Those expelled from Muface: “With my illness they no longer give me insurance”

José Luis de Perosanz Almajano has been cared for by the same professionals for 40 years through a private insurance company through Muface. This is what he chose when he started working in the education sector, because as a public employee he had that right. Now, at 65 years old, already retired, he sees how, after decades in which he has barely used the service because he does not need health care beyond the typical colds or viruses, when he is beginning to need it most he can lose it. «Now is when the ailments begin to appear and when, even if it is for prevention, I have to go for check-ups. “This is going to be completely undone,” he laments in conversation with ABC.

“Concern” is the word he repeats most when he explains how he is experiencing the negotiations between the Government and the insurers. The professionals who care for him, points out this retired professor, have been the same for years. They already know him, they have his medical history, they have done the relevant tests… «My urologist already knows what is happening to me, he sees me every year. Now will I have to go to the family doctor to make an appointment to see another specialist? Changing centers and doctors, says De Perosanz, would mean a mismatch in his life. He is also concerned that, in the event that there is no agreement and the agreement disappears, his data will correctly reach the health service that will treat him. «Our system is very fragmentary, it is not that we have our history centralized like in Social Security. We go to the urologist in one place, to the digestive doctor in another, we get checkups in another, etc. When I hear some statements that say not to worry, that our data will matter… I think it is something very complicated,” he laments.

He also fears how public health will be affected by the fact that, if there is finally no agreement, the civil servants who are currently cared for by private insurers will fall into the system. «I can’t imagine what will happen if we land in public health, which is already as it is, all these people. It seems that the users matter little,” he says. But he is also not sure if, if he wanted to continue with private care, an insurance company would accept him at his age. And if he does, he believes the cost would be significant. “I understand that if I go now and want to make sure, they will charge me a price that I don’t know if I can afford, because I’m not 30 years old anymore,” he says. And it also tries to put an end to the discourse that mutualists are privileged to have this system compared to the rest of the population. «There are many people who do not fully understand how Muface works. There are lights and shadows. We entered the system with certain conditions and I don’t know if it is very ethical to change them in the middle of the game. Furthermore, many people do not know that while a Social Security retiree barely pays for their prescriptions, we continue to pay exactly the same as when we are active,” he says. He also does not understand why this situation occurs at this time: “I don’t know if there is really such an urgent and clear problem to do it this way.”

De Perosanz is awaiting a knee operation that he trusts will be performed, but he does not have everything with him due to how the negotiation evolves. He hopes that it will be solved because, he considers, “it is not a logistical issue, it is ideological, because there is a sector of the Government that understands that those of us who have this system are privileged and I think they do not understand it well.” But the truth is that insurers are already delaying or canceling appointments for mutual members, as CSIF recently reported. This week the union has presented a hundred complaints received by users of the model to the Ombudsman and also to the deputies of Congress. Yesterday, he organized a demonstration in Madrid against the end of the model that brought together 35,000 people according to the headquarters, a figure that the Government Delegation reduced to 6,000.

The lack of an agreement also worries Sandra Nombela, a teacher, very much. In his case, age would not be a problem to be able to continue with his private insurance company if the agreement with Muface is not renewed, since he is 45 years old, but the illness he has would be: two years ago he was diagnosed with lymphoma that is growing and which, therefore, requires treatment. At first, the professionals thought about treating her with chemotherapy, but the hospital where she was treated, through a private insurer through Muface, gave her the option of doing it with immunotherapy through a clinical trial.

She currently has 18 months of treatment left, so the first thing that crossed her mind when the doubts about renewing the agreement began was what would happen to her. “I contacted the hematologist and she reassured me, she told me that in my case there would be no problem because the clinical trial is financed by a company, so I would continue,” he says. But his concern continues about the follow-up that will be given once he finishes the immunotherapy: “What will happen to my follow-up when the clinical trial ends?” he asks.

Nombela is always cared for by the same professionals, both doctors and nurses. They are the ones who have treated your illness from the beginning and you would like to continue with them. But it has already been reported to know if it could be like that and in your case, that option does not exist. «I am treated in a private hospital. I have asked the insurance company if they could do the insurance for me privately and I do not have that option due to my illness. If you are sick or are of a certain age they no longer insure you and this is the case of 37 percent of mutual members,” he laments.

Public health would be your only option. He does not think it is bad, since he defends that Spain has a good public health system, one of the best in the world, but he criticizes the lack of information that is being given about the situation. “I have been without sleep for 15 days and with a knot in my stomach,” he says. He continually thinks about the odyssey he will have to go through if the concert is not finally renewed, with more tests that have already been done during this time, more consultations, referrals to specialists, etc.

A “disorder” in their lives

The “upheaval” that the end of Muface would cause in the home of Diego Sastre, 33, would also be “great.” Both he and his wife are teaching professionals and, along with their children, go to private healthcare. In total, five people. «They would have to pass on all our histories and information. Could that be done? I see it as a dark alley where you don’t know what’s at the end,” he says. And he insists on the mess that would entail having to go through reviews, consultations and referrals that he has already had with his private insurer. “It would slow everything down a lot,” he criticizes.

If there is no agreement between the Government and the insurers, this professor points out, both he and his family would initially land in public health. Although he does not rule out that sooner or later all or some of them will move to the private sector, as he is concerned about the collapse that could occur in the system. “The collapse in public health already exists today and if all the officials are going to arrive on top of it, it will increase,” he predicts. In his opinion, Muface is the system that today allows the sustainability of the health system. “If we manage to saturate a system that is already very saturated, what we will cause is a very large gap,” he concludes.

However, the Ministry of Health (which has no powers in renewing the concert) has already made its calculations to assess the entry of officials into the public one. According to a report prepared a few weeks ago, the department headed by Mónica García sees it as “both viable and reasonable” for mutual members to be cared for in the public health system. Their estimates place just over one million public workers who are served by private insurers through this model, 67.3% of all civil servants. Its transfer, the text points out, would mean an increase of 2.12% in the number of people who go to the public.