Morocco’s health reform: from territorial health groups to tariff revision
Territorial health groups’ autonomy depends on viable public hospitals, requiring revised tariffs, reliable billing and equitable access to care.
With the extension of mandatory health insurance (AMO) now covering most of Morocco’s population, the health system faces an unprecedented challenge in absorbing demand. Against this backdrop, the establishment of territorial health groups (GSTs) under Framework Law 06-22 marks a major shift in approach: the aim is no longer simply to extend financial coverage, but to ensure that a citizen’s place of residence no longer determines the quality of care they can access. This decentralisation seeks to treat the supply of care as an integrated regional system, from prevention to highly specialised services. Its central challenge is to align financing mechanisms with the actual costs borne by the public sector.
Strategic context
The overhaul of the national health system is built around extensive regionalisation. The creation of GSTs gives the regions unprecedented financial and administrative management autonomy. The objective is to adapt resource allocation to each territory’s specific needs, shorten decision-making processes and strengthen accountability for resource use. For example, the Rabat–Salé–Kénitra region’s GST, with a transition budget of MAD 1.8 billion for 2026, illustrates this drive to ensure public service continuity, optimise health product procurement and organise care around university hospital referral centres.
The financial paradox of public hospitals
Public health care in Morocco faces a severe budgetary paradox: the public sector manages the most demanding cases and functions, including emergencies, complex conditions requiring substantial resources, prevention and university training, yet receives only a small proportion of AMO reimbursements. This disconnect between the care provided and the capacity to recover payment weakens institutions’ autonomy.
Without a revision of the national reference tariff (TNR), the tariffs applied remain disconnected from economic reality. Public hospitals incur a structural deficit on the procedures they perform, effectively limiting their capacity to invest and their attractiveness to qualified health professionals.
Case analysis: payment recovery and traceability
The autonomy granted to GSTs by law comes with a requirement for financial performance under state oversight. Regional management teams identify substantial revenue losses along the billing chain. The gap between the actual cost of care and health insurance tariffs prevents full financial recognition of public hospitals’ functions.
To address this under-recognition, GSTs must modernise the patient’s administrative journey. Full digitalisation, from admission to billing, is identified as the main lever for reliable recovery of payments from funding bodies and for data-driven budget planning.
Policy pillars and recommendations
First pillar: revise the national reference tariff (TNR) as a prerequisite for autonomy. The documented financial paradox cannot be resolved simply by optimising hospitals’ internal management. It calls for structured, consensus-based dialogue with CNSS to reassess tariffs so that they reflect the costs borne by public hospitals.
Second pillar: build integrated hospital information systems. Rigorous digital traceability of medical procedures must be institutionalised before full financial autonomy, to avoid reproducing the payment recovery shortfalls observed in the past.
Third pillar: structure contributions from the private sector and foundations to complement public provision. Mobilising additional resources to meet health needs must follow a clear direction: pooling efforts and technical facilities while setting shared objectives and measurable outcomes for citizens.
Fourth pillar: strengthen regional referral infrastructure. Opening advanced facilities, such as the new Ibn Sina University Hospital, should drive progress across the entire regional public network by concentrating highly specialised care, providing training and disseminating expertise throughout the territory.
Institutional challenges and conclusion
Reform through the creation of territorial health groups proposes a coherent shift in approach: moving from centralised resource management to integrated regional planning that combines governance, billing, partnerships and equitable access. The main institutional challenge lies in the capacity of the state and AMO bodies to translate this organisational framework into a viable economic model for public hospitals.
The consistency between the ambition for territorial equity and the payments actually recovered by GSTs will be the main test of this reform’s credibility. Without a TNR revision, the financial autonomy sought by the framework law risks running up against the limits of chronic underfunding of complex care.
Limitations and objections
Projections of improved care through territorial restructuring alone rest on the assumption of a rapid, frictionless digital transition. Yet establishing reliable information systems across entire regions often encounters organisational resistance and technical constraints on the ground. Moreover, the anticipated increase in reimbursements to the public sector if the TNR is revised will require robust assessments of health insurers’ overall fiscal space to safeguard the balance of the health financing system as a whole.