The fate of Muface, the mutual fund on which the healthcare of 1.5 million civil servants depends – a million of them in private healthcare – has been up in the air for more than a month. The Government is preparing a new tender with insurers to try to save the system, but if negotiations fail, the end of Muface is a real possibility. If this were to happen, there would be a series of autonomous communities that would be particularly affected. It is about Madrid, Andalusia and Extremadura, which are the territories where the aging healthcare population would grow the most with the transfer of officials.
Specifically, these three autonomies would register increases of around 4.5% in its health population over 65 years of agewhich is the age group that represents the most cost for the system, given that the use that older people make of it is more intensive. Furthermore, in the case of Madrid and Andalusia, the condition is added that they are the two territories with the lowest average health expenditure per inhabitant.
Castilla-La Mancha would also notice a significant impact as it is the community where more officials with private healthcare from Muface would transition to public healthcare, although in its case the weight of the aging population is somewhat lower. The other side of the spectrum is embodied by the Basque Country, Navarra, the Balearic Islands and Catalonia.where the increase in pressure on public health does not reach 2% of the protected population.
This increase in pressure on already stressed health systems will undoubtedly have consequences. The analysts consulted by this newspaper predict moments of short-term stressalthough they consider that if the State transfers sufficient resources, the transfer to public health is perfectly viable.
“There will most likely be tensions for some years. More queues, tensions in services… but if the resources that are being allocated to Muface were allocated appropriately to the national health system there should not be problems,” reflects Sergi Jimenez, professor of Economics at Pompeu Fabra University (UPF) and researcher at the Center for Research in Economics and Health at said institution.
According to a report prepared by the Extraordinary Chair of Sustainable and Responsible Health of the Complutense University of Madrid (UCM), The cost that the end of Muface would mean for the public coffers would be around 1,000 million euros. This chair, in which the ASPE health insurers’ association also collaborates, estimates that this is the difference between the premium paid by Muface and the total health expenditure. The aforementioned document summarizes some of the effects that the end of Muface could have on the public system.
One of the most striking is the increase in demand in primary carealready saturated in many autonomous communities. The UCM report estimates that it would be necessary to increase hospital beds by almost 4,000, something that can be “very difficult to absorb” in provinces such as Madrid, Seville, Valencia or Barcelona, they point out. They also add that waiting lists for outpatient clinics would skyrocket by 266% while the surgical wait would double.
Uncertain consequences
Neverthelessthese forecasts are surrounded by great uncertainty. Firstly, because it is not at all clear that all officials decided to join the public service. If this were to happen, it is to be expected that many of them would choose to take out private insurance to maintain, even partially, the coverage they now enjoy. Especially if one takes into account that three out of every four mutual members are employees of group A, the one that offers the best remuneration.
“Many people who are now in Muface are going to take out private policies. If the agreement is not signedthe companies themselves will offer complementary insurance at a relatively low cost“, reflects Guillem López Casasnovas, director of the Center for Research in Economics and Health at UPF in conversation with this newspaper. “Insurers have seen that it can be more profitable for them to forget about the Muface premium and go for complementary insurance. I think there are companies that are not going to sign because they are doing better with this,” he adds.
This effect could be especially noticeable in primary care or specialist offices, where diagnoses are made. “Many people with private policies want to not wait for the diagnosis.“, maintains López. “The problem is that when you have the diagnosis you go to the public for treatment: by paying you skip one of the two waiting lists. From an equity point of view, this also has its consequences,” he concludes.
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