Luxembourg doctors operate at a loss to themselves

In the face of long waiting times for ophthalmic surgeries, three doctors from Luxembourg have taken the unusual step of moving cataract surgery out of the hospital and into private practice. Although such interventions are traditionally carried out in hospitals, from 2022, surgeons Carla Schmartz, Tom Pavant and a colleague began operating directly in their clinic near the capital's railway station.

Even before the pandemic, patients were waiting six to 12 months for surgery, Schmartz said, and later those wait times only increased due to overloaded operating rooms. To cope with the bottle neck, doctors invested in an additional operating theatre and all the necessary equipment.

However, private practices in Luxembourg cannot count on the same financial support as hospitals: the National Health Insurance Fund (CNS) only reimburses the surgeon's fees, but does not cover the costs of premises, materials, sterilisation and staff. As a result, doctors work at a loss, making up the difference through cross-financing. For example, part of the income from laser vision correction (not covered by CNS) goes to cover the deficit from cataract surgeries. Practitioners also negotiate discounts with suppliers and redistribute their own fees.

Patients do not pay more than in the hospital, with the exception of 185 euros for the pre-operative examination. This approach has reduced the waiting time for surgery to 2-3 months, and the total number of operations has reached 1,500 per year, of which 1,000 are cataract operations.

This approach is an example of what the so-called ambulatory shift, which has long been discussed in the professional community and government, might look like, Pavan said. The idea is to allow uncomplicated surgeries to be performed outside of hospitals, in private practice settings, which would reduce pressure on the system and cut costs.

Schmartz emphasises that if Luxembourg were to officially introduce such a model, it would be cheaper than the hospital tariff, because private practices do not have the overhead costs of large structures like hospitals. However, no one is suggesting that hospitals should be displaced: on the contrary, doctors continue to be on duty and operate in hospitals, and they believe that complex cases should continue to be treated in hospital.