The Independent Authority for Fiscal Responsibility (AIReF), under a mandate from the Council of Ministers and within the framework of the Spending Review 2022-2026, has carried out an exhaustive evaluation of the civil servant mutual insurance system in Spain, based on the analysis of more than 400 million anonymized microdata and a survey of mutual insurance members. This evaluation, which includes and combines administrative information, hospital activity, pharmaceutical consumption and healthcare activity, provides empirical evidence on the efficiency, effectiveness and equity of the current system.
The international comparative analysis reveals that Spain is a singular exception among countries with tax-financed universal health care systems (Beveridge model). While countries such as Italy and Turkey integrated their special regimes for civil servants during the constitution of their national health systems, and others such as Greece and Portugal did so in the framework of structural reforms during periods of economic crisis, Spain maintains a differentiated system.
