Morocco’s reference health tariff: agreement in principle and governance challenges
The agreement in principle on Morocco’s national reference tariff raises questions of governance, patient costs and AMO sustainability while a formal agreement remains outstanding.
For the same procedure, a private clinic may charge two to three times the tariff used by compulsory health insurance (AMO) to calculate reimbursement, leaving the patient to pay the difference. This tariff—the national reference tariff (TNR)—was set in 2006 and has been revised only marginally since. Against this background, an agreement in principle to revise the TNR for certain services coincides with a different regulatory tension: private providers’ complaints that dozens of clinic operating-licence applications are blocked. This brief documents the governance paradox—agreement on prices alongside disagreement over the regulation of supply—and examines its implications for AMO sustainability and equitable access. It emphasises that no formal agreement has yet been signed.
Strategic context
The TNR is the reference tariff established through national agreements under the National Health Insurance Agency (ANAM), on which managing bodies calculate reimbursements. For private-sector outpatient care, the reimbursement rate applied to the TNR base is around 70%, with coverage varying by procedure and sector. The persistent gap between a reference tariff almost frozen since 2006 and the changing actual costs of private practice has increased the additional charges borne by households.
The structure of coverage illustrates the issue. Reimbursement rates applied to the TNR base differ by procedure and sector, with public hospital care attracting higher coverage than outpatient treatment in private clinics. When the reference tariff remains far below the price charged, the insured person pays the difference: the nominal reimbursement rate then conceals a substantially heavier actual out-of-pocket burden. It is this gap between stated and effective coverage that revising the TNR is intended to address.
The expansion of the insured population in recent years has also increased demand backed by purchasing power for private-sector care, intensifying pressure on an unchanged schedule. AMO sustainability therefore depends on the interaction of three variables: reference tariff levels, reimbursement rates and the volume of covered procedures. Changing one without considering the other two would shift the constraint rather than resolve it.
The issue can be framed in institutional economics terms. First, AMO’s financial sustainability requires any tariff increase to rest on an explicit funding path. Second, the recent expansion of coverage has increased effective demand, adding pressure to an outdated tariff schedule. Finally, the gap between amounts charged and reimbursed represents an information and regulatory failure to the insured person’s detriment, one whose correction extends beyond the level of the TNR alone.
Case analysis: the June 2026 agreement in principle
Two concurrent developments must be carefully distinguished. The first is an agreement in principle: CNSS has approved revising the TNR for certain services reimbursable under AMO. According to Dr Saïd Afif, president of the national trade union grouping of private medical specialists, CNSS Director-General Hassan Boubrik gave this agreement verbally during two meetings with the private-sector coalition. A methodological qualification is essential: this is an agreement in principle, not a signed agreement. A new agreement still needs to be concluded between the private doctors’ coalition, the health ministry, the Medical Council, CNSS and ANAM before it can take effect; it remained unsigned as of 18 June 2026.
The second development is the private sector’s complaint that the supervising ministry has blocked dozens of operating-licence applications. This tension follows an earlier controversy: in October 2025, Health and Social Protection Minister Amine Tehraoui told Parliament that investment subsidies for private clinics were being stopped. The National Association of Private Clinics responded through its president, Rédouane Samlali, that no member clinic had ever received such subsidies; the minister subsequently clarified that he meant the grant provided under the Investment Charter.
The October 2025 controversy sheds light on the current tension. Akdital, listed in Casablanca, also denied receiving operating or equipment subsidies, alongside the professional association. The minister later stated on national television that he meant only the Investment Charter grant. This sequence shows that the licensing dispute concerns not an isolated event but the definition of public support for the private sector itself. It also illuminates CNOPS’s absence from the expected signatories: the fund covering civil servants had historically declined to join this type of agreement, fearing for AMO’s financial balance. Even a formalised agreement could therefore remain limited in scope.
Neutral analysis requires both rationales to be presented. Raising the TNR would mechanically improve the reimbursement base and reduce out-of-pocket costs for insured people using private care; it answers a longstanding professional demand. Equally, control over licensing is a legitimate supply-regulation function whose criteria must be clear and grounded in law. Caution is also needed with figures: frequently quoted amounts—increases in general practitioner consultation tariffs and reimbursement rates—relate to the 2020 agreements, not a 2026 agreement, while the levels sought by practitioners remain demands. Revised 2026 values have not been published in open sources and cannot be treated as settled.
Policy pillars and recommendations
The following recommendations distinguish price, supply and funding, so that tariff reform is not detached from the conditions needed for sustainability and regulation.
1. Publish the revised tariff schedule
Turning the agreement in principle into an enforceable rule requires official publication of the revised TNR values. Such transparency would stop outdated figures circulating and give insured people reliable information about their reimbursement base.
2. Coordinate tariff reform with the licensing regime
Treating price and supply separately sustains the observed paradox. Tariff reform should be explicitly coordinated with operating licences, with the latter based on published, legally grounded criteria rather than discretionary judgement.
3. Base tariff increases on AMO sustainability
Any TNR increase should be supported by an actuarial assessment of its effect on AMO’s financial balance. Historical concerns about the scheme’s equilibrium are a reminder that an unfunded increase would shift the constraint rather than resolve it.
4. Formalise multi-party agreement governance
The range of signatories—the private doctors’ coalition, the ministry, the Medical Council, CNSS and ANAM—requires a formal agreement framework with a dispute-resolution mechanism. CNOPS’s historical abstention from this type of agreement illustrates the risk of a partial agreement without general effect.
5. Regulate additional charges to reduce out-of-pocket costs
A TNR increase reduces patients’ out-of-pocket costs only if accompanied by controls on charges above the reference tariff. Otherwise, a parallel rise in billed amounts could absorb the increase in the reimbursement base.
Institutional challenges and conclusion
This case illustrates a governance paradox: actors agree on the principle of higher tariffs while simultaneously disagreeing over the regulation of private supply. The central risk is that an agreement in principle, not yet translated into a formal agreement, persists alongside a stalled licensing regime without an overall resolution. Progress requires publication of revised tariffs, coordination of price and supply, and an actuarial foundation for the increases. The available evidence, still essentially reliant on a single source, does not establish that an agreement has been signed or allow its parameters to be quantified; any contrary assertion would be premature. The reform’s health impact will be measured by an effective reduction in insured people’s out-of-pocket costs, not simply by a nominal rise in the schedule.
Beyond this specific case, the issue raises a question about the sequencing of AMO reforms: raising the reference tariff without stabilising licensing or controlling additional charges would address a symptom without changing the cost structure. The reform’s credibility will depend as much on its overall coherence as on the tariff levels chosen.