The Independent Fiscal Responsibility Authority (AIReF) has proposed incorporating new mutualists into the National Health System (SNS) and recommended transforming the current mandatory affiliation into a voluntary regime.
The independent body presented a study on administrative mutualism on Monday, highlighting Spain’s unique system compared to other countries in the region.
Currently, civil servants of the State Administration and trainee civil servants aspiring to enter the Administration Bodies are mandatory mutualists.
The initial incorporation into the Administrative Mutualism Regime is mandatory, unique, and permanent from the moment of taking office or the start of the trainee period.
The current mandatory affiliation forces mutualists to choose between public or private modalities, limiting access, especially for those opting for the private modality, to the universal public provision characteristics of other citizens.
Given this dual scenario, characterized by correlated preferences with the complexity of required care and notable differences in efficiency and equity, AIReF proposes two structural reforms.
Firstly, it suggests transforming the current mandatory affiliation into a voluntary regime through a comprehensive consultative process with all mutualists over the next two to three years.
This reform would rationalize the system and generate savings for both civil servants and public finances by eliminating contributions from those opting out of the mutualist system.
‘ IF INCORPORATED: 0.9 MORE DAILY PRIMARY CARE CONSULTATIONS
Furthermore, the independent authority believes that the gradual integration of new mutualists into the national health system, accompanied by an enhancement of their capacities, would help address inefficiencies.
As an indicative calculation, transferring 1.6 million civil servants to public healthcare would result in 0.9 additional daily primary care consultations, 24.6 more patients per 1,000 inhabitants in specialized consultations (30% increase), and 1.3 more patients per 1,000 inhabitants in the surgical field (7.2% increase).
Therefore, AIReF advises against the immediate integration of all mutualists into the SNS and conditions this gradual integration on the parallel strengthening of public system capacities, especially in improving waitlist situations.
GRADUAL INCORPORATION TO AVOID OVERLOADING WAITLISTS
In this regard, AIReF suggests evaluating recent determinants of waitlists and potential instruments and alternatives to improve the current situation.
In addition to these structural reforms, a set of measures aimed at reinforcing the healthcare dimension of administrative mutualism and improving system efficiency and effectiveness in its current configuration is proposed. These measures include strengthening healthcare information systems, enhancing coordination with the SNS, evaluating the clinical appropriateness of healthcare visits, and promoting digital medical records.
In the pharmaceutical field, optimizing the mechanisms for acquiring hospital medications dispensed to outpatients, promoting the use of generics and biosimilars, and accelerating the implementation of electronic prescriptions are suggested.
TURNING TO PUBLIC PROVISION IN SEVERE CASES
Although only 24% of mutualists opt for public provision, this proportion significantly increases to 70% in cases requiring hospital episodes for severe and extreme conditions.
This trend is particularly accentuated in patients needing oncology treatments like chemotherapy or nephrology and dialysis services. AIReF reports that over 66% of severe or extreme hospitalizations of mutualists are managed in publicly-owned centers, rising to 90% for those under 40 with such conditions.
PRIVATE: MORE ACCESSIBLE IN TRAUMATOLOGY, DERMATOLOGY, OR GYNECOLOGY
AIReF has also noted greater accessibility to certain healthcare services among mutualists opting for the private modality. Specifically, the rates quadruple those of the national healthcare system in specialties like traumatology, dermatology, and gynecology.
«This characteristic is particularly evident in the use of advanced imaging diagnostic tests, especially in MRI, where the rate exceeds that of the national health system by more than three times,» explained the organization in its report.
Regarding efficiency, the evaluation reveals significant differences between public and private modalities, especially in the pharmaceutical sector. AIReF found that private centers bill mutualities for hospital medications at significantly higher prices than those acquired by public health services, sometimes even six times higher.
Moreover, variations in the use of generic drugs (40% in the public modality versus 32% in the private one) and biosimilars, with differences of up to 23 percentage points in some molecules, were observed.
Additionally, AIReF considers the heterogeneous and limited development of electronic prescriptions in the private modality of the mutualist system as a significant limitation, restricting the ability to implement strategies for improving prescription quality.
FUENTE