In a significant shift within Spain's healthcare landscape, DKV has announced that it will not participate in the upcoming contract to provide healthcare services to 1.53 million civil servants and their families covered by Muface. This decision marks the end of DKV's nearly 50-year involvement with the program, which has also seen the departure of SegurCaixa Adeslas, the country's largest health insurance provider. Despite a substantial 33.5% increase in the compensation offered to insurers, these companies remain unconvinced of the viability of the arrangement. At present, Asisa is the only insurer still considering participation, with a deadline set for January 15 to confirm its involvement for the 2025-2027 period. The resignation of DKV is viewed as a serious challenge for the Minister of Public Function, Óscar López, who has emphasized the government's commitment to ensuring healthcare for public employees. The budgetary measures taken--amounting to an additional EUR1 billion compared to the previous contract--have not achieved the desired results. Until April 1, current services will continue to be provided by Adeslas, Asisa, and DKV, with the ministry considering extending the previous contract until September. However, this extension is seen merely as a temporary fix for a system under significant strain. DKV cited substantial financial losses of EUR70 million from the previous contract and anticipated further losses of between EUR70 million to EUR100 million if it were to participate in the new agreement. The recent premium increases have not sufficiently offset rising operational costs, the aging population of members, and increased healthcare service utilization following the COVID-19 pandemic. The crux of the situation now lies in whether Asisa can provide services to all Muface beneficiaries independently and whether it perceives this as a viable option. Asisa previously declined to participate in the first tender, which proposed a 17% increase in premiums, citing potential financial risks. It remains uncertain if the current 33.5% increase is enough to change its stance. Insurer representatives have indicated that they are meticulously reviewing the tender documents and will finalize their decision as the deadline approaches. Muface, established during the Franco era, was designed to offer medical services to public employees at a time when healthcare was largely privatized or charity-based. Following the democratic transition, various smaller mutual societies merged into three larger entities: Muface, which serves primarily teachers and other public sector workers; Isfas, which covers military personnel and civil guards; and Mugeju, which caters to judicial employees. While insurers have engaged in the other two mutualities, the Muface process is currently stalled in administrative courts. Under the Muface model, public employees can choose annually between receiving healthcare through participating private insurers or opting for the public health system. This choice typically fosters loyalty among members, who often remain with their selected provider for years. The current uncertainty, however, has caused considerable anxiety among hundreds of thousands of individuals about their future healthcare options. The insurance sector has long argued that the Muface model is chronically underfunded. This ongoing issue has led numerous companies, including Mapfre, Sanitas, Caser, and Axa, to withdraw from the program, frustrated by the continuous financial losses associated with the service. The prospect of expanding their client base and marketing additional services has failed to entice DKV and Adeslas back into the fold. In light of DKV's withdrawal, the insurer has communicated with its current beneficiaries, informing them that they may transition to the public health system during January. A subsequent window will open once the new contract is enacted, allowing for potential shifts back to a contracted entity, depending on Asisa's eventual decision. The implications of Muface's potential collapse extend to the regional health services, as the central government holds the authority to set the terms for the contract. Should no insurers come forward, the 17 regional health services would need to absorb hundreds of thousands of new patients. With two-thirds of Muface members being educators, the financial burden would also fall on regional education authorities. Several regional officials have urged Minister López to find a solution that does not further overburden the public health system. Concerns have been raised across various public sector unions, including CSIF, CC OO, and UGT, demanding that the government and insurance companies work towards a resolution that safeguards the healthcare needs of public employees and their families. The president of CSIF has criticized the government's handling of the Muface crisis and indicated that the union will advise its members on potential legal actions due to the lack of guaranteed healthcare services. Reports have surfaced of clinics and hospitals cancelling appointments and procedures, despite the government's directive for continuous care.