Cheikh Amine, Bouatia Mustapha, Ajaja Mohamed Rida, El Malhouf Naoufel, Cherrah Yahia, Abouqal Redouane, El Hassani Amine
Abulcasis University, Faculty of Pharmacy, Rabat, Morocco.
Mohammed V University, Faculty of Medicine and Pharmacy, Rabat, Morocco.
Value Health Reg Issues. 2019 Sep;19:132-137. doi: 10.1016/j.vhri.2019.07.008. Epub 2019 Aug 27.
Disparities in the reimbursement rules between the 2 funds that manage mandatory health insurance in Morocco could negatively affect the accessibility of insured persons to healthcare services and products.
The objective is to analyze the impact of these disparities on access to care and to assess the insured's copayment difference between the 2 funds.
Healthcare utilization rates of the insured population in the 2 funds were analyzed by sector, sex, and age groups for 2014. We also looked at the percentage of copayment paid by the insured depending on the fund, methods of reimbursement, type of care, and nature of diseases. The analysis was based on data retrieved and aggregated at the National Agency for Health Insurance.
The healthcare utilization rate differs significantly between the 2 funds. It is higher for the insured in the public sector (45%) compared with those in the private sector (18.5%) (P < .001). The healthcare utilization rate differs significantly according to the age groups in the 2 sectors (P < .001, respectively), and according to the sex of the insured in the 2 sectors (the healthcare utilization rate is higher for women than for men [P < .001, respectively]). The copayment percentage incurred by insured persons was 32.1% for employees in the public sector and 36.4% for employees in the private sector.
Differences in reimbursement rules between the 2 funds may be the cause of inequity in access to care between insured persons. This situation can jeopardize the objectives of a universal and equitable health insurance scheme.
摩洛哥负责管理强制性医疗保险的两个基金在报销规则上存在差异，这可能会对被保险人获得医疗服务和产品的机会产生负面影响。
分析这些差异对医疗服务可及性的影响，并评估两个基金之间被保险人的自付费用差异。
分析了2014年两个基金中被保险人群按部门、性别和年龄组划分的医疗服务利用率。我们还研究了被保险人根据基金、报销方式、护理类型和疾病性质支付的自付费用百分比。该分析基于在国家医疗保险机构检索和汇总的数据。
两个基金的医疗服务利用率存在显著差异。公共部门的被保险人（45%）高于私营部门的被保险人（18.5%）（P <.001）。两个部门的医疗服务利用率根据年龄组（分别为P <.001）以及两个部门被保险人的性别（女性的医疗服务利用率高于男性[分别为P <.001]）存在显著差异。公共部门员工的被保险人自付费用百分比为32.1%，私营部门员工为36.4%。
两个基金报销规则的差异可能是被保险人在获得医疗服务方面不公平的原因。这种情况可能会危及全民公平医疗保险计划的目标。
