Couverture sanitaire universelle et obstacles financiers aux soins
L'impact des paiements ex ante au Maroc
DOI :
https://doi.org/10.23882/emss26262Mots-clés :
Universal health coverage (UHC), Ex-ante payment, Forgoing access to healthcare, Poor populations, Propensity score matching (PSM)Résumé
Objectif : Cet article examine les limites d'un modèle de couverture sanitaire universelle (CSU) basé sur le paiement ex ante des services de santé avec remboursement ex post, dans un contexte marqué par des inégalités importantes dans l'accès aux services de santé. Bien que ce modèle vise à rationaliser la consommation de soins de santé et à promouvoir l'équité, il reste peu adapté aux besoins des populations les plus pauvres, qui sont souvent dans l'incapacité d'avancer les frais médicaux. Méthodes : Pour aborder cette question, l'étude adopte une approche méthodologique quantitative basée sur une enquête de terrain menée auprès de ménages marocains. L'analyse s'appuie sur des techniques économétriques, notamment la régression logistique binaire et l'appariement par score de propension (PSM), afin de tester l'hypothèse selon laquelle les paiements ex ante constituent un obstacle important à l'accès aux soins de santé et d'évaluer l'impact réel des mécanismes de prépaiement sur la demande de soins de santé. Résultats : Les résultats indiquent que dans les systèmes caractérisés par une couverture limitée ou des exigences de paiement ex ante, l'accès aux services de santé reste limité pour les populations à faibles revenus. En revanche, une couverture universelle complète améliore l'accès aux soins, tout en soulevant des préoccupations liées au gaspillage des ressources et au risque moral. Conclusion : L'étude souligne la nécessité d'intégrer les disparités de revenus et les coûts réels des soins de santé dans la conception des politiques de santé afin de réduire durablement les soins non dispensés et de renforcer l'équité au sein du système de santé.
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