Toward a Sustainable Financing Strategy for Universal Health Coverage

In the global pursuit of universal health coverage (UHC), it is crucial to ensure effective and sustainable health-financing mechanisms. In the context of the COVID-19 pandemic, which exposed vulnerabilities in health systems worldwide, the World Health Organization (WHO) conducted an exhaustive study focused on Morocco.

The study UHC in Morocco: a bottom-up estimation of public hospitals’ financing size based on a costing database, published in Health Economics Review, highlights the need for strategic costing approaches to improve health-system efficiency and support the country’s ambitious health-reform agenda.

Morocco, like many other countries, faces the challenge of strengthening its health system to achieve UHC. The pandemic highlighted both the weaknesses and strengths of Morocco’s health infrastructure. In response, the government undertook significant reforms, including the generalization of health insurance and structural transformations of the health system.

Significant variations in unit costs between different hospitals and levels of care.

Cost Variability by Level of Care: The costs of care and medical services vary considerably from one level of care to another. For example, the average cost of one hospitalization day for surgery is 755 dirhams (DH) in a provincial hospital, compared with 886 DH in a university hospital. This variation is also observed in other services, such as neonatology and intensive care.
Cost Variability Within the Same Level of Care: Within the same level of care, costs can vary significantly from one facility to another. For example, in provincial hospitals, the cost of one hospitalization day in surgery can range from 292 to 1,550 DH, and the cost of one day in an intensive-care unit can range from 906 to 2,859 DH.
Impact on Health Financing: Estimates based on the collected data suggest that nearly 12 billion dirhams are needed to finance hospitals in Morocco in 2023. This includes operating costs across all levels of care, as well as outpatient consultation costs. It is also noted that the share of pharmaceutical products in total cost varies by type of service.

Implications and Conclusion

With resources scarce, especially in low- and middle-income countries, implementing a cost-containment strategy is imperative. This strategy should be based on evidence-informed approaches to address inefficiencies while ensuring equitable access to essential services.
Implementing strategic purchasing mechanisms is essential to improve the quality and performance of healthcare delivery. This approach should be informed by robust costing methodologies to optimize resource allocation and improve hospital efficiency.
Cost studies play a central role in decision-making and in the development of cost standards. By accurately assessing the costs of hospital activities, decision-makers can make informed choices about resource allocation and financing strategies.