After last year's 40 million euro deficit, the National Health Fund (CNS) is happy to report a 25 million euro surplus in 2023. However, the outlook for the future is less rosy.

The increase is attributed to the fact that less money was spent this year, while contributions to the Fund increased in line with index instalments. However, the CNS warns that next year could see a deficit of up to 50 million euros. An urgent solution is required within the next few years to guarantee the Health Fund's future funding.

How can we guarantee CNS funding in future, and why is immediate payment no longer widespread?

These were two central questions asked at Wednesday's Social Security committee meeting to tackle health and maternity insurance. However, discussions took place without the relevant ministers, due to the fact that the current acting health and social security ministers will not be part of the next government and therefore cannot make any decisions.

Quadripartite/Reportage Claudia Kollwelter

The predicted deficit of 50 million euros for the 2024 financial year poses a particular problem for the committee, and the proposed solutions were met with varied responses. Employer representatives said an increase in contributions was out of the question; however, the trade unions viewed it differently.

OGBL spokesman Carlos Pereira said: "If it becomes necessary to increase or cap contributions, then perhaps high earners and those who really contribute to the CNS system might finally come together to finance the whole system."

The LCGB union supports neither an increase in contributions nor a reduction in benefits, while the AMMD (doctors and dentists association) say the CNS and Social Security General Inspectorate projections do not take into account any medical care developments. AMMD president Alain Schmit explained patient waitlists have increased in length, which creates a knock-on effect on sick leave and in turn, health insurance, which eventually picks up the bill. "It is therefore a bit of a vicious circle," he concluded.

Perreira criticised the inert response in terms of introducing immediate direct payments. At the end of September, Acting Minister of Social Security Claude Haagen announced that the computer system required to process instant direct payments was operational. However, this is not sufficient, according to the LCGB's Christophe Knebler.

"We need software suppliers who are capable of installing this. Medical practices must have the necessary software and hardware available, but this has not been carried out, to date. What use is a system which is operational but cannot be used, because the general conditions have not been put in place?"

In the meantime, the trade unions lament the fact that medical insurance policyholders continue to suffer.