The resolution of the Muface crisis seems increasingly closer. At least, for now. The Government’s economic concession, with a second offer with a cumulative increase in the premium of 33.5%, aims to undo the tangle in which insurers, unions and ministries had become involved in the last two months and which had been left in limbo private healthcare for tens of thousands of public officials. From opposing positions and pressure strategies, all parties agree that a “reformulation” of the model is necessary. If private companies attend the new competition put on the table for 2025, 2026 and 2027, a three-year scenario is proposed in which to rethink a system inherited from the last years of Franco’s rule.
“The priority is to put out to tender the concert and give security and peace of mind to the mutual members. That is what the Government is dedicated to,” Minister Óscar López defended this Wednesday, in a commission in Congress. The head of Public Service was, however, “delighted to debate.” “Do you think Muface is perfect? Believe me, it’s not. Does it require reforms? Believe me, it requires them,” he admitted to the rest of the parliamentary groups. “Some will discover that, after 50 years, there are things that have not been reviewed, such as that there are officials who are not from the General Administration of the State, who are from the autonomous communities, who are paid by the (private) insurance. General Budgets of the State and not the autonomous communities,” he stated.
The Ministry of Public Function has been talking about the need for “a reflection on the model” for weeks, even suggesting that officials choose between public or private healthcare “forever”, instead of opting for a change every January. This would make “it easier to plan the system’s sources of income and its sustainability,” said voices close to the department headed by Óscar López. “It is likely that, seeing the current transfer dynamics and the fact that someone from the public sector can take out private insurance on their own, but someone from the private sector cannot contract to be seen in the public service, this measure would exacerbate trips to the SNS. “, indicate sources from the Ministry of Health.
70% of new officials choose the public
These dynamics refer to the election preferences of mutual members, a milestone that Minister López also valued this Wednesday. “Let’s analyze the data if we want to be truly effective: of the officials who right now have the possibility of being in Muface, 70% are (with private insurance) and 30% are not. Of those who enter new, it is the other way around: 70% choose the public and 30% do not,” he explained. “It is evident that there is an elephant in the room that no one wants to see, which is the older population,” he insisted.
“In the next 3 years, it is difficult for this dynamic to change, since the majority choice of the public provider by the new mutual members is a trend that has already been going on for five years and it is difficult for it to change after the instability. shown in this last tender”, they point out from Health.
The representative of Sumar, Engracia Rivera, regretted that given the “two paths” opened after the first refusal of the private insurers, Public Function had chosen to improve the offer, instead of starting a process of incorporation into the national health system. “We dislike it,” he said in the congressional committee, because “not only does it ensure increased premiums, but it represents a fairly large profit margin.” Rivera cited an increase in concerts of 58.4% between 2018 and 2027, compared to the CPI dedicated to medicine of 14.7% and a cumulative increase of 26.4% between 2018 and 2024 and premiums that grew by 18, 6%. “Although they say that they did not increase, they did also increase in that period,” he stated.
“Work so that this is the last tender”
The Sumar parliamentary group presented a non-legal proposal in Congress a few days ago for the integration of all officials in the health care of the national health system, making clear the two souls of the coalition Government in this matter and its intention to “continue working so that this is the last tender that will be carried out.” The text proposes the creation of an inter-ministerial commission, an “adequate transition system” and that “the corresponding financing of health care to private insurers would be fully transferred to the public system and in a final and proportional manner to the different autonomous communities, taking into account “It takes into account demographic criteria and morbidity profiles.”
The Government’s offer represents a total amount of 4,478 million euros in three years, with an increase of 19.37% in the premium for 2025, 7.25% more in 2026 and another 4.32% in 2027, with a cumulative 33.4%, almost double the first proposal, which the insurers rejected. This increase occurs despite the fact that the mutual society itself had admitted in a report, published on December 10, that the companies “do not provide evidence of the costs” to justify an increase.
Any ‘Muface to be phased out’ proposal could be the most rational and efficient solution. Perhaps the most practical would be that no new civil servant can enter private insurance and that any migration of these to public health is irreversible.”
