Impact of the Basic Mandatory Health Insurance “AMO-Tadamon” on Continuity of Care Among Breast Cancer Patients Treated at the Oncology Center of the CHU Mohammed VI in Tangier: A Mixed Longitudinal Cohort Study

Abstract

Introduction: In Morocco, AMO-Tadamon is a basic mandatory health insurance scheme designed to ensure right to health for all. Implementation of this reform is advantageous for access to healthcare services. However, its impact on continuity of care needs to be assessed. In this study, we aimed to evaluate its impact on continuity of care for breast cancer patients at the Oncology Center of CHU Mohammed VI-Tangier between September 2022 and September 2023. Methods: This was a mixed longitudinal cohort study. Follow-up information was collected over 13 months. December 1, 2022 was the index-event. Continuity of care was measured using "Bice-Boxerman Continuity of Care Index" and "Usual Provider Continuity" over three chronological sequences. Results/Discussion: We recorded 74 cases in total, 16/74 were lost to follow-up (21.6%). Significant association (p=0.001; CI (0.01-0.04)) was observed between AMO-Tadamon generalization and continuity of care in our patients. For both indicators (UPC and COCI), mean continuity of care scores ranged from 0.25 to 0.75 over the three reference periods. This indicates a moderate overall continuity of care. During the first 4 months of this reform, significant positive associations were found between Therapy postponement and its implementation (p=0.003; CI (0.01--0.04)). Moreover, access to expensive drugs was significantly higher in the postgeneralization period (p=0.027; CI (0.01-0.04)). Conclusion: Our study suggests a negative impact of this reform on patient care during the period of its generalization and a positive effect on access to expensive drugs after its generalization. A long-term follow-up study is planned. This will assess the impact of this reform on survival.