Health Insurance: Ministry of Health promises to review effective reimbursement bases

The union representing private sector physicians met with the Minister of Health and Social Protection and the Commissioner of the National Health Insurance Agency. During this meeting, three commitments from the ministry were obtained, including a review of national benchmark prices.

A meeting was held on Thursday, March 17, at the headquarters of the Ministry of Health and Social Protection in Rabat, with the participation of a union representing doctors in the liberal department, the Minister of Health and Social Protection, Calid Eight Taleb, and the Director General. Khalid Larou of the National Health Insurance Agency (ANAM). These unions have just discussed the main conclusions of this conference.

During this meeting, private sector physicians emphasized their main demands, especially the revision of the Trap-neuter-Return (TNR). Professor Jaâfar Heikel, an epidemiologist and health economist contacted by Le360, explained that the Ministry of Health has promised to prepare a revised National Reference Price (TNR) file between October 2022 and the end of the month.

He recalled that TNR was the standard tariff for repayment of medical expenses under the Compulsory Health Insurance System (AMO). Therefore, this fee will be determined in consultation between the organization governing this insurance and the medical professional within the framework of the agreement binding these parties.

Since 2006, even if the Basic Medical Insurance Law n ° 65-00 stipulates revisions every three years, this fee has not been revised due to the rise in service prices. Therefore, practitioners are seeking the application of the law, especially when the prices of these care practices have evolved and the TNR has stagnated for more than 15 years, creating a discrepancy between the applied prices and reality. Field, Professor Heikel said.

In this regard, the Ministry of Health and ANAM will carry out costing for each medical practice to establish the basis for claiming these actions and estimate how much each service will actually cost now. I was asked.

According to Jaâfar Heikel, patients are paying high fees as a result of this discrepancy. For example, a patient pays 300 dirhams for consultation with a specialist, but only 120 dirhams are refunded based on the 150 dirham reference rate (ie 80% percentage).

Therefore, patients currently pay more than 54% of the price of the services offered, while health insurance covers 80%. As a rule, the remaining charges should not exceed 20%, but unfortunately it is not.

Dr. Saïd Afif, President of the National Trade Union College of Private Medical Specialists, agrees with Dr. Jaâfar Heikel. Dr. Afif is certainly in a previous publication on Le360 that liberal sector practitioners need revisions calculated based on the actual cost of each service, as recommended by the new development model. Was emphasized. This will cover the patient at an 80% rate and allow the patient to pay a minimum at their own expense.

In addition to the revision of the national standard price, the Ministry of Health has promised to revise the general nomenclature of occupational acts and increase the number of redeemable acts from 3,000 to 7,000. The ministry also promised to work with the National Social Security Fund (CNSS) to create a list of incentives for doctors and dentists. Therefore, a technical meeting is scheduled for the near future to consider all the details related to these points that were on the agenda of last Thursday’s meeting.