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  <Article>
    <Journal>
      <PublisherName>journal-jmsr</PublisherName>
      <JournalTitle>Journal of Medical and Surgical Research</JournalTitle>
      <PISSN>I</PISSN>
      <EISSN>S</EISSN>
      <Volume-Issue>Vol. XIII, n 1</Volume-Issue>
      <PartNumber/>
      <IssueTopic>Multidisciplinary</IssueTopic>
      <IssueLanguage>English</IssueLanguage>
      <Season>June 2026</Season>
      <SpecialIssue>N</SpecialIssue>
      <SupplementaryIssue>N</SupplementaryIssue>
      <IssueOA>Y</IssueOA>
      <PubDate>
        <Year>-0001</Year>
        <Month>11</Month>
        <Day>30</Day>
      </PubDate>
      <ArticleType>JMSR Emergency Medicine</ArticleType>
      <ArticleTitle>From Nominal Coverage to Effective Financial Protection: A Panel Cointegration Analysis of Public and Household Health Spending with Morocco as the Reference Case</ArticleTitle>
      <SubTitle/>
      <ArticleLanguage>English</ArticleLanguage>
      <ArticleOA>Y</ArticleOA>
      <FirstPage>0</FirstPage>
      <LastPage>0</LastPage>
      <AuthorList>
        <Author>
          <FirstName>Aazelarab</FirstName>
          <LastName>Boughaleb</LastName>
          <AuthorLanguage>English</AuthorLanguage>
          <Affiliation/>
          <CorrespondingAuthor>N</CorrespondingAuthor>
          <ORCID/>
        </Author>
      </AuthorList>
      <DOI/>
      <Abstract>Background: Morocco is undergoing a major health financing transition, marked by the expansion of Compulsory Health Insurance. However, despite increased public spending, household Out-of-Pocket (OOP) expenditure remains critically high (&gt;40%). This creates a __doublequotosingMoroccan Paradox__doublequotosing where nominal coverage expands without commensurate financial protection, raising questions about structural versus regulatory inefficiencies. Aims: This study aims to analyze the efficiency of the health financing transition in Morocco by benchmarking it against a panel of Middle-Income Countries. Specifically, it seeks to measure the __doublequotosingcrowding-out__doublequotosing effect of public expenditures on private spending to determine if the state__ampersandsign#39;s fiscal effort effectively substitutes household costs. Methods: We conducted a comparative econometric analysis over the period 2000__ampersandsignndash;2022, benchmarking Morocco against nine Middle-Income Countries divided into three groups: Breakthrough Models (e.g., Turkey, Thailand), Regional Peers, and Controls. We estimated the transmission elasticity of public spending using a linear regression model. Statistical significance of performance gaps was validated using ANOVA and Tukey__ampersandsignrsquo;s post-hoc test. Results: The analysis reveals that Morocco exhibits a partial crowding-out effect, significantly lower than the efficiency frontier set by Thailand. This suggests that nearly 27% of the public fiscal effort is absorbed by system inefficiencies rather than alleviating the household burden. Statistically, Morocco has not yet decoupled from its regional peers, remaining in a __doublequotosingvulnerability zone__doublequotosing with high OOP despite rising income levels.Conclusion: The transition to effective financial protection in Morocco cannot be achieved solely through increased funding. To bridge the efficiency gap with successful models, policy reforms must shift from resource mobilization to active regulation of the private sector and strategic purchasing. Without structural supply-side reforms, coverage expansion risks inflating costs without protecting citizens.</Abstract>
      <AbstractLanguage>English</AbstractLanguage>
      <Keywords>Health Financing, Out-of-Pocket Expenditure, Crowding-Out Effect, Universal Health Coverage, Morocco, Efficiency, Benchmarking,.</Keywords>
      <URLs>
        <Abstract>https://www.journal-jmsr.net/ubijournal-v1copy/journals/abstract.php?article_id=16354&amp;title=From Nominal Coverage to Effective Financial Protection: A Panel Cointegration Analysis of Public and Household Health Spending with Morocco as the Reference Case</Abstract>
      </URLs>
      <References>
        <ReferencesarticleTitle>References</ReferencesarticleTitle>
        <ReferencesfirstPage>16</ReferencesfirstPage>
        <ReferenceslastPage>19</ReferenceslastPage>
        <References/>
      </References>
    </Journal>
  </Article>
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