La trappe des décisions irréfléchies : le Régime d’assistance médicale au Maroc (RAMed) et le Plan Sésame au Sénégal

Abstract

L'article montre comment les besoins politiques des acteurs publics, notamment les besoins de légitimité, les conduisent à prendre des décisions fondées sur leurs intérêts conjoncturels et non sur leur faisabilité et sur le soutenabilité. Une fois prises, ces décisions sont difficiles à réformer, même si les politiques publiques qui en résultent s'avèrent dysfonctionnelles. En effet, les acteurs politiques risque, de nouveau, leur légitimité s'ils reviennent sur les avantages qu'ils ont accordés. Nous présentant deux cas, un au Maroc et un autre au Sénégal. Il s'agit de deux dispositifs d'accès gratuit aux soins.

The Limits of Free Health Care Schemes: the Case of Access to Care for Beneficiaries of the Moroccan Medical Assistance Scheme (RAMed) Suffering From Cancer

“…Like all public policies, it does not escape politicization and the complementary mechanisms of seeking legitimacy [9] and avoiding blame [10] on the part of the political actors who decide on them and supervise their implementation. Some free education projects, such as the Sesame Plan in Senegal [11], are thus clearly part of the search for legitimacy and appear to be connected to electoral issues [12]. In addition to the general questioning of the sustainability of free education, there is a speci c questioning, not without foundation, of the conditions and contexts of its implementation.…”

The emergence of the national medical assistance scheme for the poorest in Mali

“…the protection of the monarchy's leadership within a determined process of liberalisation of authoritarianism" (Ferrié et al, 2018). The aim appears to be truly focused on the need to "re-legitimise the monarchy" (Ferrié and Omary, 2019).…”

“…The emergence of this programme was largely political, as it had been an electoral promise made by Macky Sall. As a result, the launch was rushed and chaotic, "ill-considered" and "without consultation" (Ferrié & Omary, 2019). In Ghana, people classi ed as the poorest (also bene ciaries of a cash transfer programme, Livelihood Empowerment Against Poverty) are enrolled free of charge on the national health insurance scheme, on paper since 2004 but in reality since 2013 (Umeh, 2018).…”

The emergence of the national medical assistance scheme for the poorest in Mali

“…the protection of the monarchy's leadership within a determined process of liberalisation of authoritarianism" [14]. The aim appears to be truly focused on the need to "re-legitimise the monarchy" [15].…”

“…The emergence of this programme was largely political, as it had been an electoral promise made by Macky Sall. As a result, the launch was rushed and chaotic, "ill-considered" and "without consultation" (Ferrié & Omary, 2019). In Ghana, people classi ed as the poorest (also bene ciaries of a cash transfer programme, Livelihood Empowerment Against Poverty) are enrolled free of charge on the national health insurance scheme, on paper since 2004 but in reality since 2013 [20].…”