José Ramón Repullo
— Health management expert
“Without knowing the response from the insurers, it is not clear if the time that can be gained will be used to carry out renovations or to leave them for the next person in charge whose turn it is to renovate in three years,” considers health management expert José Ramón. Repullo, who regrets that “political procrastination is a currency of Spanish politics.” In his opinion, “any proposal for ‘Muface to be phased out’ could be the most rational and efficient solution.” “Perhaps the most practical would be that no new civil servant can enter private insurance and that any migration of those to public health is irreversible,” he proposes. It is something similar to what happened in 2011 with the reform of the Passive Classes Regime, a system of recognition and payment of pensions to civil servants and their families.
“Propose a roadmap now”
From Health they are committed to “proposing now a roadmap for transfer to the national health system when the new agreement expires, gradually, proposing extension of patients with ongoing treatment processes and transitioning Muface to a kind of” action social “for complementary benefits”. “There would even be the possibility that mutual members would move to the SNS as a whole and Muface would collectively negotiate some voluntary insurance for those who wanted to benefit with more advantageous conditions,” indicate ministerial sources consulted by elDiario.es.
The department headed by Mónica García published a report in which it accused private insurers of selecting patients and pointed out that “for the first time in many years, the possibility of incorporating the mutual population into public health care is both a viable and viable option. reasonable”. The Ministry of Health, which is not competent in matters of mutual benefit, did begin to study the effect of a possible transfer of civil servants, which several experts considered as “not catastrophic.”
Currently there are around 770,000 civil servants and over 424,000 beneficiaries of private insurance at the expense of the General State Budgets. These – and those who opt for public health – have a part withheld from their payroll for the mutual benefit, but this withholding will not increase by 33.4%, so the 4,478 million are covered with everyone’s money. “We have made an increase of 300 million euros and the budgets are not infinite. When you put in 300 million euros, it is at the expense of something else. We work for Muface policyholders and for 48 million more Spaniards,” Public Service sources acknowledged a few weeks ago. That increase, waiting for insurers to accept, is now greater.
Insurers “value the effort”
Sources from the sector assure that they “value the effort” that the administration has made and are open to analyzing solutions that allow “fixing the imbalances in the medium and long term”, always betting on the survival of the system. “We have always thought that we can work to find formulas that allow us to improve the sustainability and viability of mutuality,” indicate these voices, who prefer “not to advance scenarios,” but who give other resurgences as an example. “A few years ago, Isfas—the military mutual fund—was more deteriorated than Muface, but the entry of new troops into the Armed Forces lowered the average age and, with the same funding, one is sustainable and the other is not,” they say. .
The end of Muface, of Isfas or of Mugeju, of justice, would not be the first of a mutuality. After the general health law, approved in 1986some special regimes were being assimilated by the national health system, such as those for employed workers in the agricultural, maritime or coal mining sectors. “Seven years late, in 1993, those who were members of the National Social Security Fund for Local Administration were also included in the SNS health care,” indicates the explanatory statement of Sumar’s non-legal proposal. “Munpal has already passed away and nothing happened. The world did not disappear, no public employee was left without health care,” defends Rivera.
Health sources insist that “various actors, both in favor and against the Muface model, do seem to have insisted that this instability of the model according to which it is at the expense of the pressures and will of the insurers, generates no stability at all.” mutualists, especially when there is a stable model: the SNS.” For this reason, they ask to “assume” that for the mutual insurance company “to be profitable for private insurers, the capital will have to rise much higher than what its integration into the SNS would entail, as it is a much smaller economy of scale.” “You can kick forward, but there will be a limit,” say voices close to García.
The expert José Ramón Repullo considers that, although this ‘Muface to be extinguished’ could be the most rational and efficient solution, it would require a “convergence of political, social and union actors, which is unlikely in times of stranding.” “The end of administrative mutualism, if it occurs, will rather be the result of a major sustainability crisis, which will be managed at that time with specific and improvised solutions; and not a planned and ordered process,” he predicts. All in all, he considers that “making the problem visible and putting it on the public and political agenda is already a triumph for those who question the model.”
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