As promised, and following the call of the unions, the doctors of the liberal sector (general practitioners, specialists, dentists) held a strike on January 20 to protest against the rate of contribution to the health insurance system for the self-employed (AMI ), set by the government as part of the deployment of the project to generalize medical coverage.
According to liberal doctors, the rates taxed by the government to doctors are “ unfair » in comparison with other liberal professions (architects, notaries, pharmacists, etc.). According to the unions of liberal doctors (CSNMSP, SNMSL, SNMG, ANCP), 80% of doctors took part in the strike of January 20 on a national scale, including 90% in the region of Rabat-Sale-Kénitra (near of 100% of clinics in Rabat).
The few doctors in the liberal sector who did not take part in the strike believe that the representatives of the liberal doctors negotiated badly with the government and the organizations concerned by the deployment of the generalization of medical coverage, from the outset, in terms of relates to contribution rates.
In an analysis on the strike of liberal doctors, Dr Saïd El Kettani, liberal internist in the city of Settat after more than 20 years of work in the public sector, is for this strike decision, but partially disagrees with the reasons given. by the unions.
» The protests of the liberal doctors and dental surgeons certainly concern the contributions to the financing of the AMO, but insist, rightly, on other structural dysfunctions of the health system in Morocco. They cite as examples the marginalization of the councils of the order (CNOM, ONMD), the absence of accompanying incentive measures, the non-periodic review of the national reference tariff (TNR) and the reference system for professional acts, and this since 2006, the delay in setting up the care pathway and the very thorny problem of the illegal practice of medicine. This shows, very clearly, the absence of a holistic vision of the problem and of an efficient proposal for the implementation of this royal project.“, believes Dr. El Kettani.
The point on which this internist is in “ total disagreement ” is ” the contestation of the contribution rates to the financing of the AMO“. He explains this by the fact that the people who negotiated on behalf of the doctors must assume their responsibility“.
On this point, Dr. Badreddine Dassouli, president of the National Union of Doctors of the Liberal Sector (SNMSL), had explained to us that indeed during the negotiations around the necessary contributions of doctors from the liberal sector, to the Health Insurance of the Independents (AMI ), an agreement was reached between the National Council of the Order of Physicians (CNOM) and the unions. Then, another agreement was concluded between the President of the CNOM, representing the doctors, and the organizations concerned, namely the Ministry of Health and Social Protection.
In this agreement, the partners agreed on 4 times the SMIG for general practitioners, and 5.5 times the SMIG for specialist doctors, but on condition that they have incentive measures in the form of a reduction in the amount of the employer’s contribution, which do not appear in decree 2.21.290 implementing law no. 98.15 relating to the basic AMO scheme. » These measures just disappeared from the decree, when it was the only advantage that had pushed us to accept this agreement”, he pointed out.
What philosophy to properly apply the AMO
We all want health insurance to be generalized to the liberal professions and then to all Moroccan women and men. But when it comes to determining the contributions of liberal professionals, Dr. El Kettani finds that the quotas are « corporatists » and sometimes even take into account the age and the number of years of exercise.
” However, the calculators have forgotten the holistic vision, since liberal professionals pay taxes“, specifies the doctor, noting that” the tax department should contribute to equity, instead of quotas, and therefore the insured will pay according to his declarations to the taxman“.
” Thus, it is the real wage which should be the barometer“, considers the internist, citing the example of a pharmacist in Khenifra who will certainly not have the same recipe as a pharmacist in the center of Rabat or Casablanca, which is the same for the other liberal professions, he said.
On the argument: taxpayers do not pay their taxes and that tax evasion is commonplace in Morocco all over the world)”, Dr. El Kettani believes that here too “ it is holistic and progressive solutions that will solve this problem“.
Analyzing the table of self-employed contributions to the medical and social coverage scheme, Dr. El Kettani explained that by introducing AMO contributions for certain liberal professions by referring to the decrees of November 29, 2021, “ we observe corporatism and sectoral and not global negotiation in addition to the absence of equity, between professions, or even within the same profession“.
” You cannot impose the same rate on two notaries! Is it logical that a notary in Tangier who would have a high turnover and several collaborators should be taxed in the same way as a colleague of his, in Tiznit, who would have only one secretary?“, he gives as an example to explain this lack of equity in contributions to the AMI in general.
Ultimately, Dr. El Kettani believes that “ the government should assume its responsibilities in terms of social equity and the proper implementation of the royal building site. Equal access to care, quality of care and solidarity are the three fundamental principles on which the Health Insurance is based. It allows beneficiaries to receive treatment according to their needs, regardless of their age and level of resources”.
“The principle of solidarity between the healthy and the sick is implemented by financial accessibility of benefits in kind, themselves financed by compulsory revenues that are fair according to the taxpayer’s income.“, he concludes.