Spanish public health, a universal, free and decentralized system, is considered one of the best in the world. However, the lack of human, financial and material resources has shaken its foundations on several occasions, the most notable during the coronavirus pandemic. A chronic crisis that these days has put the focus on the Community of Madrid, where the Primary Care strike committee has locked itself up this Thursday in the general direction of human resources of the Ministry of Health to demand a “real” negotiation with the authorities and improve their working conditions, as well as the quality of patient care. In the midst of this context, with public health saturated, the hiring of private insurance has skyrocketed. Is there a relationship between the two data?
Private health insurance, different from accident or illness subsidy services that are focused on sick self-employed workers with medical leave, are those that allow the patient to go to the family doctor, to the specialist or undergo a crisis in a center private. Its contracting has grown steadily in the last 10 years, although under the shadow of the covid the pace has been considerably anticipated: between 2019 and 2021 the number of policies increased by 9%, a faster increase than the one that followed until then, according to the latest data collected by the Unespa employers’ association.
Thus, the coronavirus has highlighted the importance of health and has given a boost to mutuals, with more than a million new contracts in the last two years, and more than 11.5 million people registered in total in 2021 , 24.4% of the Spanish population. Until then, the increases have been a maximum of one percentage point, some 300,000 more private insurances each year. In other words, almost one in four Spaniards double finances their medical care and has private insurance.
Officials maintain the upward trend in the hiring of policies
Within the general figures, explains the insurance employer, we must consider the 1.8 million people who are officials of the central administration, justice or the military who also have a health service offered by a private entity. A percentage that varies depending on the autonomous community, with the Community of Madrid and Catalonia being the two regions with the most public employees, along with the autonomous cities of Ceuta and Melilla, where military personnel live above all.
All public workers can choose between the public or private health service through mutuals financed with public funds. And the majority of civil servants opt each year for the private one: the main one is the General Mutual Society of State Civil Servants (MUFACE), but there is also the Social Institute of the Armed Forces (ISFAS) and the General Mutual Society of the Judiciary (Mugeju ).
The weight of civil servants as a constant in private healthcare can help to identify one of the groups that keep health insurance on the rise, present in 22% of Spanish households. A business that has increased its profits by 50% over the last decade and that continues to grow at a structural level: in 2011, 6,280 million euros were paid for contracting 8.7 million insurances, while in 2021 they were 9,485 million for 11.5 million.
Reduces absenteeism
Another reason why the number of private insurances has skyrocketed is located in companies, more specifically in SMEs, many of which have incorporated private health insurance for their workers as a complementary remuneration concept.
There are three reasons: attract talent, retain professionals and reduce absenteeism. Regarding the first two, the entities seek to make contracts more attractive by incorporating social benefits that facilitate the daily life of workers. Regarding work absenteeism, companies try to make flexible medical services available to their employees, without long waiting lists or bureaucratic procedures that could prolong their absence. For example, in public health you need to go through a family doctor’s office if you want to go to a specialist. While in private healthcare you can skip this step.
In this sense, Madrid and Catalonia, in addition to registering the highest percentages of people with private health insurance, are the autonomies with the largest business network. If the average in Spain is around 25% of health insured, in Madrid the percentage is 38%, six points more than the 32% in Catalonia. Figures far removed from 10% in Navarra, 12% in Cantabria, 13% in Murcia or 17% in Asturias.
The public crisis
The increase in insurance can also be influenced by the price war between mutuals, with very low rates attracting people looking for an alternative to delays in public health. Well, even in regions where it is less frequent to contract medical insurance, such as Castilla-La Mancha or Extremadura, the number of insured has grown by 7.5% during the pandemic.
In this period, all attention was focused on covid patients, at the same time that the population with diseases of any other type saw their consultation with the specialist delayed or their diagnostic tests suspended, health centers closed and they suffered tremendous delays to be seen by a doctor. The latest data published by the Ministry of Health estimate an average wait of two and a half months to be seen by a specialist doctor.
In the course of that time, many patients were referred to private centers with which outpatient clinics and hospitals signed agreements to relieve their wards, subsumed between the lack of personnel and the accumulated influx. A total of 271 private hospitals (63%) have some agreement with public health in our country, according to the Spanish Private Health Alliance. The destination of the concert item is mainly hospital services (60%) and specialized services (19%).
