The Determinant of Health Services Demand in Morocco : A Microeconomic Analysis

Résumé

Abstract

Background: Equitable access to healthcare is one of the main political challenges in Morocco. Despite the current progress in the expansion of health coverage, significant disparities persist in the use of health services between different social groups and between urban and rural populations.

Aim: This study is designed to analyse the elasticity of healthcare demand within Moroccan households, with a focus at the role of social, economic and demographic factors.

Setting: This analysis is based on data from the 2014 National Household Consumption and Expenditure Survey (ENCDM), carried out by Morocco’s High Commission for Planning. The survey provides detailed information on 15,970 households and 75,691 individuals, while naturally remaining subject to the usual limitations related to sample size, geographical detail, and data confidentiality requirements.

Methods: Ordinary Least Squares (OLS) and quantile regression models were employed to estimate the determinants of the household healthcare expenditure share, measured as the ratio of health spending to total household expenditure. The explanatory variables included household income (proxied by total expenditure), health insurance coverage, the educational attainment of the household head, household size, place of residence (urban or rural), the presence of chronic illness within the household, and the employment status of the household head. Robust standard errors were used to address heteroskedasticity, and Variance Inflation Factors (VIFs) were examined to ensure that multicollinearity did not pose a concern.

Results: The study brings forward three observations about how Moroccan households approach healthcare spending. To begin with, income and insurance matter more than any other factor: families with limited resources devote only a small portion of their budget to health, while those covered by insurance show a clearer tendency to use and spend on healthcare. A second finding is that the role of education and the presence of a chronic illness becomes stronger among households that already spend more on health, suggesting that needs and decisions differ noticeably across the spending spectrum. Finally, the analysis confirms a steady gap between rural and urban areas, with urban households allocating a larger share to health services, reflecting differences in access and availability across the country.

Conclusion: The results confirm that healthcare demand in Morocco is strongly influenced by income and insurance coverage, while social and geographic inequalities continue to shape access and utilization.

Contribution: This study is among the first in Morocco to apply quantile regression to the analysis of household health expenditure, which made it possible to uncover meaningful differences in behavior across the expenditure distribution. The results add new empirical insight to the broader literature on health equity in Africa by illustrating how structural inequalities shape patterns of healthcare use. Beyond its analytical contribution, the study provides practical guidance for designing more inclusive approaches to health financing approaches that support Morocco’s efforts to expand social protection and to reduce the social and territorial gaps that continue to influence access to essential services.

Keywords Healthcare Demand, Microeconomic Analysis, Health Expenditure, Morocco, Quantile Regression, Health Insurance.