Audit finds millions still uncovered by Morocco’s health insurance system

Morocco’s compulsory health insurance system is falling short of its core objectives, despite official claims of progress, according to a recent audit by the Court of Auditors. The report points to deep structural weaknesses that continue to leave large segments of the population without effective coverage while increasing pressure on public finances.

The audit estimates that around 11 million Moroccans, nearly 30% of the population, remain outside the health insurance system. One of the main causes is unpaid contributions, which result in many insured individuals losing their rights when payments stop. Employer delays have also had a significant impact, leading to the suspension of coverage for about 1.5 million salaried workers.

Efforts to extend insurance to self-employed workers have also fallen short. While the government initially aimed to insure around 11 million people in this category, only 3.27 million had registered by 2024.

Contribution collection remains particularly weak, with less than 40% of expected payments actually collected, undermining the financial sustainability of the system.

The state-funded AMO Tadamoun scheme has expanded well beyond its initial scope. Enrollment reached 14.5 million beneficiaries, surpassing original targets by several million.

The audit links this trend to persistent youth unemployment, as many young people depend on state-funded coverage instead of entering contribution-based insurance schemes. This has created a structural imbalance, with far more beneficiaries than contributors.

Spending patterns further expose the system’s weaknesses. Public hospitals receive only a small share of health insurance expenditures, while private providers dominate reimbursements.

More than 90% of billed insurance expenses go to the private sector, leaving public healthcare facilities underfunded and increasingly reliant on direct state support.

Healthcare costs continue to rise, driven largely by chronic and high-cost diseases. These conditions account for more than half of total insurance spending, estimated at around MAD 14 billion. Medicines represent the biggest share of costs, followed by surgical procedures and dialysis services.

Despite being insured, households continue to shoulder a heavy financial burden. In 2024, patients paid roughly one-third of total treatment costs out of pocket. For chronic and long-term illnesses, nearly half of medical expenses were paid directly by patients, calling into question the effectiveness of compulsory health insurance in protecting households.

Administrative delays add to these pressures. The audit notes that treatment authorization and reimbursement requests often exceed legal deadlines, forcing patients to advance costs themselves and further increasing financial strain on families already struggling with healthcare expenses.