Adeslas, ASISA and DKV show their concern for the future of the healthcare model that serves a group of almost two million people
Worry among major insurers -Adeslas, ASISA and DKV- of the General Mutual Society of State Civil Servants (MUFACE) due to a possible bankruptcy of the model at the cost of its financing. According to sources from the companies consulted by THE SPANISH NEWSPAPERfrom the Prensa Ibérica group, only among the three insurers, have accumulated losses of more than 170 million euros in the year 2022, the first of the current concert. But in addition, they indicate, it would mean leading the public health system “to collapse” by having to assume the care of the almost two million members.
MUFACE is the public body in charge to cover health and pharmaceutical careas well as other social contingencies (temporary disability, risk situations during pregnancy, partial permanent disability and severe disability, disabled dependent descendant,…) to assigned officials. The insurers They talk about “out of date cousins” which, in turn, lower the rates companies pay doctors. They consider that it is necessary to review the model, which is underfunded, they insist, both in absolute terms and when compared with public health funding.
Only in MUFACE, with data from the last memory of the organism, form a group that, as of December 31, 2021, amounted to 1,499,451 people, of which 1,038,253 are holders and 461,198 are beneficiaries. In total, if we take into account the rest of the mutuals, ISFAS (Social Institute of the Armed Forces) and MUGEJU (Mutualidad General Judicial), the group reaches almost two million people.
bankruptcy of the model
The sources of the insurers consulted by this newspaper express their concern about a possible bankruptcy of the model. They justify it as follows: in ten years -2013-2023-, the per capita expenditure of collaborating autonomous communities and mutuals will have increased by 60.6% and the weighted premium of MUFACE by 31.6%. That is, about half. The data supposes that, if the MUFACE premium was 28.3% less in 2013, ten years later the difference it will have increased by almost thirteen points, to –41.2%.
The total expenditure of the autonomous communities has increased by 42.0% in eight years, while that of MUFACE has done so by 10.9%
Only if the premium of a mutualist had evolved in this period of time the same as the health expenditure of the rest of the citizens, in 2023 it would have to be 23% more (1,237 euros), they indicate from the insurers. The same sources give another example: the total expenditure of the autonomous communities it has increased by 42.0% in eight years, while that of MUFACE has done so by 10.9%. That is, they complain, about four times less.
The doctors’ scales
The pressure of “so outdated” premiums, they admit, reduces the scales that companies pay to doctors who care for mutual members. The rates of autonomous doctors in Spain have been on the table for months. They have been asking for decent scales (fees) for years and that companies update what they charge per consultation.
On the other hand, the concert for the provision of healthcare by companies with MUFACE must be renewed in 2025. Previous entered into force at the beginning of 2022. It is therefore time, they say, to consider the path to follow because they consider essential “a thorough review of the model to balance what is paid for a patient in the public system and a patient in the private system”. They understand that “there will always be a lower cost” in private healthcare “for the greater efficiency of the sector”.
And they warn of the end of the MUFACE model “either by elimination by the Government, or because companies are forced to leave because it is not profitable for them.” That, they clarify, would mean “the collapse of the public system” since two million more people would swell the waiting lists. In addition, it would imply the closure “of hundreds of clinics and polyclinics in provincial capitals and thousands of jobs lost“.
The management of MUFACE is aware”the impact of the current economic situation in the budget of the health agreement signed for the years 2022-2024. It is also sensitive “to the complaints and claims made by the mutualist collective or the union representation”, they indicate to THE SPANISH NEWSPAPER from the Ministry of Finance when they are consulted on this matter.
Savings for the system
When the insurers talk about “the elimination by the Government” of MUFACE, they refer to aspects such as the Non-Ley Proposition that, in September 2021, Podemos registered in the Congress of Deputies in order to resume their idea of integrate the new mutualists into public health. An idea that, from private health, it was considered that it would mean “the beginning of the end of a well-consolidated model”, which represents savings for the public system of between 720 and 800 million euros a year.
so it is in the last specific report of the IDIS Foundation on the mutual society model, which analyzes its evolution and contributions and glimpses the repercussions of a hypothetical change in it. With data from 2020, the population covered by administrative mutualism amounted to almost 1.8 million people. MUFACE is the entity that counts with a larger number of beneficiaries, specifically 65%. For its part, ISFAS has 31%, and MUGEJU, with the remaining 4%.
“Potential repercussions”
The objective of the IDIS Foundation report was to carry out a theoretical exercise of “the potential repercussions” that, under certain hypotheses, could exist in Spain in the case of applying a change in the mutuality model. Thus, the document makes various estimates and proposes different hypotheses to see the impact that the suppression of the model would have.
For example, that mutualists would not have the possibility of choosing between public or private health, so that they will directly have public insurance or “the massive loss in the number of insured, which could lead to the closure of clinics and private hospitals in the autonomous communities in which there is a high degree of dependence on mutual insurance policies”, predicts this document.
A report from the IDIS Foundation ensures that each member generates savings of 344 euros
After putting the different hypotheses on the table, the IDIS Foundation reached the following conclusions: a hypothetical elimination of the current model of mutuals would cause a “knock-on effect”. And, in his report, the latest on this group, he concludes that the health expenditure per capita of a mutual member is lower than that of a user of the National Health System (947 euros versus 1,291 euros), therefore each mutual member generates a saving of 344 euros.
Union concern
But not only insurers and the private health sector have shown concern about the future of the model. Last fall, the Independent Union Central and Officials (CSIF) assured that there was “much concern” for the healthcare provision of mutual members. From the union, they said they were aware that some hospital groups could stop collaborating with the insurers with which they work if the annual economic items were not reviewed.
The background is a historical lack of investment to maintain this healthcare modelthe union pointed out. To this day, they indicate to THE SPANISH NEWSPAPER, he The discourse continues in the same direction, emphasizing the user’s point of view to guarantee services and benefits. In April of that same 2022CSIF, together with JUPOL, the majority in the National Police, and JUCIL, the organization with the greatest representation in the Civil Guard, presented the results of a survey that collected thousands of complaints due to health cuts in the employees mutual: up to 50% of those surveyed denounced that they had been cut that unannounced attention.