Airef proposes that future civil servants join the public system and leave Muface

MadridMuface is back in the spotlight. But this time the motive isn't a new public tender to provide private healthcare to civil servants (1.6 million people), but an analysis carried out by the Independent Fiscal Authority (AIREF) on its effectiveness and efficiency. Broadly speaking, AIREF proposes that future civil servants stop attending mutual insurance companies and join the public healthcare system, so as not to continue swelling structures like Muface, which has become an anomaly in Europe. In fact, the Spanish state is the only country that has a public healthcare system and, at the same time, a separate regime for public employees. "Greece and Portugal already reformed it in 2008, coinciding with the financial crisis," recalled the organization chaired by Cristina Herrero.

Furthermore, AIREF proposes transforming the current mandatory membership in mutual insurance companies into a voluntary decision by civil servants. Currently, a mutual insurance company member is required to join Muface, Isfas (army and civil guard) or Mugeju (public employees of the Administration of Justice) and choose between the public or private option (through the companies that sign the agreement and which for the period 2025 - 2027 are Adeslas and Ad.

Both changes, however, should go hand in hand with a "strengthening of the public health system", the supervisory body clarifies. The Tax Authority recommends that a process like this not be addressed from an "immediate" incorporation, but rather over the next 2 or 3 years, especially taking into account the current waiting lists in the public system. If the transfer were immediate, Airef has calculated that it would mean an average of 0.9 additional consultations per day for the State in primary care; another 24.6 patients per 1,000 inhabitants (30% more) in specialized consultations and a 7.2% more patients need surgical care.

It's worth remembering that a system like Muface is funded through taxes, that is, through the state's public coffers, and through the contributions of public employees (who pay a monthly fee). "If a civil servant opts out of the mutual insurance company, there would be neither a state contribution nor a contribution," Herrero recalled.

After analyzing 400 million pieces of data, as well as conducting a survey among civil servants, Airef has found that in terms of effectiveness, during the period analyzed, 24% of civil servants ultimately opted to use the public health system. However, the figure rises to 70% when the pathology was serious or extreme, such as dialysis or chemotherapy. At the same time, in some cases, the private option provides a faster response when it comes to specialties, and Airef cites dermatology or gynecology as examples.

Negotiation with mutual insurance companies

The report has just been published just after a tortuous negotiation The Spanish government's negotiations with the mutual insurance companies for the latest public tender for the Muface (Health Insurance Company) contract for the period 2025-2027. After the agreement was declared void last October, the Spanish government entered into a back-and-forth with the companies until the contract was increased to €4.8085 billion, €1.276 billion more than the current agreement, with a cumulative premium increase of 41.2%. While the Ministry of Digital Transformation and Public Service (PSOE), which has led the negotiations, defended the system, the Ministry of Health (Sumar) proposed, precisely, ending this formula. "This report is in line with what we defended," stated the Minister of Health, Mónica García, in statements to the media.