OBG talks to Houssaine Louardi, Minister of Health

Interview: Houssaine Louardi

What are the main challenges facing the introduction of the medical assistance regime (Régime d’ Assistance Medicale, RAMED)?

HOUSSAINE LOUARDI: The two principal challenges in implementing the RAMED scheme, which will provide health insurance for low-income families, are the staffing levels in the medical sector and difficulty in securing medicine and expensive medical implants. Other challenges concern health care provision for long term and costly ailments; improving the hospital information systems; and easing RAMED eligibility procedures.

To overcome these challenges, employees at the regional level need to be re-allocated and better trained and recruited. Also, the budget for medication and medical implants needs to be increased from current levels of Dh2.4bn (€213.4m) and Dh190m (€16.9m), respectively. Additionally, the ministry is in the process of expanding health care capacity by constructing new hospitals and by creating two new academic medical centres in Tangier and Agadir. Another key measure is the introduction of mobile hospital units, two of which are being purchased at this time. Some 80 local emergency units will also be established to support the 11 first aid medical service programmes.

Finally, we are close to implementing a health insurance scheme for the self-employed, which will help improve awareness for those individuals eligible to receive RAMED benefits. In the medium term, vulnerable populations should be able to secure improved access to health care, particularly for serious and costly ailments, as well as for expensive medical implants.

What approaches can be taken to help make the cost of medicine more affordable?

LOUARDI: The high prices of medicine in Morocco can be attributed to several factors, which in essence relate to regulatory issues. The setting of prices under the system of “marginal benefits” for wholesalers is influenced by total medical coverage (which is currently being expanded), the small production volumes and the import of the active ingredients. In addition to these factors, costs are also kept high by the poor availability of generic options, covering only 30% of medicines.

To improve access to medicine for the population, the Ministry of Health is providing support to make medication financially affordable by reforming the price-setting mechanism under the National Pharmaceuticals Policy that was launched on January 23, 2013.

This new policy also intends to promote the usage of alternative options through the use of “biological equivalents”, thereby granting permission for pharmacists and citizens to use natural substitutes.

The new policy has already led to a price reduction in over 300 pharmaceuticals products, including some very expensive medicines costing over Dh500 (€44) as well as some types of medication used for grave and chronic diseases. A second price reduction is planned that could involve some 1000 additional medicines.

How do you view the progress made on introducing compulsory medical coverage?

LOUARDI: The introduction of the obligatory health insurance scheme (Assurance Maladie Obligatoire, AMO) has been a great success. It began with the introduction in 2002 of Law No. 65-00 on basic medical coverage, followed by the entry into force of the AMO scheme in 2005 and the conclusion of national agreements between managing organisations and private and public health care providers. A revision of these agreements is planned for 2013. Also, we have developed a list of reimbursable medications and we are moving to extend this list so that it covers over 75% of medicines sold on the Moroccan market.

To improve the administration of the AMO scheme, medical checks have been put in place and standard rates have been adopted by the National Fund for Social Welfare Organisations. The social security programme is also moving to progressively exempt its insured from co-payments for many long-term diseases, and to extend its basket of care to include outpatient care.