As part of the deployment of the site of generalization of medical coverage, the government adopted draft decree n ° 2.21.290 implementing law n ° 98.15 relating to the AMO regime and law 99.15 for workers. independent. A text whose content aroused the anger of doctors in the liberal sector, because according to them, not meeting their expectations and missing ” equity »In relation to AMI contributors.
A group of private sector unions therefore approached the head of government on this matter, and decided to boycott the payment of the first CNSS contribution until the resumption of discussions on the content of the decree. Point.
Presented by the Minister of Health, Khalid Ait Taleb, the draft decree, drawn up with a view to defining the modalities of application of the aforementioned laws to doctors, fixes the flat-rate income of general practitioners at 4 times the value of the non-agricultural minimum wage multiplied by the normal annual working time.
In the case of medical specialists, the flat-rate income increases to 5.5 times the non-agricultural minimum wage multiplied by the normal annual working time, while the flat-rate income for pharmacists has been set at three times the value of the non-agricultural minimum wage multiplied by the normal annual working time, compared to 4 times the minimum wage for notaries.
The trade unions in the liberal sector point out not only the absence of the points agreed with the competent authorities in the decree, in particular the addition of incentive measures, but also denounce the lack ” equity »Compared to contributors to the AMI (health insurance for the self-employed).
” The proposals put forward do not appear in the decree adopted by the government. Progressive contributions had been proposed according to seniority. For some doctors whose activity is going well, they will pay the total. For doctors who are new to them or who do not have enough patients, they have separate rates. It is on this basis that we delivered our recommendations. But we find ourselves afterwards with 4 and 5 times what has been concluded. It will make us at least 2300 dhs per month. But not all doctors can afford to contribute this amount, since there are always doctors who consult at 80 dhs, especially general practitioners“, Tells us Noureddine Dassouli, president of the national union of doctors in the liberal sector (SNML).
” When we see the contributions of notaries, lawyers, pharmacists and architects, we wonder if our income is higher than theirs. They will contribute less than us while they have turnover figures which amount to millions of dirhams“, Protests Dr. Dassouli, noting that the doctors of the liberal sector have always been at the front, especially during the Covid-19 period. ” We have lost some 80 doctors during the pandemic. And is that our reward?“, He laments.
The doctor thus returns to a meeting which brought together the unions of the liberal sector, the Minister of Health, the CNSS, the CNOM and the director of ANAM. It was noted that incentives in the form of a reduction in the amount of the contribution due, would be put in place from the start of the process, he recalls.
However, these incentives were not mentioned in the decree, which prompted liberal doctors to show their unanimous disapproval of the proposed contributions to the MAI.
As an example, Dr. Dassouli cites French private doctors, who benefit from a payment of their social contributions by the CNAM (ANAM equivalent) which can reach 80% because they contribute on a daily basis to the success of the insurance. disease in France.
What doctors in the private sector offer
Unanimously in agreement on the refusal of the contributions of the doctors mentioned in the decree, the SNML, the National Association of Private Clinics (ANCP), the National Union of General Practitioners (SNMG) and the National Union College of Private Specialists, have sent a letter to the head of government Aziz Akhannouch, where they clearly explain the situation and demand to resume discussions on the content of the proposal of the said decree with all the parties in charge of this issue.
Thus, doctors in the liberal sector are demanding a rate harmonized with other similar professions, the treatment of liberal doctors as the main players in health insurance, whether CNSS, CNOPS, private…. And their financial balances through medicalized control of spending, says Dr. Tayeb Hamdi, president of the SNMG.
They also demand the progressivity of contributions at the start of the career of young doctors installed and after the legal retirement age, incentives from the funds in accordance with commitments and like what is happening in other countries ” otherwise, doctors will never be tempted to engage with the funds or make the necessary efforts, namely the CNSS taking charge of 50% of the AMI charges for doctors’ adherence to conventions and improvement of this rate by 50% in proportion to the objectives achieved“, He said.
” It is urgent to open negotiations as soon as possible between the ANAM, the funds and the unions of liberal doctors for the renewal of the agreements supposed to be renewable every 3 years, but which have remained frozen since 2006. The goal being to redefine the terms to include the duties and rights of all parties with the counter parties that are necessary for fair and egalitarian agreements. We also need to negotiate incentives to cover other social charges for contracted physicians in view of the commitments made and the achievable and achieved objectives.“, Explains the president of the SNMG.
The unions also offer other incentive measures, particularly in the area of family allowances, which consists of 60 to 100% coverage by the CPAM depending on income, in addition to a supplementary old-age allowance (ASV). and other measures.
For the moment the unions are awaiting the government’s reaction to their mail. In the meantime, a call for a boycott of the payment of CNSS contributions has been launched, as a first step. If nothing is done, a strike by doctors in the liberal sector can be observed, says Dr. Dassouli, which can disrupt the functioning of the health system, in which the private sector is a key player.