The System Needs Illico A Stronger And Unique ANAM (regulator)

Written by Lamiae Boumahrou |

Among the priority reforms to achieve one of the pillars of the site of the expansion of social protection, namely the generalization of health coverage to all Moroccans, that of strengthening the role of the regulator, namely the National Agency of ‘Health Insurance (ANAM). An imperative to guarantee an effective, efficient and equitable health system. Update with the Director General of ANAM, Dr Khalid Lahlou.

Morocco is preparing to start a titanic project. A project requiring the involvement of all but also prerequisites for a successfulextension of social protection. A dream for all Moroccans which will materialize in 5 years after the deployment of the 4 phases of the site.

The first will consist in extending compulsory medical coverage to all Moroccans in 2 years, i.e. by 2022 to reach 22 million additional AMO beneficiaries.

A major challenge for a successful transition from an assistance plan to an insurance plan. Except that to achieve this, it is imperative to strengthen the role of ANAM so that it becomes a strong and independent regulator able to guarantee the reform of the governance of the AMO regime.

ANAM, a regulator with tied hands

Unfortunately, despite the efforts made by this body to name only the national conventions, the national benchmark pricing, regulatory actions, etc. the National Health Insurance Agency (ANAM) does not play its true roles today. An observation that does not date from today. The very limited and ambiguous scope of intervention of the Agency were raised in the report of the 2018 Court of Auditors and most recently in theOpinion of the Competition Council on the competitive situation in the drug market in Morocco.

« It turned out that ANAM was, as its missions expanded, overwhelmed by bureaucratic considerations and procedures inherited from its parent ministerial department. This made its regulatory action ineffective, hence the little impact of these decisions generally taken late on the drug market. ”, We read in the opinion.

Same story on the side of theDriss Jettou institution who noted that ” the reading of law n ° 65.00 and its implementing decrees make it difficult to situate the role supposed to be performed by ANAM. This manifests itself at the level of the disconnect between the law and its implementing texts, which makes the powers of ANAM, as a regulatory body, ambiguous ”.

These authorities clearly show the need to review the regulations to strengthen the role of this so important regulator in the project that Morocco will launch shortly.

ANAM must become a public authority able to take regulatory decisions at all levels.

This is how much theamendment of law n ° 65-00 laying down the code for Basic Medical Coverage becomes urgent in order to provide the system with a strong and unique regulator (ANAM) capable of ensuring the management of a complex and dynamic system like that of health insurance.

It is above all a question of correcting the contradictions of the law. And for good reason, article 58 of the said law stipulates that the ANAM is the body which ensures the proper functioning of the Basic Medical Coverage system (CMB) while article 59 entrusts the Agency only with the mission to “propose to the administration the measures necessary for the regulation of the basic Compulsory Health Insurance system…”. A state of affairs which is reflected in the multiple dysfunctions that our health system is experiencing, but also in the reigning anarchy given that the ANAM has its hands tied.

What the regulator thinks

Contacted by us, the Director General of ANAM, Dr Khalid Lahlou, told us that theANAM has a fundamental role in the process of generalization ofMASTER. « Today, the challenge is not only the generalization of health insurance but also the establishment of an effective, efficient and equitable health system able to meet the expectations of the population. », He clarified.

He added that among the constraints and difficulties which hinder the proper functioning of the AMO, we find the limits of the legal mechanism of the AMO characterized by the incompatibility of general and specific provisions and the inadequacy of the provisions to regulate the system ; and the inconsistency of the legal mechanism entrusting ANAM with the monitoring of compliance with the provisions of the AMO and to the ministerial departments the effective control of this compliance.

« We also note the overlap of entities responsible for exercising controls relating to the application of the AMO legal system; the fragmentation of regulation between several entities and the fragmentation of governance; the composition of the ANAM Board of Directors responsible for regulation; the practices of the managing bodies take precedence over the regulatory measures proposed by the ANAM as well as the absence of general rules relating to the mobility of persons subject to the CMB regimes in the perspective of the universality of coverage », Specified the DG de l’ANAM.

So many limits, the combination of which encourages supplementing the legal system by overhauling certain legal provisions or by adding regulatory texts which, without affecting the areas of jurisdiction of ANAM. And this by providing details on the exercise of its missions and priorities for action with a view to the gradual entry into force of the AMO regimes.

But not only. It is also imperative to remedy another contradiction and not the least, notably the fact that ANAM is under the supervision of the Ministry of Health. A Moroccan specificity which, once again, narrows the Agency’s field of intervention. Not to mention the management bodies (CNSS, CNOPS and insurance), which the Agency is supposed to control, which sit on the Board of Directors of ANAM.

All these irregularities mean that the latter’s action in terms of market regulation must be reinforced. This is why it is now imperative to equip oneself with effective regulatory tools in order to complete this project, so important for society, of expanding health coverage.

In short, this undeniably involves an incessant and imminent overhaul of Law No. 65-00, which, through an examination, reveals constraints or difficulties hampering the proper functioning of the AMO with regard to the spirit and the letter of the law.

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