Mandatory Health Insurance in Morocco: Expansion, Financial Sustainability and International Benchmarking

Abstract

Morocco has undertaken a rapid expansion of Mandatory Health Insurance as part of its social protection reform. This transition creates major opportunities for financial protection but also raises questions regarding effective coverage, expenditure growth, provider mix and long-term sustainability.  A retrospective documentary and comparative analysis (2005–2026) was complemented by a structured narrative PubMed/MEDLINE search conducted on 4 September 2026. Sequential thematic searches through MED49 covered insurance expansion, financing, financial protection, provider payment, hospital efficiency, medicines, HTA, primary care, workforce, access, quality and health information systems. Retained searches account for 991 cumulative bibliographic occurrences before deduplication. From individually documented data, 150 unique PMIDs could be reconstructed with certainty and underwent initial title/abstract screening: 136 were retained and 14 excluded; no record remained uncertain after targeted verification. This reconstructed subset is not the exhaustive deduplicated corpus of the 991 occurrences.  Administrative AMO coverage exceeded 32 million people in 2025 (about 88% of the population), while effective coverage was estimated at about 70% at end-2024 under the Court of Accounts perimeter. In nominal terms, AMO expenditure increased by 83.2% between 2022 and 2024 versus about 36% for resources; these rates are not adjusted for inflation and should not be interpreted as real growth rates. Out-of-pocket spending represented 37.25% of current health expenditure in 2023. A national costing study in 39 public hospitals documented large inter-hospital variations in unit costs and estimated required public-hospital financing at approximately USD 1.19 billion for 2023, supporting cost-based tariffs and strategic purchasing.  Morocco has largely achieved the administrative expansion phase, but financial protection and purchasing efficiency remain the core challenges. International experience supports stronger prepayment, strategic purchasing, primary care, health technology assessment and systematic monitoring of effective coverage and household financial hardship.

Classification JEL : I13, I18, H51.

Paper type : documentary research and structured narrative review