"Private healthcare is an essential element of the Spanish healthcare system"

During the pandemic, private healthcare gave a prime example of its commitment to caring for those affected by Covid. Do you think that very little attention has been given to this by the Management Bodies dealing with healthcare politics?

The problem does not lie in the attention paid by the administrations, but rather in the terms in which the debate occurs regarding the role of private healthcare, which is almost always weighed down by ideological questions and priorities that are a long way from reality. The pandemic has shown the importance of private healthcare as an essential element of the Spanish healthcare system in which millions of citizens place their trust and that acts with great responsibility. It would be good to assume this reality and, from this point on, build up a more productive debate, centred on laying down the best possible strategy to take advantage of the capacities of private healthcare in the service of the well-being of all citizens.

ASISA alone attended over 100,000 patients with COVID-19 in its care network, many of them referred by the public healthcare service. What should we learn from this period?

The fundamental lesson is that healthcare resources are limited and responding to large-scale healthcare crises demands the coordination of all the healthcare mechanisms in a country, both public and private, because they all are part of the healthcare system. Significant value must be given to this lesson when planning the future of the healthcare sector, particularly in a situation where the costs are rising, as can be seen in the one caused by this crisis. Additionally, the pandemic has shown the commitment of the private healthcare groups to society, and specifically, the collaboration that we have given to the national and regional healthcare authorities. This should continue in the future if we want to strengthen and prepare our healthcare system against any adversity.

What are the challenges facing the health sector?

The great challenge involves facing up to the increase in care costs due to different factors, amongst which are: a change in morbidity, technological development, demographic evolution and trust in the decisive capacity of medicine.  The progressive ageing of the population is causing an increase in chronicity that makes treatments last longer over time and that is forcing us to transform our system, which is still highly centred on acute disease. At the same time, the technological advances are going to allow us move towards a more personalised, more precise medicine, which will raise the demand pull and will have repercussions on the rise in costs, forcing a greater effort to be made regarding finances, training etc. Adapting to this challenge involves relying, on the one hand, on more efficient organisation and management models for the care services to make a more efficient use of the resources and on the other hand, increasing awareness about the advantages of prevention in health.

Should the system adapt to a new situation in which a large part of the healthcare expenditure occurs at the end of life?

The ageing of the population, along with the increase in chronicity, is a challenge for all the healthcare systems in the developed world. In the case of current private health insurance, the premiums are calculated in terms of the risk associated to the age, in such a way that, indirectly, older people are excluded due to the high cost, right at the time when they might need it most. We must move forward towards another model based on the introduction of more long-term plans that they can join with premiums that are levelled out during their validity, or in the development of group insurance alternatives, without exclusion due to risk, with mixed funding as a result of the public-private collaboration.

The ageing of the population, alongside the increase in chronicity, is a challenge for all the healthcare systems in the developed world

ASISA closes 2020 with a 4.28% growth after a year that was seriously complicated by the pandemic. How do you evaluate these figures?

The results for 2020 were very positive, taking into account that it was a very complicated year. We continue growing in the sectors where we are present, moving forward in our multi-sector diversification strategy, increasing our client portfolio. We are also strengthening our own care network, in which we have invested over 415 million euros since 2010. This is the best guarantee of our institutional commitment to the quality of the care and  the professional performance by our medical staff. We also took a significant step in the implantation of new tele-medicine tools to guarantee access to professionals and patients during the lockdown. An effort that we have kept up in 2021. We continue to grow, in spite of the fact that we are facing an important increase in costs linked to the protection measures that the pandemic requires and to the impact that its presence has caused on the care of other pathologies. This continuous growth, even in periods of crisis, shows that companies with a cooperative base have a growing development capacity in a world that needs supportive effort based on values that it characterises.

What does the renewal of Muface mean for the sector?

The new agreement must be used to continue moving forward in the consolidation of administrative mutualism as an essential element in the public.-private collaboration in the service of citizens’ health. ASISA has always defended this model because it is well-configured from the legal point of view and it fits in perfectly with our healthcare system, to which it gives an organisational and management alternative that are more flexible and dynamic than the general one.

The new agreement involves an increase in the premiums.

The reality is that the premium, in spite of the 10% rise that will be reached in 2024, continue to be insufficient to guarantee the feasibility of the model in the medium and long term, because the financing of administrative mutualism is too far removed from the average of the budget per person of the rest of the National Health System, in spite of maintaining the same cover demands of the service portfolio as the National Health System. Attempting to do this with greater demands in the conditions of access and response speed than the National Health System itself, with a difference of almost 40% in the real expenditure, results in a huge effort that gives rise to a very difficult financial situation for the future of the model.

What benefits does administrative mutualism bring?

Administrative mutualism is the backbone of our healthcare system that introduces a factor of quality and competitiveness, in both the care and the management.

The agreement has been reached after the proposal by Unidas Podemos to dismantle the future of the healthcare attention to civil servants through mutual societies and integrate them into the general regime. What are the risks of this proposal that the Government seems to have deactivated at least until 2024? In addition to 800 million in direct extra costs for the Public Healthcare system, the disappearance of the private offer in many regions…

The disappearance of administrative mutualism would cause an incredible upheaval in our healthcare system with immediate consequences, both economic and social, as well as for healthcare itself. The IDIS has recently quantified this impact in a report. In the first place, the public system would have to take on the direct healthcare of 1.8 million citizens, with a cost of around 900 million euros per year, without taking into account the investments required in infrastructures to take on the care of this new group. On the other hand, the insurance companies would lose a part of their clients, with the fiscal impact that this loss of activity would cause, which IDIS estimates at over 30 million euros and with the destruction of a part of the private care network which, in some regions, where it represents the largest part of the volume of the private insurance market, could completely disappear. Around 40,000 private healthcare professionals could lose their jobs and a significant percentage of the private care centres in these regions could disappear. Another immediate consequence would be the increase in the pressure for care place on the public centres, with the subsequent increase in the waiting lists and the hospital occupation rates. Taking this analysis into account, it seems obvious that administrative mutualism is a common good that we must conserve. 

The 2008 economic crisis and particularly, the Covid-19 crisis have challenged the healthcare system. Is this public-private collaboration more necessary than ever to obtain a social protection system, making it more solid, resilient and efficient? 

Promoting the public-private collaboration is necessary to continue maintaining our Welfare State. We are not a country that is rich enough to allow two systems to be maintained, a public one and a private one, separate from each other. The crisis has accelerated the problems that our protection system has been showing for some time and it has brought us to a new situation, which we must take advantage of to push a new, much more integrated model forward, which combines the strength of the public system with the dynamism and the capacity for innovation of the private sector, allowing all the available resources to be mobilised in a coordinated manner and in which all the agents who, in one way or another, are dedicated to looking after people, will take part.