Moroccan Doctors Want Pregnant Women to Pay UpFront for Cesareans

Rabat – Private doctors in Morocco have announced they will no longer accept reimbursements from the National Fund of Social Welfare Organizations (CNOPS) for cesarean operations.“Our position on this matter is firm” Doctor Hachem Tyal, the deputy director of the National Association of Private Clinics told Morocco World News.The National Coordination of Private Doctors (CNMP) announced in a press release on April 20 that “from 1st May 2019, for reasons beyond their control, gynecologists will no longer accept reimbursements from CNOPS.” Patients receiving c-sections will now have to pay clinics upfront for the surgery’s full cost, and it will be their responsibility to seek reimbursement from CNOPS.CNMP’s  decision is a direct response to recent changes by CNOPS in its c-section reimbursement procedure. The changes angered doctors who claim CNOPS is accusing them of performing unnecessary cesareans. Doctors also claim that CNOPS is attempting to control the cesarean birth rate.In a press release on April 17, CNOPS announced that from May 1, all cesareans performed without a medical justification would be reimbursed at the same rate as a natural delivery. CNOPS also introduced more stringent reimbursement requirements. Cesarean providers seeking CNOPS reimbursements would have to provide a document identifying the reasons for the cesarean, a risk-benefit analysis of the procedure and the conditions of its delivery, stated CNOPS in the press release. High rate of cesareansAccording to CNOPS, the new requirements come in response to the “abnormally high rate of cesareans” in Morocco. In 2017, CNOPS counted 30,583 births, of which 18,522, or 61%, were by cesarean. In 2013, cesareans accounted for 35% of births. Spending by CNOPS on cesareans increased from MAD 13 million ($1.3 million) in 2013 to MAD 130 million in 2017 ($13 million).According to Tyal, these numbers are biased. “The cesarean numbers recorded by the CNOPS are completely biased. Many women in Morocco do not have access to CNOPS so these numbers do not take into account the high number of natural births for which no CNOPS reimbursement is claimed. These numbers do not reflect the real childbirth situation in Morocco,” Tyal told MWN.Read Also: Morocco’s CNOPS Files Fraud Lawsuit against Privately Owned ClinicsAziz Khorsi, head of communication at CNOPS told Morocco World News that the CNOPS statistics do only reflect patients covered by CNOPS. He added, however, that “the cesarean statistics are worrying.”“The reimbursement procedure has not changed significantly. All we are requiring is a medical report.”Read Also: Public Doctors Condemn Health Sector Problems, Threaten to EmigrateThe World Health Organization considers the ideal rate for cesareans to be between 10% and 15% of births.In its press release, CNOPS also cited a report by the Organisation for Economic Co-operation and Development, noting that non-necessary medical procedures and “wastages” account for 20% of spendings on health.Doctors have expressed anger about this comment, saying CNOPS is suggesting gynecologists in Morocco are performing unnecessary cesareans.“This is pure and simple defamation. The CNOPS must not make allegations that gynecologists are crooks,”  Tyal complained. Tyal wants the CNOPS to reconsider the changes it has made to the reimbursement policy.“CNOPS is not here to control the rate of cesarean births. It makes no sense. This is a medical decision to be taken by the doctors,” he said. “CNOPS must reconsider its position. CNOPS is threatening the health of mothers and children and it’s comments towards gynecologists are defamatory.”The National Association of Private Clinics is meeting with the Minister of Health this morning to discuss the issue.