The recent authorization by the Council of Ministers of the tender for the General Mutual Society of State Civil Servants (Muface) for the years 2025-2026 has generated an intense debate around the viability of this health coverage model. Serving more than 1.5 million people, Muface has been a mainstay in public health care since 1975, based on public-private collaboration. However, both The Central Union of Independent and Civil Servants Unions (CSIF) and the IDIS Foundation have expressed serious concerns regarding the insufficiency of the Government’s proposal to ensure its long-term sustainability. For their part, the main unions of medical professionals, the State Confederation of Medical Unions (CESM) and the nursing union (SATSE), have preferred not to comment on the matter.
An insufficient increase
The main point of controversy revolves around the 17.12 percent increase proposed in the new agreement, which is significantly different from the 24 percent that was initially proposed by the mutual company itself. Elisa Abascal, spokesperson for the CSIF union, has described this increase as “very insufficient”stressing that it does not compensate for the increasing costs derived from the COVID-19 pandemic, inflation and the general increase in health spending. These concerns point to a possible decline in the quality of health care that officials receive, a possibility that the union is not willing to allow.: “We are not going to allow this government to let Muface die of starvation,” Abascal warned, reaffirming the union’s willingness to mobilize if new cuts are presented.
“We are not going to allow this government to let Muface die of starvation”
Elisa Abascal, spokesperson for the CSIF union
For its part, The IDIS Foundation has warned that the proposed premium of 1,208 euros per person in the new agreement is 43 percent lower than the per capita investment in the general public health regime, which stands at 1,736 euros. This difference, they say, makes the provision of the service by insurance companies unsustainable. The Foundation estimates that only in 2023, The attention to mutual members generated losses of 142 million euros for insurersa figure that adds to the losses accumulated for years!
Impact on the National Health System
The possibility that the Muface model will not be renewed under adequate conditions poses a worrying scenario for both officials and the health system as a whole.. According to a report by the IDIS Foundation, if the care of mutualists had to be absorbed by the National Health System (SNS), a collapse would occur on several fronts. This would imply, among other consequences, a 2 percent increase in the national total of primary care visits, which would be equivalent to more than five million additional visits. Also planned is a 266 percent increase in waiting lists for external consultations and 115 percent on waiting lists for surgeries.
The collapse of MUFACE would mean a 266% increase in waiting lists for outpatient consultations and a 115% increase in waiting lists for surgeries
Furthermore, the impact on hospital bed occupancy would be significant, with the need to add almost 4,000 beds to the public system to avoid saturation. All this would generate a increase in public health spending of 1,214 million euros annually1.3 percent more. This increase, according to the IDIS Foundation, is a clear reflection of the unsustainability of transferring Muface coverage to the SNS without adequate planning and financing.
The model in question
The debate around Muface is not only about the numbers, but also about the support model itself. Since its creation in 1975, Muface has operated under a public-private collaboration system, in which officials can choose to receive health care through the SNS or through private insurers. However, this collaboration has been questioned repeatedly, especially by those who advocate 100% public healthcare.
“They are trying to dismantle the system by starvation, making it difficult for officials to access doctors and hospitals due to lack of resources”
Miguel Borra, president of the CSIF union
Miguel Borra, president of the CSIF union, He defends the model in an interview on RTVE, pointing out that it is not a privatization of assistance, but rather another option within the public system: “Muface is a public healthcare model that is provided in collaboration with private insurers. What we do not understand is why a system that has demonstrated its viability for 50 years is being questioned.“. Borra insists that the real threat to this model is underfunding: “They are trying to dismantle the system through starvation, making it difficult for officials to access doctors and hospitals due to lack of resources.”
Consequences
If the MUFACE model were to collapse, the consequences would be devastating for both the health system and employment in the private sector. According to Borra, The disappearance of Muface could mean the loss of up to 15,000 jobs in private healthcare, in addition to the impact it would have on healthcare professionals currently working under this regime.. In this sense, the IDIS Foundation also warns that the public-private collaboration model has not only been efficient, but has avoided overloading the SNS, allowing both systems to coexist in a complementary manner.
The disappearance of MUFACE could mean the loss of up to 15,000 jobs in private healthcare
Despite the proposed increase in the insurance premium, Both CSIF and IDIS agree that the Government’s proposal is insufficient to guarantee the sustainability of the Muface model in the long term.. The lack of agreement between insurers and the Executive puts the health care of 1.5 million people at risk and could aggravate the structural problems that the SNS already faces.
The uncertainty surrounding the future of MUFACE demands an immediate solution, and Both the CSIF union and the IDIS Foundation urge the Government to reconsider its proposal and establish adequate financing to avoid the collapse of a model that has proven effective for five decades.. The dismantling of Muface would not only have a direct impact on the health of officials, but also on the sustainability of the Spanish health system as a whole.