Migrants and refugees' health financing in Morocco : how much is the hidden contribution of the government through free services?

Background The health of migrants and refugees is a key component in achieving Universal Health Coverage (UHC). This paper aims to assess the scale of financing mobilized by the Moroccan government for migrants and refugees health, and addressing health issues related to these populations within the ongoing health reforms. Methods The primary objective of this study was to estimate the financial resources allocated by the government for migrants' and refugees' healthcare. A bottom-up approach was used to assess the unit costs of all services provided across five primary healthcare (PHC) centers and three hospitals in two regions of Morocco. A detailed costing methodology was applied, accounting for all cost components at the health facility level, including depreciation of capital assets. By combining unit costs and service volumes, we estimated the total government expenditure on healthcare for migrants and refugees. As the free service provision shifts to a third-party payment system with the expansion of health insurance, this financing must be accounted for. To better prepare for future contracting, we also calculated the disease-specific costs for migrants and refugees using activity-based costing (ABC) methods, which allowed us to develop a database of costs per disease associated with migrant and refugee healthcare. Data from 2022 were used for the analysis. Results The study found that the government mobilizes approximately 5% of its total annual primary healthcare budget for migrants and refugees, amounting to $141,652.66. For secondary-level care, the cost was $184,921.92 (3% of total hospital costs) for one hospital, $46,778.20 (0.37% of the total cost) for a second hospital, and $78,193.53 for a teaching hospital. These findings are crucial for informing the development of alternative financing mechanisms following the expansion of health insurance coverage, with the cost per pathology serving as a foundation for designing these mechanisms. Conclusion The study also highlighted that hospitals across different levels of care manage costly diseases, further underscoring the importance of government investment in migrant and refugee healthcare. The nondiscriminatory access to healthcare services and the model of care established in Morocco could serve as a foundation for developing sustainable healthcare financing models for migrants and refugees.