Unmasking the Limitations: RAMED and Morocco's Struggle for Equitable Healthcare Access

In Morocco's relentless pursuit of ensuring equitable access to healthcare services for its citizens, observers assert that much remains to be accomplished. This assertion finds credence in the recent report by the Moroccan Institute for Policy Analysis (MIPA), which unveils that the nationwide implementation of the "RAMED" program, aimed at enhancing healthcare accessibility for economically vulnerable segments, unfolded amidst the Moroccan healthcare system's inability to accommodate new service seekers and a dearth of expertise in targeting eligible beneficiaries for social programs.

Titled "The RAMED Program Fell Short of Expectations," the report indicates that the RAMED system encountered grave errors in terms of integration criteria. Deviations from proper integration exerted immense strain on the system, diminishing the quality of healthcare provided to segments relying on public hospitals, while exclusion deviations undermined the program's capacity to cover all intended beneficiaries.

"Prior to the implementation of RAMED, access to healthcare for vulnerable and impoverished categories was contingent upon a 'certificate of need,' which attested to the inability to bear healthcare expenses from personal resources and had to be presented at every medical consultation. This method was hampered by numerous obstacles, including the need to obtain a new certificate for each hospital visit, the absence of a clear procedure for its issuance, and its subjective assessment by the issuing authority, often represented by a 'provider,' rendering the process cumbersome, opaque, and unreliable," the report states.

The MIPA Institute also highlighted that RAMED encountered obstacles threatening its sustainability, particularly concerning its financing. The program drew resources from public hospitals and contributions from certain entities, further weakening the reception capacity of public hospitals.

"The vast number of individuals eligible for RAMED and the massive influx of enrollments at the onset of its implementation posed administrative and financial challenges, increasing the pressure on hospitals and healthcare professionals across all categories. Moreover, RAMED's improvised financial management undermined its sustainability and led to funding difficulties, especially due to the insufficient regularity of contributions from vulnerable families and the utilization of hospital resources, which drained their finances," stated the study's author.

Authored by Salma Sadki, a professor of economics at Ibn Tofail University in Kenitra, the report noted that the absence of a unified social registry rendered the precise distribution of resources across the population impossible, compelling responsible authorities to rely on a monetary threshold, though this was a weakness of the system and limited its outreach to vulnerable and impoverished segments in all their components.

According to numerous reports and studies, RAMED beneficiaries disrupted hospital operations for several reasons, including long wait times and increased demand for care in the face of inadequate hospital capacities and equipment. It is worth noting that the equivalent of 11 million new beneficiaries began seeking services from Moroccan hospitals, which were neither reformed nor developed to accommodate them. Among the reasons were also the irregularity of contributions from vulnerable families and the cessation of RAMED card renewals due to dissatisfaction with the quality of services provided. Additionally, convalescence difficulties, subject to stringent hierarchical rules for accessing different levels of health centers, further compounded the issue.

This situation led to lengthy queues and substantial delays in accessing hospitals, often exposing RAMED beneficiaries' health to risks and prompting them to seek private healthcare in pursuit of better quality and reasonable wait times.

In the same context, the report confirmed that "RAMED" failed to attain the desired level and did not fully achieve its objectives, particularly those related to expanding coverage and improving the quality of services provided.

In rural areas, the suffering of RAMED cardholders extended beyond the aforementioned challenges, exacerbated by additional difficulties and problems hindering their access to healthcare services, notably the distances to be traveled to reach health centers, imposing transportation costs often unaffordable for this category.

Moreover, the RAMED system is based on the gratuity of hospital services and not medications. "How, then, can vulnerable and impoverished categories obtain the necessary medications? And given their inability to obtain prescribed medications during medical consultations, what is the purpose of free diagnosis in hospitals? In this context, can we speak of RAMED's contribution to improving healthcare services for vulnerable categories?" the specialist ponders.

In conclusion, the Institute formulated recommendations to strengthen the effectiveness of Morocco's social protection system, including improving the healthcare system to align with international standards, integrating public hospitals into policies aimed at expanding social coverage, raising awareness about the importance of health capital, bolstering investments in healthcare infrastructure development, and ensuring the provision of medical care for chronic illnesses.