MUFACE renews the healthcare agreement

The agreement is valid for two years and will provide coverage to 1,477,320 beneficiaries

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29 December 2017

Two periods have been established (January and June) for members to choose a private insurer or return to the public health system. The official agreement was signed yesterday, 28 December, with the presence of Mr. Francisco J. Juan on behalf of the company.

On Thursday, in the presence of the Minister of the Treasury and Public Function, Cristóbal Montoro, DKV signed the renewal of the healthcare agreement for the General State Civil Servants Mutual Society (Muface) for two years, with an increase of 5.62% in premiums for this period.

Francisco Juan, the General Manager of DKV's Health unit, signed and ratified the agreement, which includes two contracts: one for health care in Spain, which totals more than Euros 2.161 billion and involves Asisa, Adeslas and Igualatorio de Cantabria, as well as DKV; and another, for around Euros 30 million, which exclusively involves DKV and which covers health care for the 7,400 mutual insurance policyholders and their families who intend to or already live outside Spain.

"This represents a new chapter in the long history of the Muface model, which is supported by good results. A healthcare system like the Spanish one is a lesson in efficiency, effectiveness and modernity, as it has combined public and private interests in order to become the model for a modern and advanced society. According to Dr Francisco Juan, the General Manager of DKV's Health unit, "It has also allowed the development of a private health system, which is gaining strength and quality and has enabled other people to access health care".

Montoro spoke along the same lines, emphasising that the agreement is testament to the fact that public-private collaboration is possible in Spain and thanking the efforts and "patience" of the health care insurers because "at the worst financial moments" they made sure the health care system was not put at risk.

New additions to the agreement

The agreement will remain in effect for two years and will provide cover to 1,477,320 beneficiaries, who could be joined by a further 100,000 new mutual insurance policyholders as a result of the procedures put in place by public administrations to provide stability to temporary staff.

Two dates have been set (January and June) for individuals to choose between private or public healthcare providers. Thirteen new municipalities (Talavera, Alcalá de Henares, Torrejón de Ardoz, Alcorcón, Fuenlabrada, Móstoles, Gandía, Oliva, Lorca, Mérida, Almendralejo, Jerez de la Frontera and El Puerto de Santa María) will also be able to access the portfolio of specialist services offered to provincial capitals and other major towns (level III) such as neurology, pneumology, intensive care and urology, among others.

Protection for people living on smaller islands has also been improved because the health care resources of La Gomera have been increased to level I status and mutual insurance policyholders living in La Gomera, Formentera and El Hierro will be refunded expenses they incur to travel to other islands to receive specialist health care services. Health care in rural areas has been enhanced through agreements with all Autonomous Communities, which extend coverage to situations that were not previously covered in many regions (travel and primary care); The agreement also includes robotic surgery and intraoperative radiation therapy, which will enable patients with serious illnesses to access surgical procedures that enable quicker and more comfortable recovery and help to prevent the need for further procedures.

A commitment has also been made to implement the electronic prescription project included in the Muface Plan de Impulso [promotion plan] and to encourage doctors to use them. Furthermore, there is an incentive for private insurers to offer additional services that will enhance the agreement, such as oral health care; and cover has been provided for palliative care at patients' homes.

The agreement also includes coordination with autonomous emergency 112 services, in which Muface commits to promote collaboration instruments with the health care services of autonomous communities that deal with mutual insurance policyholders in emergencies, and creates an incentive that rewards the over 65s for their loyalty and decision to continue to use DKV. For the first time, the agreement expressly prohibits the transfer of risks between companies, which is when a company encourages policyholders to subscribe to another company for more expensive treatments.

As remuneration, DKV will continue to receive the annual quality incentive (3.5% of premiums), allocated to four objectives: health care quality plans (with a substantial renewal of objectives), implementing the electronic prescription service, keeping customers aged 65 or over and offering additional services and benefits. 

"Agreements with mutual insurance providers require ongoing management as regards controlling costs due to the restrictions imposed by their premiums; however, they give the company numerous advantages as regards competition: greater purchasing power compared to suppliers (which is more important where there is concentration), critical mass and positioning to access other groups, increased brand awareness and the option to offer other company products to a group with adequate purchasing power and proven job stability", notes Pascual Moreno, head of Public Administrations at DKV.