A necessary collaboration for sustainability
Public-private collaboration in healthcare, as in other fundamental services such as education, is a key element for the sustainability of the system. Private healthcare makes up 2.6% of the country’s GDP, over 32,000 million euros and it generates almost 279,000 jobs. It also frees up resources of the public system, giving cover to 19.6% of the population, around 9.2 million people. And it improves access to healthcare, as it supplies 56% of the hospitals in Spain – 441 out of a total of 784 and 32% of the hospital beds.
The examples of public-private collaboration in different fields share a series of advantages: they optimize the financial efficiency of the economic effort made by the administrations; they mobilize all the resources available in a coordinate and subsidiary manner; and they have the trust of the citizens, who when they can choose, do not hesitate to exercise their freedom of option. It is worth mentioning that during the Covid-19 pandemic the private centres worked side by side with the public system. Assistència Sanitària alone carried out over 40,000 tests, including PCRs and antigen tests, without counting those that were carried out in the Hospital de Barcelona in 2020.
And ASISA, nationally, attended over 100,000 patients for Covid-19 in its care network from the beginning of the pandemic, many of them referred by Public healthcare and it administrated the hospital ingression of over 6,500 insured parties, both in its own centres and in associated ones. The HLA Group has invested over 15 million euros in reorganizing the centres, extending the intensive care units and hospital beds and reinforcing the staff. It has also given home care for Covid-19 to over 65,000 insured people.
Another example of public-private collaboration is the renewal of the Spanish Government’s trust in the mutual societies to give healthcare cover to civil servants, with a new agreement for the 2022-2024 period. This was carried out a few days after Unidas Podemos recorded a No Law Proposal in the Congress to integrate the new members of mutual societies into public healthcare and to progressively eliminate the General State Mutual System of Civil Servants (Muface), which in 2020 attended to 1.5 million public civil servants.
The new agreement, the amount of which will reach 3,571 million euros, means an increased premium of 8% for next year, 8.75% for the following one and 10% for 2024. The aim is to guarantee care for civil servants and to cover the new incorporations that are the result of the public employment offers that were approved in May, a total of 10,254 places in the General Administration of the State that will come into effect after the examinations in November.
Data
3.000 million euros. The public system would have to spend this figure to be able to look after the almost 1.8 members of mutual societies.
720 and 800 million euros in savings a year, thanks to administrative mutualism.
917 euros was the mutual societies’ premium in 2020, for the 1,368 euros of average healthcare expenditure per person in the public system.
9,2 million people are attended by private healthcare.
Following the publication in July of information about the Plan of action for the transformation of the National Health System (SNS in its Spanish acronym) in the post-Covid-19 era, prepared by 20 experts and in which one of the steps that was proposed was to eliminate the mutual societies, the Government reacted guaranteeing that the healthcare model would rely on Muface in the future. This was repeated in February, when Unidas Podemos stated its “commitment to strengthening the public healthcare system and eliminating the mutual societies that generate a clear inequality amongst the population.”
Due to the controversy stirred up/generated the private healthcare employers’ association, Instituto para el Desarrollo e Integración de la Sanidad (IDIS Foundation), published the document Impact of the model change of the Mutual Societies where it pointed out an unquestionable economic fact: “Administrative mutualism saves the public system between 720 and 800 million euros per year,” as “the average premium is much lower than the public healthcare expenditure per capita, specifically 451 euros less.” The same text indicates that eliminating the model “would cost the public system around 3,000 million euros to attend to the almost 1.8 million members of mutual societies at present,” including Muface, Mugeju and Isfas, compared to the current 2,230.
Additionally, almost 1.5 million policies would be lost; 16% of the activity of the insurance companies. The lack of members of mutual societies in some areas would make the number of policyholders to drop, which would mean the closure of around thirty private care centres.
These closures would cause the loss of 39,000 jobs, a 15% increase in public hospital occupation which would move on to 98%, and an increase in the waiting lists of between 28 and 30 days for surgery and around 34 days in outpatient consultations.
