Wherever you look, healthcare is going through a very complex time. And the public administrations are not making it any easier. I have commented on this in previous blogs. We have imbalances, a serious problem of underfunding and challenges that have been on the table for many years now, and few public managers are willing to face the challenge of healthcare in Spain with courage. And I say this because even the doyen of public-private collaboration in Spain, Muface, is going through a critical moment.
For those who do not know it, Muface is the public body in charge of managing the administrative mutualism for the personnel of the State Administration, i.e. health care for State civil servants. The group of mutualists and beneficiaries of Muface comprises approximately 1.5 million people. It should be remembered that, in addition to Muface, Spain also has Mugeju and Isfas, similar bodies for judges, prosecutors and all staff of the Justice Administration, in the first case, and the Armed Forces in the second. However, for the sake of simplicity, in this article I am going to talk about Muface, although the problems I refer to below affect all of them.
And I say that it is the dean model of public-private collaboration in Spain because, although some readers of this blog may not be aware of it, civil servants can choose between being cared for by public or private healthcare. And curiously enough, this freedom of choice, which only they have, has survived all the governments of democracy, of whatever political persuasion, and has the unconditional support of the main political parties and trade unions. Yes, also of those who speak out against other areas of private collaboration in healthcare and who are intransigent and sectarian towards these models.
Undoubtedly, Muface is an organisation that has great social recognition and is a pioneer in a model of public-private partnership that generates great satisfaction among the large group of civil servants and their families. And I could not agree more. But I always like to analyse and reflect on health management models and how they deal with health care for citizens, our priority. On this occasion I am going to focus on the Muface model, following some of the information that has appeared in the media in recent days.
To begin with, and however many decades the Muface model has been in place, it never ceases to amaze me that civil servants are the only ones who can choose between receiving healthcare in the public or private system. And I don’t mean that in a pejorative sense. It is a much more advanced model than any other public-private partnership model that has been implemented subsequently, such as the model created by the Ribera group, which has been so much questioned by certain political parties and trade unions. The Muface model is socially accepted by all, and yet its pillars are shaken by the immobility and lack of courage of the politicians responsible for its management, to the detriment of the citizens who enjoy this model.
I would like to contribute two thoughts to this debate:
- As I explained in the last blog, it is essential that the different administrations address the serious problem of financing the Spanish healthcare system and commit to increasing investment in public and private healthcare. Quality and excellence come at a price. And what we cannot do is look the other way and expect to maintain a model with the same conditions as 10, 20 or 50 years ago. Right now, society is not the same, nor does it have the same needs. For this reason, the different healthcare management models face the serious problem of underfunding, which is causing problems of quality and commitment, and generating rejection and dissatisfaction on the part of citizens and providers. If a model works, administrations have to take it seriously and prioritise fair funding. I advocate increasing funding in the system, but with a commitment to use resources in a different way, with more transparency and professionalism. In my opinion, there is a lack of institutional loyalty, objectivity and realism to assess, with data in hand, the fair financing of each public-private partnership model. We have an increasingly ageing population, with more chronic illnesses as a result of age and advances in treatments, while at the same time there is a lack of professionals and the Covid pandemic has turned the system upside down.
- I would also like to say publicly that I am very surprised that there are trade unions who, when referring to the model that Ribera represents, for example, talk about «doing business with health» and in the case of Muface (with 80% of users choosing private health care), considering it a «social conquest» of civil servants, align themselves with the insurers to demand that the central government increase funding, without being ashamed of the clear contradiction. Because let’s not forget that, in the end, they are protecting the insurers’ bottom line. And I insist. I am not against it because all health managers today have to face the challenge of underfunding. But this case demonstrates, once again, the audacity of some trade unions in Spain, which are capable of criticising and praising similar models according to their own particular interests. They criticise the Ribera model, which manages public hospitals with better care for citizens and at a lower cost to the administration, but they praise and take a frontline position in defence of the Muface model because they themselves and their affiliates want to be able to continue to choose. They defend their private privileges but condemn the general public to more limited care, simply because they will not have to suffer the consequences of what they condemn.
And I will end as I began. Underfunding is one of the major problems of the health system in Spain and all managers are suffering from it, not just Muface. My intention with these reflections is to show that the challenges facing all health managers are the same. Hence the need to depoliticise healthcare and seek joint solutions that help to guarantee excellence in care and the sustainability of the system in the medium and long term.
I am attaching the two news items about Muface that have led me to write this blog entry.