Foundations and Actuarial Risk of Morocco's Basic Medical Coverage (2000–2035): An OLS-HAC and Monte Carlo Approach

Abstract

Over two decades, Morocco has extended health coverage to nearly 84% of its population. From the creation of the AMO in 2002 to the integration of RAMED beneficiaries into the AMO Tadamoun programme in 2022, this expansion raises a question that remains unanswered in quantitative terms, namely the medium-term financial sustainability of the contributory scheme. This article addresses that gap by combining, on Moroccan data spanning 2000–2023, robust econometric estimation (ordinary least squares with Newey-West HAC standard errors) and stochastic Monte Carlo simulation. The results show that per capita GDP growth is the primary driver of health expenditure, and that two major institutional breaks, namely the 2020 pandemic shock and the accounting integration of the state's contribution to AMO Tadamoun in 2022, have permanently altered the financing trajectory. On this basis, and absent new regulatory mechanisms, simulations indicate that the probability of a deficit in the contributory scheme reaches 80.8% by 2028 and exceeds 99% from 2030 onwards. These figures are not a deterministic forecast but a measure of actuarial risk, subject to revision as post-merger CNOPS-CNSS data become available. Scenarios including an earmarked behavioural tax of 2,000 M MAD per year eliminate the risk of deficit over the entire 2024–2035 horizon under the retained calibration assumptions. These findings make a clear case for activating regulatory instruments before 2027, in order to preserve the gains of a decade of universal coverage.

JEL Classification: H51, I13, I15, C22, C15

Paper type: Empirical Research