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Faced with the challenges faced by public hospitals, the implementation of an efficient management control system emerges as imperative to improve the quality-of-care services. The objective of this article initially is to shed light on the perception of the actors (medical and administrative bodies) in relation to management control systems by focusing on the organizational framework specific to these institutions. Secondly, it aims to examine in depth the management control practices currently employed, while exploring the complex existing relationship between medical necessities and the predominant economic considerations within Moroccan university hospitals, based on the Giddens’ theory of structuration.This research is based on a review of the literature, as well as a qualitative empirical study using semi-structured interview guides. The analysis of the results demonstrates the complexity of hospital organizations in Morocco, as well as the organizational, institutional, regulatory, financial, and human challenges hindering the effectiveness of management control in Moroccan university hospitals.