Universal health coverage and financial barriers to care: The impact of ex-ante payments in Morocco

Objective: This article examines the limitations of a universal health coverage (UHC) model based on ex ante payment for healthcare services with ex post reimbursement, in a context marked by significant inequalities in access to health services. Although this model aims to rationalize healthcare consumption and promote equity, it remains poorly suited to the needs of the poorest populations, who are often unable to advance medical expenses. Methods: To address this issue, the study adopts a quantitative methodological approach based on a field survey conducted among Moroccan households. The analysis relies on econometric techniques, including binary logistic regression and propensity score matching (PSM), to test the hypothesis that ex ante payments constitute a significant barrier to access to healthcare and to assess the actual impact of prepayment mechanisms on healthcare demand. Results: The findings indicate that in systems characterized by limited coverage or ex-ante payment requirements, access to healthcare services remains constrained for low-income populations. By contrast, comprehensive UHC improves access to care, while simultaneously raising concerns related to resource waste and moral hazard. Conclusion: The study underscores the need to integrate income disparities and the real costs of healthcare into health policy design in order to sustainably reduce foregone care and enhance equity within the healthcare system.