The agreement with the General Mutual Society of State Civil Servants (Muface) is at a critical moment and its future is uncertain. The terms of the renewal of the agreement, which allows millions of public workers to choose between public and private healthcare – the latter also financed by the State – have generated deep concern among defenders of public healthcare, private insurers, who see his great business falters; and the officials themselves, who benefit from this service. The starting point of this crisis is marked by the supposed insufficient financing offered by the Government, a fact that, according to the private healthcare employers’ association, could endanger the continuity of this model.
The Ministry of Public Service has proposed a 14% increase in the premium paid by mutualists, an offer that private companies consider insufficient to cover the rising costs of medical care. These companies, including Asisa, Adeslas, DKV and Mapfre, warn that with this increase they would not be able to maintain current quality levels, which would translate into a worsening of services and longer waiting times for officials ( when shortening deadlines is one of the main reasons why this system is supposedly maintained).
The operators demand nothing more and nothing less than an increase of 40%, while Muface’s demand is around 25%. The Government, for its part, plans to approve in the Council of Ministers this Tuesday the same specifications as the current one for the new agreement, due to the considerable public deficit that it already has and for which the Treasury sees no room for a greater increase. . With agreement or not, the negotiation has a limit of January 1, 2025, so time is of the essence.
Insurers talk about “deliberate end”
From the side of the insurers, grouped in the Spanish Private Health Alliance (ASPE), the Government has even been accused of seeking a “deliberate end” to the Muface model. According to its representatives, the current financial offer is designed to “transfer responsibility for the failure of the negotiations to the private sector”, while leaving attention to officials in a “precarious position”. Added to this, the employers’ association explains, is the challenge of the aging of the mutualist population, whose average age has increased by 7% in the last decade, which increases the medical care needs of this group.
The scenario is, however, a little different. Different studies, such as the Muface Mystery report. Selection based on risk or worsening of perceived quality? –published by the University of Las Palmas de Gran Canaria in 2019–, highlight how private operators work under what researchers define as a “risk selection” of users. Dynamic that consists of inducing certain types of more serious or chronic diseases to end up, to a large extent, being treated in public hospitals. The ultimate logic is, at the end of the day, to attract as many healthy officials as possible; as well as avoiding the maximum proportion of workers who may entail large costs.
This same study highlights that the choice of the National Social Security Institute over private clinics, among civil servants, has gone from 14.1% to 20.4% in the last decade. Although, each year, more than 70% of public employees tend to choose private healthcare on average.
Time for the resources to go entirely to the public?
This position had already been warned years ago by figures such as the current Secretary of State for Health, Javier Padilla, and now it has re-emerged. Padilla has defended the capacity of the public system to absorb mutual members, in the event that the agreement with the insurers is not renewed. In this sense, he has argued that the majority of mutualists do not present a high complexity in their care, so the public system could assume their care without major complications. Statement that has generated some discomfort, both in the private sector and among some unions.
Mónica García has described Muface as an “anachronistic subsystem” and Javier Padilla has defended the capacity of the public system to absorb mutualists
In any case, Padilla’s opinion is in line with what is supported by associations in defense of public health, such as the Federation of Associations for the Defense of Public Health (FADSP), which maintains that the disappearance of the mutual model would be beneficial for the public health system in the long term.
For these organizations, the current model perpetuates inequalities by financing with public resources a private system that is not available to all citizens. The FADSP advocates for the full integration of civil servants into the public system, which, according to its forecast, would alleviate the financial and administrative tensions derived from agreements with insurers.
The FADSP considers that the current model perpetuates inequalities by financing with public resources a private system that is not available to all citizens.
This position has also been supported by the Minister of Health, Mónica García, who has described Muface as an “anachronistic subsystem.” García stressed in a recent interview on Hora 25 that the agreement with the insurers does not include effective Primary Care for mutual members, although he made it clear, in turn, that the idea of eliminating this model is not on the table. For García, however, public health must be the fundamental pillar of the health system in Spain.
The consequences of a possible dissolution of the agreement would be complex. The affected group includes more than 1.5 million employees and their families, who currently receive care through private healthcare. If the insurers decide to withdraw from the agreement, these mutualists would be forced to resort to the public system, which could overwhelm the resources of an already stressed public health system. That is why public health associations focus on the need for adequate financing for the National Health System (SNS).
