2023-06-30 15:08:02
The Independent Union Central and Officials (CSIF) has asked the general council of the General Mutual Society of State Civil Servants (MUFACE) to increase the financing of the health concert to avoid cuts in assistance as they have been warning for a long time. At the general council meeting, held on June 28, the union asked about the steps taken by the general management of Muface for an increase in that financing. CSIF thus joins the concern expressed recently by the main insurers of MUFACE to El Periódico de Españafrom the Prensa Ibérica group, about a possible bankruptcy of the model.
As reported by CSIF, the management of MUFACE informed them that they are looking for ways to increase the budget allocation for the public contract with insurers, in collaboration with the State Attorney’s Office. In parallel, the union has addressed the political parties, within the framework of the electoral campaign, to “ensure financing for the system so that the health quality received by mutual members is not affected, given the increase of the prices that have occurred in the last year”.
According to the data from the MUFACE report, closed as of December 2022, the organization has a total of 1,053,934 holders, which represents an increase of 15,500 people compared to the previous year. In this way, CSIF continues, it continues to approach a group of one and a half million people between holders and beneficiaries (relatives of mutual members). In total, if we take into account the rest of the mutuals, ISFAS (Social Institute of the Armed Forces) and MUGEJU (Mutualidad General Judicial), the group reaches almost two million people.
health benefits
The report specifies that, during the past year, more than 2,000 consultations on health benefits related to use of non-concerted mediaprior authorization of services, diagnostic means, benefits not included in the agreement or vital emergency situationsamong others.
In 2022, 1,148 administrative appeals were registered (16.19% more than a year earlier), most of them for reimbursement of health care expenses
In addition, CSIF details, in the same year, 1,148 administrative appeals were registered (16.19% more than the previous year), most of them corresponding to the refund of health care expensesreimbursement of pharmacy and prosthesis expenses. In the report, however, CSIF complains, “health care claims are not analyzed against actions of concerted medical entities“So the union demands that the mutuality break it down.
The future of the model
Just a few days ago, Adeslas, ASISA and DKV, the main MUFACE insurers due to a possible bankruptcy of the model at the cost of its financing. According to sources from the companies consulted by this newspaper, only among the three insurers have accumulated losses of more than 170 million euros in the year 2022, the first of the current concert. But in addition, they indicate, it would mean leading the public health system “to collapse” by having to assume the care of the almost two million members.
MUFACE is the public body in charge to cover health and pharmaceutical careas well as other social contingencies (temporary disability, risk situations during pregnancy, partial permanent disability and severe disability, disabled dependent descendant,…) to assigned officials. They consider that it is necessary to review the model, which is underfunded, they insist, both in absolute terms and when compared with public health funding.
The pressure of “so outdated” premiums, indicate from the companies, reduce the scales that the insurers they pay the doctors who treat the mutualists. The rates of autonomous doctors in Spain have been on the table for months. They have been asking for decent scales (fees) for years and that companies update what they charge per consultation.
renew the concert
The concert for the provision of healthcare by companies with MUFACE must be renewed in 2025. Previous entered into force at the beginning of 2022. It is therefore time, consider the insurers, to consider the future. They see essential “a thorough review of the model to balance what is paid for a patient in the public system and a patient in the private system.” They understand that “there will always be a lower cost” in private healthcare “for the greater efficiency of the sector”.
MUFACE’s management pointed out that it is aware “the impact of the current economic situation in the budget of the health agreement signed for the years 2022-2024. It is also sensitive “to the complaints and claims made by the mutualist collective or union representation.”
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