The independent trade union and central public officials (CSIF), the most representative union in public administrationsreported Monday, that there are already MUFACE patients for whom the insurers they are denying health care. An extreme that refutes THE NEWSPAPER OF SPAIN by companies. “It is not true. We normally serve the members of the mutuals”, explains the DKV to the newspaper. ASISA, for its part, denies that insurers adhering to the mutuals’ contracts can “carry out a risk selection among the mutuals’ population”, as it underlines. the report from the Ministry of Health published this Monday denouncing the “more than evident existence” of this practice, in reference to patients who financially They are not profitable.
The CSIF union, which took to the streets last week in defense of the MUFACE model, underlines that “it receives cases of mutual society members who are denied assistance in clinics or medical checksbecause the insurers don’t have clear ideas about the future of the concert.” Punctual for the moment, they tell this newspaper.
On October 8, the Council of Ministers authorized MUFACE to hold concerts to ensure access to healthcare for beneficiaries who choose to receive it through insurance institutions. An offer of over 1,337 million euros for 2025 and 1,344 million euros for 2026 was made; an increase of just over 17% compared to the previous concert.
Until January 31st
None of the three insurers – DKV, ASISA and Adeslas - decided to opt for this agreement, which has remained void since November 5, when they announced their decision. To date, we are still waiting for the details of the new tender and a more attractive offer from the Government to see if we continue in a model whose survival it is increasingly doubtful. In any case, the DKV insists: the concert involves obligation caring for patients until January 31st.
Official assistance informationMUFACE recently launched a message of calm: it is guaranteed. Public service highlighted days later. Beyond the expiration of the contract, beyond January 31st, in the Public Sector Contracts Code there are mechanisms “that guarantee assistance under the same conditions until the expired contract is replaced with another”. What would it translate? in another nine months.
The health report
On Monday itself, the Ministry of Health published its report on the impact that the disappearance of MUFACE would have on public health, due to the relocation of 1.5 million people. Under current conditions, the model “it’s not sustainable”he concludes. A statement on which, the Ministry of Public Serviceon which the organization depends, does not enter into the evaluations.
In statements released to the media after the publication of the document, the Secretary of State for Health, Javier Padilla, He questioned why insurers decided not to join the new agreement despite the proposed premium increase. by the Government. “Basically the reasons are very clear and that is that there is an increase in the age of the population and we know that up to 70% of new public employees They directly choose to turn to public health“.
The scenarios
The Health report talks about various issues and also possible scenarios. One, “evident and continuous”, which it would even mean increasing above the previous offer, the concert proposal for private insurers. An option which, according to the Ministry, could be ”
Padilla suggests “increasing the price of the contract to unsuspected levels to make it profitable“, is unsustainable. A public system indicates that it must be ready to hire its public employees and the idea of its Ministry is to work in ”a planned additionin an orderly manner” by focusing to the most vulnerable patientswith more serious illnesses.
But, even in that document, the department headed by Mónica García denounces “the more than evident existence of risk selection practices by insurers”. This means they refer patients who have problems to the public system economically unprofitable.
ASISA denies Health
A statement which, in this case, is denied by another of the concert’s insurance companies, ASISA. “Insurers linked to concerts of administrative mutuals They cannot carry out risk selection among the mutual population. Among other things, it is not insurers who choose the mutualists they insure, but rather mutualists who freely choose their healthcare provider, be it an insurer or the public system,” this company states.
“The agreements do not provide any mechanism for insurers to select their own insured or to promote the referral of an insured to another insurer. the public system. It is the insured who can freely choose the type of assistance he prefers at any time and based on his own preferences, needs and/or pathologies”, they add.
ASISA continues: the conditions for the care of the insured are established by the Administration through agreements without the insurers you can modify them in any case. “In the event of discrepancies between the insurer and the members of the mutuals, the agreements establish the mechanisms for their resolution by the mutuals, who monitor the actions of the insurers at all times to ensure that they respect the established conditions”, underlines this company.
