the CNSS general scheme, lowering the minimum contribution period required for pension entitlement from 3,240 to 1,320 days will bring forward, by a few years, the emergence of the scheme’s overall deficit and the depletion of its reserves” notes the press release by the Systemic Risk Coordination and Monitoring Committee (CCSRS) on financial stability in 2024.
The generalization of AMO is facing major structural challenges that threaten the financial viability of the system in the medium and long term. Vitavox Institute looks at the economic imbalances threatening Morocco’s health system.
CNOPS in Difficulty
The National Fund of Social Welfare Organizations (CNOPS), which manages Compulsory Health Insurance (AMO) for civil servants, is going through a difficult financial period. After recording a deficit of 1.5 billion dirhams in 2021, the situation did not improve, with successive deficits of 878 million dirhams in 2022 and 1 billion dirhams in 2023, according to L’Économiste. Forecasts for 2024 are just as alarming, with an estimated deficit of 1.34 billion dirhams. To cover these deficits, CNOPS had to draw on its reserves, which stood at only 1.6 billion dirhams in 2023. At this pace, these reserves will quickly be exhausted, threatening the sustainability of the health-insurance scheme for civil servants.
The CNSS: A Fragile Balance
The National Social Security Fund (CNSS), which manages AMO for private-sector employees, currently appears less affected by these financial imbalances. It currently shows a comfortable surplus of 40 billion dirhams. However, this situation could deteriorate quickly if no measures are taken to restore the scheme’s finances. Some specific sectors, such as self-employed workers (TNS), are already experiencing difficulties. In 2023, TNS contributions amounted to 793 million dirhams, while expenditure reached 1.3 billion dirhams, creating a deficit of 507 million dirhams.
Structural Factors Contributing to Imbalances
In its dossier “AMO in Danger”, TelQuel highlights several structural factors contributing to the imbalances in Compulsory Health Insurance (AMO).
- Absence of a Comprehensive Actuarial Study: The absence of a comprehensive actuarial study on the real cost of generalizing AMO makes it difficult to obtain clear visibility on long-term financing needs.
- Weaknesses in Governance and Regulation: Shortcomings in health-system governance and regulation exacerbate the imbalances. The role of the National Health Insurance Agency (ANAM) in coordination and regulation remains insufficient.
- Imbalance Between Public and Private Supply: The concentration of the private sector along the Casablanca-Kénitra axis, combined with weak public supply in certain regions, creates disparities in access to care. Paradoxically, 90% of AMO resources are captured by the private sector, despite its minority share in the care offering, placing additional pressure on fund finances.
- Abusive Practices in the Private Sector: Recurring abusive practices in the private sector, such as overbilling, fictitious procedures or overconsumption of costly medical acts, undermine the financial balance of the funds. Stronger controls and sanctions are needed to curb these abuses.
- High Medicine Prices: The high level of medicine prices in Morocco, significantly more expensive than abroad, weighs heavily on fund budgets. Potential savings of 30% to 50%, or even up to 80% for certain costly medicines, could be achieved with a more effective price-regulation policy.
Conclusion
Like Morocco today, many countries have undertaken broad reforms of their health systems, with the introduction of compulsory health insurance for the entire population at their core. These reforms are often accompanied by periods of financial imbalance and recurring challenges, whether in terms of regulation, cost control or quality of care. The examples of Turkey and France illustrate this phenomenon well.
The question for Morocco, then, is: what lessons can be drawn from successful experiences in other countries to ensure the financial sustainability and equity of our health system?