The government wants to solve the Muface mess. After the insurers’ sit-in on the civil service as part of the agreement to provide health care to hundreds of thousands of civil servants and their families in 2025 and 2026, the ministry led by Óscar López chose to throw the ball back into the court of private companies. The Executive will open this Wednesday a period of preliminary market consultations, during which companies will have to say to what extent they would be ready to provide health care to the nearly 770,000 public workers and their 424,000 beneficiaries who have today today opted for private health care.
“We are going to launch a new call for tenders, but with a new procedure and with a market study so that there is transparency,” say ministry sources. De facto, the decision changes the procedure: if previously it was the Government which estimated the costs for insurers, now it is up to them to calculate these expenses. “We gave figures, we proposed the largest increase in history and you say that it costs more, well, tell me how much it costs,” these voices verbalize.
Prior market consultations are included in the Public Procurement Act and authorize contracting bodies, in this case Muface, to carry out market studies and consult directly with economic operators on their projects and the requirements they will need to participate in the procedure. It is not a question of private insurers setting the price at which they would be prepared to participate in the new call for tenders, but rather of justifying this figure. “The idea is that they can indicate what bonus they offer for each age group and that they provide solid evidence on how these bonuses are constructed,” say the sources consulted.
Businesses will have 10 days to present this evidence and justify the amount of money they need to be profitable. Following these allegations, the ministry will prepare new specifications, without the information offered by insurers being binding. Nor will companies be able to agree on their answer. “We don’t even think they’re doing it, because it’s illegal,” say the sources consulted.
The Ministry of Civil Service has insisted in recent weeks that the health care of mutual members is guaranteed under current conditions. The Executive has in its bag the trump card of an extension which would oblige Adeslas, Asisa and DKV, beneficiaries of the current agreement, to continue for months to serve their civil servants under current conditions.
“They created the situation. The action taken by the government was to approve the largest increase in Muface’s history. This is an objective fact,” state ministerial sources, who however assume that a hypothetical new call for tenders will cost more. Logic dictates that if a company had wanted to bid for an increase of less than 17%, it would have already done so in the first call for tenders.
In recent months, the private healthcare lobby has argued that even a 25% increase would be insufficient to provide the service, after years of “losses”. Companies highlight the increase in the average age of mutual members, around 57.8 years, the costs due to inflation and the services superior to those provided by public health. The failed bid meant a bill of 1,337 million euros for the first year and 1,345 million for the second. “We have made an increase of 300 million euros and the budgets are not infinite. When we put in 300 million euros, it’s to the detriment of something else. We work for Muface policyholders and for 48 million other Spaniards,” ministry sources indicate.
The insurers’ refusal also created a contradiction within the coalition government. While the Public Service affirms that the Executive “does not plan to dismantle Muface”, the Ministry of Health, without power in the matter, published a report in which it assures that “the current context means that, for for the first time “In many years, the possibility of integrating the mutualist population into the public health system will be an option that is both viable and reasonable.”
Even if the civil service insists on dismantling Muface, it is not on the table, it is open to rethinking the model. Something which, in any case, would be done in parallel with the call for tenders and would not affect the next competition, but would be based on the principles of “transparency, efficiency of public spending and equity”. “It’s an old invention that has layers and some elements that are more rational than others. Otherwise, we wouldn’t be where we are. It’s obvious that there are things to review,” acknowledge these same sources, who affirm that there are “patches.”
One of the options being analyzed by the government is for civil servants to choose “once and for all” whether they want private insurance or public health. This would represent a change from the current model, which allows mutual members to move from one system to another each January. This measure, estimates the Civil Service, would “facilitate the planning of the system’s sources of income and its sustainability”. But there are other keys that can be affected, such as pharmaceutical spending or certain duplicities, such as civil servants who depend on the autonomous communities, but for whom the central state pays private insurance.
Even without confirming any of these possibilities, two things seem clear: that the government is not going to break Muface’s game during this legislature, but that it is open to studying formulas that change the rules of the game.
