The Government and the private insurers that provide the Muface service were unable to agree on the renewal of the agreement that articulates the health of 1.1 million civil servants and 420,000 of their families, when the term expired. Adeslas, Asisa and DKV, the three companies that now provide the service, were not satisfied with the 17% increase offered by the Executive, and for this reason they left the tender void. Faced with this scenario, the Government takes a new step this Wednesday: at 12:00 in the morning it publishes a preliminary market consultation, for which it asks “all insurance companies to report the price of this service, with the aim of providing the new tender with the greatest transparency,” say sources from the Ministry of Public Function, which is leading the negotiation.
That is, the department headed by Óscar López asks all private insurers, beyond the three that now provide the service, to detail at what price they would assume Muface. Change the direction of the conversation: instead of the Government offering a specific improvement, it listens to potential service providers to modulate its future offer. Starting this Wednesday, interested companies have ten days to respond. Then a negotiation will be opened for which the Government does not impose deadlines. Although the agreement ends on January 31, the Executive, based on the Public Sector Contracts law. This gives the ministry time until the end of October next year.
Public Service sources believe that this is a situation “created by the insurers”, by leaving the tender void despite the fact that the Government offered the largest increase in history, of 17%. “In terms of betting, we do it more than anyone else. Such a large increase has never been proposed,” they claim. Ministry data indicate that the average increase over the last 20 years is 4.4%. Faced with this position, insurers affirm that not even with that 17% jump would it be profitable for them to continue providing the service. Their original demand asked for a 38% increase to compensate for the chronic underfunding suffered by the model, and which the companies quantify in . They argue that the rise in costs and the increase in the average age of the population forces them to request a greater increase in the tender.
“Absolute tranquility”
López’s ministry requests “absolute tranquility” from the protected mutualists: “The Government does not have any of its plans to dismantle Muface. We want to transmit tranquility. We are going to go to a new tender.” This position, so forceful, is different from that shown by the Ministry of Health, led by Mónica García, from Más Madrid and part of the Sumar government quota. “If the Muface model falls, which does not depend on me but on a negotiation, this population of 2.12% can come to public health because it is prepared to welcome them,” García said this Tuesday in the Senate, in statements collected by Servimedia.
These words come a day after his ministry published a hypothetical end to Muface. He sees it as “viable and reasonable” to serve all public health officials. Public Service, in the hands of the PSOE and which directs the negotiation, closes this door: “Insurers will continue to provide their services under current conditions until there is a new agreement.” “We are not going to dissolve Muface,” the same sources insist, but at the same time they specify that the model “will not be eternal.”
The process that the Government is now launching, the preliminary market consultation, is a common instrument in public procurement. With it, the Executive believes that it brings “transparency” to the new bidding process, “that the criteria are clear” and are objective. Thus, the ministry expects each insurer to detail the reason for how much they would charge for each type of protected citizen. Based on “this market investigation”, the Public Service will take “the next steps.”
An important clarification is that the insurers that did not provide the Muface service could have already presented themselves in the process that has remained void, it was not limited to Adeslas, Asisa and DKV. Likewise, neither these companies nor any other are obliged to present their conditions in this preliminary market consultation, it is a request for information by the ministry before launching the new tender. “We will see if three, four, five, eight or twelve show up,” they add from the ministry.
Pending improvements
“In parallel,” says López’s department, “we are going to study improvements, reforms that may occur in Muface.” They give as an example applying drug auction principles, which could make pharmaceutical prescriptions cheaper. The same sources maintain that it is necessary to “introduce rationality into the system”, since Muface is “an invention that has been accumulating layers, and some are more rational than others.” Among those layers not very functional, the ministry mentions that there are thousands of mutual members who work for the autonomous communities, such as education professionals, whose health coverage is the task of Muface, which is financed with funds from the central government. “The scenario presented forces us to open a reflection on the mutualism model that must revolve around three main principles: transparency, equity and sustainability.”
The Government insists that “no one will be left without assistance in February”, when the agreement in force ends, given “the extension mechanisms” that the Executive has. At the same time, the ministry refuses to set deadlines to close this negotiation, in order not to weaken its position. Along the same lines, he refuses to answer what increase he is willing to offer, since this could help insurers set a price. Public Service does not specify if there are already other insurers that have shown interest in taking on Muface.
The current agreement, which governs the period 2022-2024, contemplates total financing of 3,521 million euros, with an incremental premium of 10% in the last year of about 1,200 million.
70% of new ones prefer public
The ministry defends that one of the key reflections is “the voluntariness of the model, which would mean that public employees now covered by mutualism can choose to be in the common regime or in the special regime, once and for all.” With this approach, Public Function believes, “it would be easier to plan the system’s sources of income and its sustainability.”
Since 2015, the ministry has observed a change, whereby 72% of new mutual members (those entitled to Muface) choose public healthcare. “Although 70% of the current owners are in the private sector and 30% in the public sector, the new ones are betting on the public sector,” the ministry insists. He believes that these figures are key: “This preference for the public affects the model. “It increases the resources that mutual societies receive from contributions from the State that do not translate into health care costs, as they are attended to by the health services of the autonomous communities.”
