The Spanish Private Health Alliance (ASPE) warns of the problem that is looming in the context of the new concert of MUFACE for medical assistance for civil servants if a premium per mutualist similar to that of health expenditure per citizen is not agreed.
If the new agreement for the 2025-2026 biennium does not imply a significant increase in the premium that guarantees full accessibility for mutualists to all health services throughout the territory and that at the same time the health service is sufficiently remunerated so as not to suffer losses in the provision of the service, There is a risk that the tendency for private centres to stop contracting because costs are not covered by remuneration will increase. and that there is therefore less accessibility and a restrictive medical framework that discourages civil servants from choosing private health care. This situation would lead to an exodus towards public care of a significant number of mutualists and family members and, consequently, a potential increase in waiting lists.
In this sense, the employers’ association stresses the importance of stopping limiting the supply of more frequently used specialized medical services (for example, dialysis or oncology treatments) in all territories, due to insufficient funding. “The increase in the premium of MUFACE must be directed
“guarantee a complete medical picture across the entire national territory and that mutualists benefit from a quality service with effective access to all services and specialties,” he declared. Carlos Rus, President of ASPE.
ASPE demands that the revaluation of the premium be passed on fairly and sufficiently to hospitals and health centres that currently provide care in a way that is deficient in relation to costs. If there remains a considerable difference in the remuneration of health centers between the price paid by mutualist and that which they receive under insurance, health providers will be discouraged from organizing the provision of services to members of mutual societies. This will mean that the medical framework will be more restrictive and will lead to a reduction in the choice of private health care by mutualists, choosing the public system.
The lack of funding has generated an untenable situation in recent years, affecting mutualists’ access to health care and causing longer waiting times because either insurers select their medical tables more restrictively or Some providers are forced to stop offering the service for the current low rates. The increase in the premium should serve, according to ASPE, to reorient the two situations.
“The financing model must take into account the situation of health care providers, who are the ones who ultimately bear the costs arising from mutualist health care,” he says. Carlos Rus.
The employers’ association of the health sector recalls that the rates for patients of the administrative mutuality are 10% lower than those applied to insured persons of health companies, which further aggravates the financial imbalance of health centers in the provision of services. , caused by the progressive increase in the average age of mutualists and the associated increase in attendance; a situation that has already forced many centers to stop serving mutualists due to the inadequacy of current rates.
As the report highlights Administrative mutualism: Predictive model on the choice of mutualists and future scenariosprepared this year by the Chair of Sustainable and Responsible Health of the Complutense University of Madrid, it is estimated that – in recent years – Insurance companies only passed on 50% of the increase in premiums to providersalways keeping in mind that this impact may vary depending on the provider, the insurance company, the geographical location and the activity to be carried out. In the case of smaller centers or doctors with their own practice, it is even possible that the improvement that the insurance companies have transferred to them is significantly lower.
A first step
ASPE considers that the proposal to increase the premium by 24% MUFACE in 2025 and 1% in 2026 is a first step on the right track, but warns that this amount is not sufficient to ensure the viability of the administrative mutualism model.
The employers’ organization stresses the need to assimilate the mutual premium to the real health expenditure per citizen, which amounts to 1,608 euros (with the possible increase, The MUFACE premium would still amount to 1,301 euros per mutualist in 2026), in order to ensure the sustainability of the system, as the UCM report concludes.
“If we fail to obtain truly adequate financing that includes all the stakeholders involved, the model risks disappearing, despite the boost that this agreement is trying to give it,” says Carlos Rus.
According to the above-mentioned report, the current MUFACE model saves to the State more than 890 million euros per year and its disappearance would have an economic impact of more than 1,000 million euros for public health. euros by having to absorb the assistance of all mutualists, in addition to causing an increase in waiting lists of 266% for an outpatient consultation and 115% for a surgical intervention.
