Morocco health reform: Why AMO coverage has yet to guarantee real access to care

Five years into Morocco’s broad health-system overhaul and the expansion of compulsory health insurance, the country has significantly widened the formal reach of medical coverage. Yet an assessment by physician and health-policy researcher Dr. Tayeb Hamdi points to a persistent gap between being registered with an insurance scheme and actually being able to obtain affordable and timely healthcare.

The distinction is increasingly important as Morocco moves from expanding coverage on paper to addressing the practical conditions that determine whether patients can use that coverage when they need it.

Coverage has expanded, but effective access remains uneven

Public investment in healthcare has increased substantially during the reform period. According to Dr. Hamdi’s assessment, the national health budget rose from 19.7 billion dirhams in 2021 to a projected 42.4 billion dirhams in 2026, representing more than a doubling over five years.

The expansion of the compulsory health insurance system has also produced a major increase in the number of people formally registered. In 2025, around 32 million people were enrolled, equivalent to approximately 88% of Morocco’s population.

However, administrative registration does not necessarily translate into usable healthcare rights. The study estimates that only 25.6 million people currently have effective access, leaving around 8.54 million people facing barriers despite being included in the insurance system.

Among the groups affected are non-salaried workers and beneficiaries of AMO Chamil. The study attributes part of the problem to inactive or closed insurance rights, which can prevent registered individuals from fully benefiting from their coverage.

Household payments remain a major barrier

The financial burden borne directly by households represents another central challenge. Dr. Hamdi’s analysis indicates that households continue to finance more than half of total healthcare expenditure, while direct payments at the time of treatment account for a substantial share of this burden.

The situation is particularly visible in outpatient care. According to the study, the proportion of expenses remaining at patients’ charge reaches 50.2% under CNSS and 41.1% under CNOPS.

One factor identified in the analysis is the continued use of National Reference Tariffs that have not been substantially updated since 2006. When reimbursement benchmarks remain disconnected from current medical costs, the difference can be transferred to patients, increasing the amount they must pay themselves.

The consequences extend beyond household budgets. The assessment estimates that 41.5% of Moroccans have postponed or abandoned healthcare because of financial constraints.

Public hospitals remain under pressure

The reform also faces a structural challenge involving the balance between public and private healthcare providers.

According to the figures cited by Dr. Hamdi, 91% of AMO reimbursements are directed toward private healthcare providers, compared with 9% for the public sector. The distribution highlights the pressure facing public hospitals as they seek to retain patients and strengthen their role within the restructured healthcare system.

Human resources represent another major constraint. The assessment identifies a shortage of approximately 30,000 doctors and more than 60,000 healthcare workers.

The geographical distribution of medical professionals adds another layer to the problem. Around 75% of healthcare professionals are concentrated in just three regions, leaving other parts of the country with more limited access to medical expertise and specialized services.

The study also points to continued medical emigration, estimating that more than two doctors leave Morocco each day. For the health system, retaining qualified personnel is therefore closely linked to the ability to translate insurance expansion into accessible services.

Financial sustainability adds pressure to the reform

The long-term financing of the insurance system is another issue raised by the assessment.

Dr. Hamdi’s analysis indicates that reimbursements have exceeded contributions by significant margins in some categories, reaching 121% for CNOPS and 172% for non-salaried workers.

Such figures raise questions about the financial equilibrium of insurance schemes as Morocco seeks to extend effective healthcare access while maintaining the sustainability of the system.

The challenge is consequently broader than expanding the number of insured people. It involves ensuring that financing mechanisms, reimbursement levels, healthcare capacity and the distribution of medical professionals evolve together.

A shift from administrative coverage to effective healthcare

Against this backdrop, Dr. Hamdi advocates what he describes as a national commitment to the next stage of reform. His proposals include updating the National Reference Tariffs, expanding third-party payment mechanisms for outpatient treatment and introducing a nationwide prevention package fully covered by insurance.

The assessment also sets quantitative targets for reducing the financial burden on households, calling for out-of-pocket healthcare spending to fall below 30% by 2028 and reach 25% by 2030.

The broader objective is to move beyond the measurement of coverage through registration figures alone. For patients, the effectiveness of the reform ultimately depends on whether insurance rights remain active, services are geographically accessible, reimbursements correspond to real costs and treatment can be obtained without creating an unsustainable financial burden.

As Morocco enters the next phase of its health-system transformation, the central question is therefore shifting from how ma