A health insurance crisis is looming

Luxembourg’s National Health Insurance Fund (CNS) is facing a serious financial shortfall that threatens to critically deplete its reserves as early as next year. To avoid having to raise insurance contribution rates, specialist working groups will draw up a package of cost-cutting measures by the autumn. 

CNS Director José Balanzategui noted that the level of inefficient spending in healthcare systems abroad is traditionally estimated at 15–20%, and Luxembourg is no exception. According to him, the agency began to identify certain budget items spiralling out of control – in particular expenditure on physiotherapy and laboratory tests – as early as 2015–2016; however, the measures taken at that time proved insufficient against the backdrop of an ageing population and the emergence of new, costly treatment methods.

The CNS now intends to tighten controls on long-term sick leave, the cost of which is fully transferred to the health insurance fund after 77 days of continuous incapacity for work. An increase in the number of such cases has been recorded across all sectors of the economy, but is particularly pronounced in the healthcare and construction sectors. Despite the lack of direct evidence of deliberate abuse by members of the public, the agency plans to require doctors to provide more accurate diagnosis codes in medical certificates. Alongside this, a comprehensive review will be carried out of the average length of hospital stays and the practice of prescribing expensive medicines instead of cheaper alternatives.

The largest item of expenditure in the budget remains the remuneration of medical staff. One example is the pay for radiologists, which has risen over the last five years from €600,000 to almost €950,000 per specialist. In this regard, the CNS is updating the current list of procedures, with a view to adjusting the inflated tariff coefficients. However, this process is being complicated by the protracted conflict between the government and the Association of Doctors and Dentists (AMMD), which unilaterally terminated its agreements with the CNS. The medical union is demanding the removal of the clause on ‘private services’, which allows for the collection of co-payments from citizens that are not reimbursed by the health insurance fund; however, the management of the insurance fund emphasises that conceding on this issue would lead to the creation of a two-tier healthcare system. Prime Minister Luc Frieden has previously ruled out such a scenario entirely, so the regulation of tariffs is likely to be approved by a special decree of the Grand Duke.

Despite the AMMD’s calls to bring more doctors into the country quickly in order to reduce waiting times, Balanzategui stated that there are no systemic issues regarding access to healthcare in Luxembourg, with the exception of a shortage of staff in the field of psychiatry. Summarising the fund’s position, the director emphasised that the CNS does not operate as a commercial bank, but aims to provide insured citizens with timely treatment at the best possible price. Meanwhile, Health Minister Martine Deprez had previously also confirmed that the national healthcare system would not become cheaper in the foreseeable future.