In some countries, workers can choose between private or state healthcare. In SpainFor decades, public officials have been able to opt for a special social security regime. This mutual model allows these workers to choose between public or private health care provided by insurance, being an exceptional case in Spainwhere the majority of the population is affiliated with the public health system.
Currently, in Spain More than two million beneficiaries, representing 80% of these people and their families, have chosen not to resort to state healthcare. Among the mutual societies, muface offers insurance to civilian personnel of the general administration of the State, Treasury, National Police and teachers; Isfas covers military and Civil Guard; and Mugeju It serves those who work in Justice, among others.
In Chilithe law also allows workers to choose between the state social security regime or regulated private insurance (Isapre). To do this, they must allocate their social security contribution (7% of their income) to the chosen regime. However, in practice only those who have better income and an adequate declaration of health can join Isapre. Thus, almost three million decided to replace state social security with private one. It has been shown that, when allowed to choose, a majority prefers private healthcare. As can be seen, in both countries there is a right to choose, although restricted by various regulations and excessive exposure to political ups and downs.
Recently in the mutualism system, the Spanish Government has proposed an increase of 17.12% in premiums for the next two years, in order to address the rising costs of healthcare and maintain the interest of insurers to the renewal of their contracts. However, they had requested a 38% increase due to the significant losses they had been experiencing for a long time. To measure this deficit, it is estimated that the premium that the Spanish State transfers to these insurance policies is approximately 50% lower than the per capita cost of its own health system.
In Chile, Isapres They also face a large financial deficit. Various legal barriers, new obligations not contemplated in the contracts and unusual court rulings have prevented these institutions from adjusting their premiums to compensate for increased costs, which has put the system in a difficult situation.
Some political sectors oppose public-private collaboration in health, considering it a step towards the “privatization of healthcare.” This approach has caused numerous obstacles for regulated or concerted insurance. The pressure to which they are subjected causes their financial situation to deteriorate, and fewer and fewer companies are willing to participate in these agreements with the Executive. They prefer to offer health insurance that is not regulated or subject to political decisions.
Governments are obsessed with growing state services. Therefore, when the State regulates and controls its competitor, it does so by limiting its development and constraining citizens’ choice options, because it knows that they would prefer private services. In this context, state health is driven by ideological reasons, without considering the preferences and needs of patients, and is acquiring a dominant and monopolistic position, which limits the expansion of the private sector towards lower income sectors.
State health is driven by ideological reasons, without considering the needs of patients
Private insurance in Spain They have developed integrated care models with modern hospitals and high-quality services and those who can value it and pay for it, although they also finance it with their contributions to social security.
In Chili, Isapresin its 40 years of existence, has also left a legacy of high-quality medicine, without waiting lists and with a hospital infrastructure comparable to that of developed countries.
Consequently, the correct thing is not to dismantle these systems, but on the contrary, to elevate the right to choose to all citizens who do not have such a privilege today. It is necessary, then, to become aware of the importance of promoting regimes of social security that allow greater flexibility for health choice, and implement measures and adequate state financing so that more and more people can make their own decisions regarding health care without affecting their assets. The right to health, universally recognized, should also include the right to choose, to avoid state monopoly.