The Muface crisis anticipates a problem that no one wants to face: public health has a large deficit

The three private insurers that work with Muface (Adeslas, Adisa and DKV) have abandoned the agreement for the next two years. The concerted health system offered in Spain and to which more than 1.5 million civil servants have access will no longer have the support of these private insurers, which leaves their health coverage up in the air.

What the insurers say. According to them announced by the different companieshave decided not to participate in the tender for the new Muface concert. Except for Justice (Mugeju) and Army (Isfas) officials, the rest of the officials will not be covered by these insurers for the moment.

The reason is that they consider that the model is underfunded. According to DKV calculations, while healthcare spending has increased by 60.6% in the last decade, the Muface premium has increased by only 31.6%. According to the insurers, their Losses are about 200 million euros per year.

The numbers. The offer for 2025-2026 was to increase the premium by 17.12% with a total budget of 2,681 million euros, but insurers are requesting 38%. Initially the proposal of the Government was 14% and the position of the insurers was 40%.

In addition to compensating for losses, this increase derives from the intention of the new tender to add new services such as dental insurance and treatments for cancer patients.

What does Muface say? According to Muface explainsits premium of 17.12% is the largest in history since comparable records exist. Until September 2025 there is room to reach an agreement, since a forced extension of nine months would be applied by the Public Contracts Law. However, from Mufase they explain that They are already working on a new tender. That is, a new proposal.

Despite everything, Muface is trying to reassure officials by ensuring that “all mutual members, both holders and beneficiaries, will continue to receive the same health care that they enjoy under current conditions.” A promise that seems difficult to fulfill if it does not get the support of private insurers, whether Adeslas, Adisa and DKV, or others.

Why is it not profitable? The reason behind the imbalance in Muface’s accounts is the high accident rate in the population. According to Adeslas datamore than 40% of those served are over 55 years old.

However, having these officials in Muface is cheaper than having them directly in public health. The Spanish State invests about 1,736 euros per citizen in the National Health System (SNS), for about 1,208 euros, which is the average premium in Muface.

According to a study by the Spanish Private Health Alliance (ASPE), the Muface model saves the State around 890 million euros per year, although more and more officials who choose to turn to public health.

The big question: can public health take on all officials? The Ministry of Health is the first to be considering the option of all officials moving to the SNS. But according to Government data, this would imply a growth of between 2-3% of the population served. Which would be close to 4% in the population between 64 and 79 years old.

The healthcare system would need increase suddenly by more than 700 doctors. A difficult situation considering that the public health system has been losing care capacity and it is estimated that, without taking into account the impact of Muface, More than 4,500 family doctors are needed.

How much you are willing to pay. The cards are on the table and the new tender is already being considered. One of the proposals speaks of a premium increase of 24% in 2025 and another 1% in 2026. Above the current 17.12%, it represents an additional contribution of about 106 million euros. Still far from the 40% that insurers ask for but closer.

The current government does not want to increase premiums so much and its commitment to changing the model and continuing to increase the percentage of civil servants who are committed to public health seems clear. Although, this seems like a utopia in the short term, where the public health system seems far from being able to assume that cost at once.

Image | Ministry for Digital Transformation and Public Service

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