Rabat, Morocco –
After spending a month in Rabat’s largest public hospital (Moulay Youssef Hospital) and children’s hospital (Rabat Children’s Hospital), here are five comparisons between US and Moroccan healthcare:
- Socialized Medicine: Morocco has a version of Medicaid, known as Ramed. Only individuals of low SES qualify for Ramed, in contrast to the US, where Medicaid is an option low SES and other groups in society (i.e. dialysis patients). Like in the US, people who rely on Ramed have severely limited options. For example, they are only accepted by public hospitals, which are often poorly funded, with staff that is underpaid.
- Paperwork: While US healthcare has its fair share of nuances, Ramed is burdened with inefficient and ineffective administrative requirements. Those who rely on Ramed must present several forms of ID, making sure to have multiple photocopies of each ID. However, this facade of professionalism is underscored by the Ramed selection process, which includes a “nomination” to be considered for Ramed. Who nominates you? Allocated “watchers” in your community, that observe your lifestyle and thus subjectively determine your eligibility for Ramed. Needless to say, this asymmetrical, inconsistent application of professionalism leaves plenty of room for corruption.
- Funding: While Ramed is fairly well-funded by the Moroccan government, the allocation of these funds remains inefficiently managed. The Moroccan government allocates funds equally to every department in every public hospital. Unfortunately, this issue is exacerbated by the varying financial needs of every department, resulting in a paradoxical shortage in one department and surplus in another.
- Benefactors (Mohsinin): Due to the mismanagement of funds, and the fact that Ramed does not cover everything (including prescriptions), Ramed recipients often rely on money donated by benefactors, known as “mohsinin.” These benefactors, especially active during Ramadan, donate money to the department of social work in public hospitals, in hopes that the department will allocate the funds to patients most in need.
- Humanity: While Ramed may provide some relief to those unable to afford healthcare, a significant portion of Moroccans do not qualify for Ramed (remember that unprofessional selection process I described earlier?), but also struggle to afford healthcare. Therefore, the most surprising and heart-warming aspect of Moroccan healthcare was not related to the legality of healthcare at all: it was that some doctors in public hospitals will pay for their patients.
I recognize that the heartwarming observation described above is only a temporary solution to an underlying, more permanent problem. However, coming from the US, a nation where some refuse seeing Medicaid patients because they are less profitable, I think the most important lesson we can learn from Moroccan healthcare is highlighted by an oath all US medical students take, but perhaps learn to forget: