Compulsory Medical Insurance: The challenge for RAMED beneficiaries

It’s like a jigsaw puzzle whose pieces come together each mon­th as the implementing decrees are published. The generalization of compulsory health insurance to self-employed and independent workers is progressing, and one of the important parts awaits the amendment of Law 65-00 on medical coverage.

The arrival of the beneficiaries of RAMED (Medi­cal Assistance Regime) scheduled to start in the second half of the year can only take place once the law on medi­cal coverage has been amended and the implementing legislation have been published. The arrival at the National Social Security Agency (CNSS) of this vulnerable population will be made in exchange for a contribution, which will be borne by the Government: 6.37% of the minimum wage. It is a question of making RAMED beneficiaries benefit from a basket of care identical to that of private sector employees. For the moment, the operational plan for the changeover to an insurance system has not yet been decided and several questions will have to be settled: will the beneficiaries of RAMED pay the costs for care services if they go to pri­vate sector healthcare facilities? Will they benefit from the direct payment by insurers’ system?

These are so many questions on which policies are expected to be established in order to make vulnerable popula­tions, amounting to 5.5 million people, benefit from the Compulsory Medi­cal Insurance (AMO) managed by the Social Security agency. Started in 2021, the extension of medical cove­rage to self-employed workers and to individuals must be completed before the end of this year. For now, tight management of the different catego­ries is planned. Eventually, 8.5 million policyholders and 22 million benefi­ciaries will join the compulsory health insurance scheme. This will result in a significant increase in the activity of the Social Security agency. The num­ber of insured people should increase from 3.5 million to 11 million people while the number of beneficiaries will be multiplied by 4, moving from 7 to 29 million. As for the number of di­sease records, it should reach 80,000 to 90,000 files per day versus nearly 20,000 today. This is a ramp-up for which the Social Security agency (CNSS) has been preparing for seve­ral months. Its information system is adapted to support a different popu­lation of employees and to strengthen its capacity to process a much greater flow of data and transactions. CNSS has also reviewed its organization and its processes. CNSS has also carried out the necessary recruitments and established partnerships to be closer to the insured. The Social Security agency has also invested in digitaliza­tion, and a large part of the procedures can be carried out remotely. CNSS also plans total paperless processes as well as the implementation of the electronic healthcare sheet.

Khadija MASMOUDI