Finances News Hebdo: What are the potential repercussions of the privatization of the health sector on the operation of hospitals in the Kingdom?
Abdelmadjid Belaïche : The new health system must rest firmly on two legs, one represented by the public sector and the other by the private sector. Otherwise, our health system will be lame. All those who think that the future of health lies in unlimited privatization are as mistaken as those who think that it is public health alone that will save the future of our health system. In this area, these two sectors must work not in opposition, but in synergy and collaboration and develop, as much as possible, in a balanced manner. Unfortunately, the observation is that the private sector has experienced extraordinary development, which we can only welcome, while public hospitals have not kept pace despite some notable achievements. This imbalance is likely to widen the gap in terms of access to care and in terms of quality, particularly for the most deprived populations or those in remote or isolated rural areas. Furthermore, this disparity leads to a migration of doctors and paramedical staff to a much more attractive private sector, both in terms of remuneration and working conditions. Furthermore, almost 90% of health insurance reimbursements go to private sector care and 10% to the public sector. Such a gap risks widening further and leading to underfunding and under-equipment of public hospitals, if the latter do not keep pace and if confidence in the public sector is not restored among the population. Finally, the cost of care will be even higher. The ideal is for both sectors to develop in a balanced and harmonious manner in order to create profitable competition for both patients and health insurance funds. And this, not only on an economic level, but also in terms of quality of care and scaling up by integrating the most innovative health technologies.
FNH: In addition to the rise of private infrastructure, the health sector is experiencing a pronounced flight of medical and paramedical staff from the public to the private sector. What policies should be considered to attract medical skills to the public sector?
A. B. : Unfortunately, the public sector is experiencing a hemorrhage of medical and paramedical executives, which the private health sector is taking advantage of. The reasons for these leaks are particularly linked to remuneration, but also to working conditions in hospitals, which are often difficult, following the strong pressure from the sick population on these structures. There is also another factor that we cannot ignore: the retirement of doctors and nurses who are not always replaced, due to shortages in these human resources. This increases the pressure on the remaining executives who must do the work of those retiring or moving to the private sector. It is therefore important to review the public health human resources policy and to establish an ongoing dialogue with their unions. Only a dialogue will allow for a precise identification of the causes of the malaise among health personnel and to respond to them. Furthermore, the modernization of hospital infrastructure and health centers and the reduction of the workload by increasing the number of medical and paramedical staff will improve working conditions and retain this valuable staff in public health. In terms of salaries, as long as the remuneration levels in the public sector remain far from those in the private sector, it will not be possible to stop the movement of departures from public health to the private sector, or worse, abroad. The salary policy must therefore be reviewed by implementing better remuneration and, above all, by favoring remuneration based on performance and the achievement of objectives and attractive bonuses for those working in remote or difficult areas.
FNH: How could cooperation between the public and private sectors benefit the Moroccan population and improve the efficiency of the health system as a whole?
A. B. : Cooperation between the public and private sectors can bring many benefits to the Moroccan population and improve the efficiency of the health system as a whole, while reducing the budgetary impacts on health insurance. This cooperation involves sharing resources and infrastructure. In general, private health structures have much better equipped and more efficient technical platforms than those of the public sector. The same is true for human resources, especially the most advanced ones. Without partnerships and bridges between these two sectors, this cutting-edge equipment from the private sector, and especially the most expensive and specialized medical equipment, will remain underused or less used. Not to mention that the use of private sector equipment will reduce the pressure of patients on the equipment and operating rooms of public hospitals. In national or regional emergency situations, following health crises such as pandemics, environmental consequences or natural disasters, synergy and cooperation between the public and private sectors will increase our response capacities. Moreover, the successful experience we saw during the Covid-19 pandemic is rich in lessons.
FNH: What examples of good practices from other countries could be adapted to the Moroccan context in order to revitalize the public health sector?
A. B. : To further develop the health sector in Morocco, it is necessary to benchmark the most successful experiences and good practices proven in other countries and adapt them to our national context. For Morocco, an integrated health system, with coordinated care pathways, is more than necessary. Indeed, the private sector must not develop as a free electron, but in harmony and complementarity with the public sector through the establishment of public-private partnerships (PPP). These PPPs will make it possible to compensate for the shortcomings of the public sector, similar to what has already been achieved in the field of hemodialysis. These PPPs will also make it possible to work in underserved rural areas, in return for tax incentives, subsidies and encouragement of private investments. The possibility for private sector doctors to practice in the hospital sector with unlimited geographical mobility must be considered. The implementation of a system of electronic, centralized, shared medical records will allow the establishment of coordinated care pathways and the monitoring of their continuity. The role of the general practitioner must be valued and the importance of the family doctor clearly highlighted. Our country is experiencing an imbalance with a much larger number of specialist doctors than that of general practitioners. This is an aberration, but one that can be understood if we consider the ridiculous remuneration of the latter. In terms of reimbursements, the reference rate for a private consultation with a general practitioner does not exceed 80 dirhams. The slightest intervention by a plumber is more expensive. In this case, how can we develop the role of the general practitioner as a gateway to coordinated care pathways? Telemedicine will largely resolve the problem of access to care and health professionals in remote and isolated rural areas and allow remote medical consultations. To do this, health professionals will have to be trained in the use of new digital technologies. Disease prevention and public health promotion through awareness campaigns and educational television and radio programs will raise awareness among the population about the importance of hygiene and dietary measures and healthy living. This will also significantly reduce the future prevalence of the most dangerous and budget-consuming chronic diseases, such as diabetes, hypertension, kidney failure and cancer. Continuing education for both hospital and private doctors will allow them to follow the rapid advances in the medical field and to acquire the most recent theoretical and practical knowledge. Adapting these successful measures and practices elsewhere to the Moroccan context will help build a robust health system. Harmonious and synergistic cooperation between the public and private sectors can only improve the efficiency of our health system and the quality of care, and help to improve accessibility and greater equity for the entire Moroccan population.
