He recent failure of the competition of the General Mutual Society of State Civil Servants (Muface) has shaken the health coverage model for public personnel in Spain and has opened one of its largest crisis since its creation in 1975. None of the insurers that provided the service, including Asisa, Adeslas and DKV, have submitted an offer for the next 2025-2026 contract, which leaves the health coverage of more than 1.5 million people. The lack of agreement has called into question the sustainability of this dual modelwhere officials and their families can choose between public and private healthcare, and has opened the debate over whether this structure meets the needs of an equitable health system.
The main problem lies in the economic aspect. Although the Government increased the premium by 17.2%, insurers consider this figure insufficient to face “the growing costs of medical care.” They have demanded a minimum increase of 25%, and some sources in the sector even speak of 40% to maintain quality in services. Given this refusal, The Ministry of Digital Transformation and Public Service has announced, through Mufacewhich will launch a new tender “with different conditions”but the deadlines and results are still uncertain. For the moment, the department headed by Óscar López has not ruled out that these new specifications include a extension of the amounts recruitment.
An opportunity to transform the health system?
This scenario worries, above all, public health defense associations, who have repeatedly denounced that the current system creates inequalities. Specifically, The Federation of Associations for the Defense of Public Health (FADSP) has stated that the Muface model is an “anomaly” and advocates its “phasing out.” In his vision, civil servants should progressively join public health, integrating on equal terms with the rest of the population. A model like the current one, they assess, gives insurers excessive power to set prices. Furthermore, they consider that these large groups are taking advantage of the situation to get more benefits, while referring the most complex patients to the public system.
A report from the University of Las Palmas de Gran Canaria already pointed out in 2019 that insurers carry out a “risk selection” by trying to attract the healthiest mutual members with fewer medical needs, while referring the most complex cases to public health. This model, the FADSP insist, perpetuates a system that benefits the private sector at the expense of public resourcesa situation that they consider unsustainable.
The impact of that cost could be considerable if there is a scenario (albeit highly unlikely) in which Muface stops offering private coverage. Public health, which already faces strain on its resources and waiting times, should absorb more than a million new users. Even so, some officials, such as Javier Padilla, Secretary of State for Health, have defended that the public system could take on mutualists, given that they do not usually present high medical complexity. In his opinion, the transition of these officials to public health should not imply an insurmountable overload. A position that, however, was not well received by all sectors. Which would mean a greater outlay of public money for private healthcare.
A new tender will be opened “with different conditions”
The current context leaves open the possibility that the Ministry forcibly extends the current contracta resource that would save time while a definitive solution is sought. The key question is how long this extension could be maintained and whether or not the Government contemplates an orderly transition plan towards public health in case the insurers withdraw permanently.
The unions They have also raised their voices in the face of uncertainty. UGT, in particular, has called an urgent meeting with the General Management of Muface next Thursday, with the aim of avoiding alarmism and seeking clear answers. The organization has expressed its concern that the quality of health care for officials is not affected. Furthermore, they have highlighted the preponderance of this model among teachers, who represent 65% of the beneficiaries, and other public administration bodies, such as those belonging to the General Administration of the State.
Meanwhile, the continuity of health care for mutual members is guaranteedat least temporarily. Muface has assured that the benefits will be maintained under the same terms and that, if necessary, mechanisms provided for in the Public Sector Contracts Law would be activated. In any case, both the statements of the Mutual Society and the call of the unions reflect the seriousness of the situation and the urgency of finding a solution before January 2025when the current concert will definitively expire.
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