The administrative mutualism model in Andalucía is undergoing a notable reconfiguration. Two years after the crisis that jeopardized its continuity, official data from the Ministry for Digital Transformation and Public Function reveal a consistent shift in the preferences of Muface-affiliated civil servants, with an increasing transfer from private insurers to the public health system.

During 2025, the number of Andalusian civil servants affiliated with public healthcare reached 81,014, compared to 67,032 registered in this system in 2024. This increase of 13,982 people represents a 21% growth in just one year, raising the proportion of those opting for the public system to 24.4%. Despite this trend, the majority of mutualists, a total of 250,501, still remain with private insurers, mainly Adeslas (129,327 users) and Asisa (121,174).

This increase in public option choice is not isolated or concentrated in specific territories but extends to all eight Andalusian provinces. Granada leads the absolute increase, rising from 10,342 mutualists in 2024 to 14,081 in 2025. Málaga also stands out, with a jump from 10,525 to 13,174, and Sevilla, reaching 17,388 mutualists in the public system compared to 14,306 the previous year. Other provinces such as Cádiz, Córdoba, Jaén, Huelva, and Almería also show growth, albeit with less intensity.

In the medium term, between 2020 and 2025, the number of Andalusian mutualists who have opted for public healthcare has grown by 33,638 people, representing a 58.4% increase over five years. This phenomenon occurs within a context of overall growth in mutualism in Andalucía, with total affiliates increasing from 321,037 in 2024 to 331,515 in 2025, indicating an internal redistribution of preferences rather than a system contraction.

The 2024 crisis, marked by the initial refusal of insurers to renew the healthcare agreement and the subsequent departure of DKV, was a key factor in this shift. Although Adeslas and Asisa confirmed their continuity in January 2025, the uncertainty led to deep reflection among mutualists about their healthcare affiliation. Structural factors such as a shortage of specialists and increased waiting times in concerted care also contributed, reinforcing the perception of public healthcare as a more stable alternative.

Recent data from 2026 confirm this dynamic, with 6,326 requests for entity changes in Andalucía. Sevilla and Cádiz concentrated the largest volume of movements. In Sevilla, Adeslas attracted 615 mutualists, while the INSS added 343 new affiliations. In Cádiz, Asisa was the main destination with 549 new registrations. Málaga showed a more balanced scenario, and Córdoba experienced a massive transfer of 567 mutualists from Adeslas to Asisa. Granada continues to stand out for the attractiveness of the public option, with the INSS capturing 275 of the 690 registered changes.