health financing discussion by MUFACE and CSIF
The Independent Association Center and Officials, known as CSIF, raised a concern during the general assembly about funding for the health program managed by MUFACE. They urged MUFACE headquarters to take concrete steps to boost the budget and prevent cuts in aid. The assembly, held on June 28, echoed worries previously voiced by MUFACE insurers to El Periódico de España from the Prensa Ibérica group about a potential strain on the current model.
CSIF indicated that MUFACE leadership, in collaboration with the State Attorney’s Office, is exploring options to increase the public contract budget with insurers. The union also challenged political parties during the election campaign to ensure sustained financing that preserves the quality of health services for members and their families. The aim is to maintain stable access to care for the near one and a half million people connected to MUFACE, as well as beneficiaries and relatives. When including ISFAS and MUGEJU, the total reaches close to two million people.
health benefits
The report notes that in the last year there were more than 2,000 consultations related to health benefits linked to MUFACE. These include services that require prior authorization, diagnostic tools, non contractual benefits, and urgent care.
In 2022, CSIF recorded 1,148 administrative appeals, a 16.19 percent increase from the previous year. The majority concerned the reimbursement of health expenses.
CSIF further explains that the same year saw 1,148 administrative appeals, largely about covering pharmacy costs and prosthetics. The report also states that health care claims are not analyzed as against the actions of compliant medical organizations. The union calls for a review of reciprocity within the system to address this issue.
the future of the model
Recently, MUFACE insurers Adeslas, ASISA, and DKV raised concerns about a possible bankruptcy of the model if funding does not improve. Industry sources cited by this newspaper indicate that only a portion of insurers has sustained losses, with the current health program showing more than 170 million euros in losses in 2022. The outlook suggests a risk of strain on the public health system, given the large membership of nearly two million.
MUFACE remains the responsible public body for covering health and pharmaceutical care, along with other social benefits for appointed officers. Both sides emphasize the need to review the underfunded model, comparing absolute funds to public health financing.
Premium pressures cited by insurers are affecting the scales used to pay doctors. Autonomy in doctor rates has been under discussion for months, with calls for fair pay for services and for updates to what insurers are willing to reimburse per consultation.
renewing the concert
The health services agreement with MUFACE needs renewal in 2025 and is currently in force since early 2022. Insurers are urged to consider a comprehensive review of the model to balance payments for patients in the public system and those in private care. The consensus is that private healthcare will always offer lower costs and greater efficiency, but the public component must remain robust.
MUFACE leadership acknowledges the impact of the current economic situation on the budgets for the 2022 to 2024 period and remains attentive to feedback from reciprocal groups and union representatives. The discussion centers on maintaining quality care while ensuring fiscal sustainability for all members.
[Citations: MUFACE report 2022 and CSIF statements, as reported in industry briefings and official releases.]