Catalonia would lose €183 million in regional funding if Muface were to disappear.
Airef estimates that the absorption of civil servants into the public health system would mean a readjustment of the funds received by the autonomous communities.
MadridAmong the various issues taken into account when distributing resources from the common regional financing system is the public health coverage of the population. If Muface were to disappear and civil servants who have chosen the private option were to be served by the public health system instead of by a mutual insurance company, such as Adeslas or Asisa, some autonomous communities would see a significant increase in the number of people their public system is required to serve. This would have a direct impact on the distribution of resources from the financing system: some communities would see these resources grow, while others would lose. This is the case of Catalonia, which would stop receiving €183.5 million. This calculation was reached by the Fiscal Authority (AIREF) through a simulation prepared within the framework of the report published this Monday on the efficiency and effectiveness of Muface.
The explanation is quite simple: in those communities where the number of mutual insurance company members who have chosen the private option is higher, switching to the public health system would entail greater public expenditure for the region. The clearest example is Extremadura, where the majority of civil servants who choose the private option is significant compared to other regions. And this expenditure would be offset by communities where the shift in mutual insurance companies from the private to the public sector is much smaller, such as Catalonia.
As Airef explains in its report, the end of mutual insurance "changes the adjusted population, as a result of the relative change in the distribution of the protected population due to the full inclusion of private mutual insurance providers." The balance, therefore, would tip in favor of regions such as Extremadura and Madrid, but to the detriment of regions where, in addition to having fewer civil servants, fewer have also chosen the private option, such as Catalonia, the Balearic Islands, and the Valencian Community. Although the public health system of these autonomous communities would also absorb civil servants who until now were served by a private mutual insurance company, the impact on the national health system would be less severe compared to other regions. As can be seen in the map accompanying the article, in its simulation Airef estimates that Catalonia (-183 million), the Balearic Islands (-22 million) and the Valencian Community (-32 million) would lose resources, while Andalusia (103.9 million), the Community of Madrid (79.3 million) and Extremadura (79 million).
Currently, there are approximately one and a half million people served by Muface (including public employees and their families). The government contracts private insurance to provide these services. In return, they pay a monthly fee through contributions, and the remaining costs are covered by the state. In addition to Muface, there is also the mutual insurance company for military personnel and civil guards (Isifas), which serves half a million people, as well as Mugeju, for judges, prosecutors, and justice officials.
Unequal distribution
In its analysis, the agency chaired by Cristina Herrero found that the distribution of private mutual insurance company employees presents "notable regional disparities." While in Extremadura they represent 5.3% of the population assigned to the public healthcare system, in the Basque Country it falls to 1.0%. The Fiscal Authority also highlights the situation in autonomous communities such as Catalonia, where they represent only 1.6%, or Madrid, where the proportion of mutual insurance company employees in the public healthcare system as a whole soars by 4%.
"These regional differences reveal a combination of factors that include both the proportion of the population in each autonomous community and the different options chosen when receiving health coverage." That is, not only is the number of civil servants at stake, but also whether they choose the private option or, on the contrary, the public health system.
Adeslas and Asisa win the new competition
However, Muface has ultimately proposed awarding the new contract for the years 2025, 2026, and 2027 to SegurCaixa Adeslas and Asisa, the mutual society reported on Tuesday. These two companies were the only insurers that submitted bids, while DKV rejected the contract. The tender represents €4,808.5 million over the three years.