Concert on health
The health document on the impact of mutual assistance on public health caused more concern between unions such as the CSIF who, after meeting him, turned to the ministries Public function and health “to ask for explanations.” In the report, the Ministry chaired by Mónica García proposes to integrate mutualists into the healthcare of autonomous communities, transferring the funding currently allocated to participating insurers. in the concert of health.
Minister Óscar López. /EP
The CSIF is “frontally opposed” to this possibility. “We will under no circumstances accept a unilateral government decision on this issue.” The trade union organization demands that the Public Service “rectifies the ministry of Mónica García and presents a new announcement for the agreement with insurers, committed to in the last General Council of MUFACE, to guarantee the quality of healthcare to the group of officials for the next few years.”
Meanwhile the union, which claims to receive”hundreds of calls from people questioning himself on this issue”, he is evaluating the extent of
the mobilizations that will be carried out “in the event that the The government does not offer an answer appropriate: demonstrations, strikes or even a strike in the public service“. ”The Government plays with the tranquility and health of one and a half million people, officials and their families (elderly and minors) who at this moment see with uncertainty the future of your healthcare“, they conclude.
How can patients advocate for their rights if they are denied coverage by their insurers?
Interview Between Time.news Editor and Health Expert
Time.news Editor: Welcome to our interview today. We’re discussing a pressing issue in Spain’s health system regarding MUFACE patients and their access to care. Joining us is Dr. Elena Morales, a public health expert who has been closely following these developments.
Dr. Elena Morales: Thank you for having me. It’s a crucial topic that affects many public employees and their families.
Editor: There have been reports indicating that insurers are denying healthcare to certain MUFACE patients. Can you elaborate on what this means for those affected?
Dr. Morales: Absolutely. MUFACE, which provides health services to civil servants, has recently come under scrutiny. The independent trade union CSIF claims that members are being denied care due to what’s being termed ‘risk selection’ by insurers – essentially, not being profitable enough for the insurance companies. This denial can severely impact patients who need routine care or have chronic conditions.
Editor: The insurers deny these claims, stating they normally serve their members. How do you interpret this contradiction between the union’s assertions and the insurers’ statements?
Dr. Morales: This discrepancy raises serious concerns about transparency and accountability in the system. Insurers like DKV and ASISA insist that they comply with regulations and meet patient needs. However, the Ministry of Health’s report suggests that practices of denying assistance based on perceived profitability do exist, indicating a dysfunctional relationship where the priorities of profit may overshadow patient care.
Editor: The recent report from the Ministry of Health describes the current MUFACE model as unsustainable. What alternatives do you think should be considered?
Dr. Morales: The Ministry’s acknowledgment that the model is unsustainable points to the need for a systemic redesign. Options could include increasing public funding for services, forming better partnerships between public health systems and the insurance providers, or even exploring a fully publicly funded model that assures all citizens equal access without profit motives coming into play.
Editor: The CSIF has argued for keeping the MUFACE model intact despite these challenges. What do you think might be the implications of further public demonstrations in support of this?
Dr. Morales: Public demonstrations highlight the desperation and urgency of the situation for many families relying on MUFACE. If these gatherings can effectively apply pressure, they could potentially lead to negotiations for reforms. However, if the government chooses to ignore these movements, it may exacerbate public dissatisfaction and erode trust in the healthcare system.
Editor: What can patients currently do if they find themselves in a situation where their insurers deny them coverage?
Dr. Morales: Patients should first document everything related to their care requests, including any denial of service. They can file formal complaints with the insurers and contact the CSIF for support. It’s also important for patients to seek clarity about their rights under the current agreements and to actively advocate for their needs. Engaging in community actions can amplify their voices as well.
Editor: Lastly, with potential changes on the horizon for MUFACE and its contractual relationships, what message would you want to give to the policymakers involved?
Dr. Morales: I would urge policymakers to prioritize patient health over financial considerations. It’s essential to create a system that’s not only economically viable but also equitable and accessible. The health of public employees is crucial, and their well-being directly affects their work and, consequently, public servitude.
Editor: Thank you, Dr. Morales, for your insights into this complex issue. As developments unfold, it’s vital to keep the conversation active about healthcare access and fairness.
Dr. Morales: Thank you for having me. It’s been a pleasure discussing these important issues, and I hope for positive changes to come!