CNOPS Raises Alarm: AMO's Financial Viability in the Public Sector Hangs by a Thread

In a sobering announcement, the National Fund for Social Welfare Organizations (CNOPS) has revealed a significant deficit for 2023, marking the third consecutive year of financial hardship for the Mandatory Health Insurance (AMO) in the public sector. This precarious situation has forced CNOPS to dip into its safety reserves to meet its obligations to the insured and healthcare providers.

During 2023, contributions from CNOPS members reached 6.31 billion dirhams, a slight increase compared to the previous year. However, payments for healthcare services saw a substantial rise, reaching 7.45 billion dirhams, resulting in a staggering deficit of 1.28 billion dirhams. This deficit follows in the footsteps of previous deficit-ridden years, jeopardizing the long-term financial viability of the AMO in the public sector.

Several factors have contributed to this challenging predicament, including the continuous expansion of the healthcare basket, especially with costly medications introduced without proper medico-economic studies. Additionally, the high prices of drugs, medical devices, biological analyses, and dental care, coupled with the delayed approval of capping reimbursements for ceramic-metal crowns and the weak framework for controlling healthcare expenditures, have exacerbated the situation. Furthermore, the capping of contributions and the absence of any revision in their rates since 2005 have compounded the problem, according to a CNOPS statement.

Dissecting the Deficit

The deficit can also be attributed to the rising number of individuals afflicted with long-term and costly illnesses, whose expenditures amounted to 3.7 billion dirhams in 2023, accounting for 53% of total expenditures. The aging population of insured individuals, with the number of retired beneficiaries increasing from 20.8% in 2006 to 38.4% in 2023, has further strained the system. Moreover, the claims ratio rose from 51.6% in 2022 to 52.9% in 2023, adding to the financial burden.

In response to these challenges, CNOPS' board of directors has approved a decision urging the competent authorities to take immediate measures to ensure the sustainability of the AMO in the public sector and restore its financial equilibrium.

Seeking Solutions

Recognizing the gravity of the situation, CNOPS has implemented several initiatives to optimize the management and monitoring of healthcare expenditures. These efforts include digitizing procedures and strengthening anti-fraud measures through the CNOPS360 software. However, despite these endeavors, the board of directors has sounded the alarm, calling for urgent measures to restore the financial balance of the AMO in the public sector and preserve its reserves until 2027.

CNOPS Laments Exclusion from AMO Reforms

Furthermore, the CNOPS board of directors has examined the draft law on the merger of AMO schemes, a process in which neither CNOPS, as the managing body, nor the Mutual Benefit Societies, which have collaborated with CNOPS for 74 years in a unique integrated management experience of AMO and supplementary coverage, were consulted.

Miloud Massid, the president of CNOPS' board of directors, expressed his concern, stating, "The exclusion or marginalization of CNOPS and the Mutual Benefit Societies from AMO reforms is at odds with the principle of participation enshrined in the framework law 21-09 on social protection and with the constitutional dimension of the mutual sector." He further clarified that "the decision to merge the schemes and examine its financial and managerial aspects, as well as its impact on the insured, the state, CNOPS, and the Mutual Benefit Societies, falls within the purview of the Interministerial Commission for the Piloting of the Social Protection System Reform and its technical committee."

Safeguarding Rights and Protecting Employees

In light of these concerns, CNOPS' board of directors has urged the government to preserve the acquired rights of the insured and protect the employees of CNOPS and the Mutual Benefit Society, given the ambiguous provisions of the draft law 54-23 on the merger of AMO schemes, which threaten their future and exclude CNOPS and the Mutual Benefit Society from the scope of AMO.

As the crisis deepens, the call for swift and decisive action echoes through the corridors of power. The financial viability of the AMO in the public sector hangs precariously in the balance, demanding immediate reforms and a collaborative approach to safeguard the rights of the insured and the future of the healthcare system itself.