The Ministry of Health has proposed that, within nine monthsnearly a million civil servants who currently receive medical care through private insurers are integrated into the public health system. The measure will affect the beneficiaries of the Muface model, which, according to the ministry, has already it is not viable in current conditions.
The report MUFACE: from private insurance to the National Health System, prepared by the Ministry of Health, reports that the General Mutuality of State Civil Servants (Muface) has approximately 1.5 million members. Of this total, 1,007,322 people, equivalent to 67.3% of mutual members, currently choose to receive health care through private insurers such as Asisa, Adeslas and DKV.
The Ministry of Health maintains in its study that “the Muface model is not sustainable because no system works if it does not have a pool of risks that allows counterweights to be exercised between those who most demand the service and those who make less intense use.” By age groups, the report reveals that 42.4% of Muface model users are in the 35 to 64 age group, while 32% correspond to those over 65 years of age.
The report highlights the reluctance of private insurers to participate in the agreement proposed by the Government
The report highlights the reluctance of private health insurers to participate in the agreement proposed by the Government and highlights that these companies are demanding an increase of more than 40% in current financing conditions. Given this situation, the Ministry of Health proposes a nine-month extension of the current agreement, in line with what is established in the Public Sector Contract Law. During this period, a process of internalization of the health care of Muface mutual members would be carried out, transferring its management to the National Health System.
Patients in therapy, the last in the transfer
During those nine months, the ministry considers a gradual incorporation, prioritizing patients who are in ongoing therapeutic processes. Given that they require continuity in their treatment, these patients should be the last to be transferred to the public health system.
For this type of patient, and in the event that there are contraindications for transfer to the public health system – such as end-of-life situations or cases of high complexity in oncological processes – an exceptional route could be evaluated. This alternative would consist of temporarily renegotiating a extraordinary assuranceallowing coverage to be extended for an additional year beyond the expiration of the initial extension.
Likewise, the report raises the possibility of implementing, during these nine months, a transition plan that ensures the continuity of care for chronic patients in their reference hospital centers. This would allow these patients to directly access their usual services, without having to undergo the standard procedure of a first consultation.
The study also provides a plan for the transfer of clinical information, with the aim of avoid duplication of diagnostic and therapeutic tests. In addition, it includes a communication plan aimed at resolving any questions that may arise during the process, thus guaranteeing a more fluid and efficient transition.
Insurers stand down Muface
On October 8, the Council of Ministers gave the green light to Muface to sign new agreements aimed at guaranteeing the provision of health care to beneficiaries who choose to receive it through insurance entities. For this purpose, an offer was presented for 1,337 million euros by 2025 and 1,344 million by 2026, which represented an increase of 16% compared to the previous concert. However, No insurance company showed interest in participating, so the process was void.
In Muface, 65% of mutual members are primary, secondary and university education teachers, while 17% belong to the General State Administration (AGE) bodies. As a result, the autonomous communities with the greatest number of mutual members coincide with those that have a higher ratio of teachers or a significant presence of AGE officials.
#Health #proposes #dissolve #Muface #integrate #affiliates #public #health #system
