The Ministry of Health is assessing the “impact” that the resumption of the public system would have on the million Muface mutualists whose health care is hanging by a thread after the cancellation of the medical coverage competition for civil servants. Mónica García’s team began to carry out this work “in an exploratory manner” to, in the event that the transfer occurs, measure what effect it would have on public resources according to the territories and the different age groups, advanced ministerial sources. , who assure that they do not want to “interfere” in a negotiation process in which Health does not participate.
According to calculations made so far by Health, the transition of those responsible for Muface to public health would mean an increase of 3.7% in the volume of the population covered by the National Health System in the age group of 64 at 79 years old. baby boomers– and 2.35% among those over 80. The percentage of people no longer supported, if this situation ultimately occurs, is between 2 and 3% compared to those who already have their public health card.
Minister Mónica García has unequivocally stated in recent weeks that the Muface system “is not a priority” for her team and called it “anachronistic.” “This gives different conditions than the rest of the citizens and, in my opinion, they are not better,” he said in an interview with Cadena Ser. Faced with the refusal of insurers to submit an offer for the competition, the ministry. reiterates that ““It is not understandable that in a country that has public health as one of its prides, its public employees are served by private health care. » However, add ministerial sources, “the negotiation processes must be respected and we will not disrupt or interfere in this process”.
Adeslas, Asisa and DKV, the three insurers which provide the service, slammed the door this Tuesday on the conditions set by the Ministry of Civil Service: a total amount of more than 1,337 million euros for the first year and 1,345 for the second, with either a total half-yearly increase of 304 million euros compared to the last year of validity of the previous concert, or 17% more. The average bonus per member was around 1,032.12 euros this year and 1,208.81 in 2026. After this resignation, Muface first announced that it was preparing a new call for tenders, even if this scenario unprecedented has led the executive to consider extending the contract with the insurers while the unions threaten. mobilizations due to “the absence of a clear plan”.
The possible arrival of civil servants in the public system is an increase in caliber that “would represent a huge challenge”, even if “this way of presenting it”, warns José Ramón Repullo, “is an argument of the insurance companies to force the negotiation”. The expert in health planning and economics believes that the “threat” will not come true, but that it could have the effect of “increasing the amounts” offered by the government for concerts. “The SNS is not in a good situation, but I have no doubt that it will eventually pass the test,” he adds.
A month ago, the Ministry of Health cited the fact that “people covered by insurers tend to use health services less due to a better average state of health” and anticipated that “it there would not necessarily be intensive and immediate use of health services. health services” in a scenario where all those responsible would turn to the public to counter the “collapse” argument used by the government. entrance hall private health care.
Three precedents for reintegration
There is precedent for large numbers of patients returning to public health care. “In 1983, there were 400,000 self-employed workers joining INSALUD overnight; In 1989, 250,000 poor people (on social assistance) followed the same path; and currently nearly 700,000 unregularized immigrants are inevitable “clients” of the National Health System (SNS),” recalls Repullo, who also raises the following reflection. “Who would have expected that SNS could overcome the deluge of demand and morbidity brought on by COVID? »
“In relative terms, it would not be catastrophic,” says health economics professor and researcher Beatriz López-Valcárcel, but there would be a “transition” problem in the short term. “The sudden integration of this group of one million people would exert enormous additional pressure on the public health system, which would have to adapt its offer and its organization and this would require a plan. Taking into account the average number of health cards per family doctor (1,400), approximately 714 additional family doctors would immediately be needed,” explains López-Valcárcel, author of the report. “The Muface mystery, selection for risk or degradation of perceived quality? “. The study already highlighted in 2019 that the aging factor and risk selection were essential to understanding the phenomenon.
The IDIS Foundation, which brings together the private sector, said in September that a 25% increase – even higher than what happened – was also insufficient to achieve “fair” conditions. Its president, Juan Abarca, mentioned the increase in the age of mutualists as one of the causes of the “inefficiency” of the private health model: “in Muface, there are 31% of insured and beneficiaries who are over 65 years old. elderly, compared to 21% in the Isfas (State security forces and organs) and 16% in Mugeju (justice officials). “No one is unaware that the older you are, the more accidents there are. We already know that 80% of health costs are borne by 20% of the population; the elderly and the chronically ill,” Abarca justified this week.
There are different positions depending on who you ask. The one shared by some experts, like Repullo, is what they call “Muface to be extinguished” and involves moving towards a gradual elimination of this concert system. “New groups go to the SNS, and changes to the SNS are not reversible. With this option, no one is harmed, and by providing sufficient information, the expectations of the insured would not be disappointed,” he affirms in a conversation with elDiario.es.
This would allow, according to his criteria, a transfer with “a reasonably long period” which would avoid “many problems”. “If accompanied by good financing of residual mutualists, the requirement for primary care and the incorporation into the information systems (and prescription) of the SNS would help to manage the dysfunctions of the model and its interference with the majority pattern » gap. López Valcárcel agrees: if absorption occurs, it must be gradual and orderly “with criteria of medical necessity and feasibility.”
