Luxembourg's health sector is moving steadily toward digitalisation, as most doctors now use the Immediate Direct Payment system and prepare for mandatory electronic invoicing by 2026.
Since 2023, around 1,900 doctors in Luxembourg – roughly two-thirds of all active practitioners – have now adopted the Immediate Direct Payment (PID) system, which allows patients to pay only their personal share of the medical bill while the rest is settled directly between doctors and the National Health Fund (CNS). According to the CNS, approximately 1,600 doctors are actively using the system each week.
The PID system has been fully functional at the Maison médicale pédiatrique and the Children’s Clinic for the past two weeks. The three remaining medical centres (maisons médicales) are expected to follow soon, said Christian Oberlé, President of the CNS, in conversation with RTL. The CHL's Policlinique is already PID-compatible, and other hospitals are in the process of adapting their systems.
The CNS is also in talks with psychotherapists, with the hope that the PID system can be introduced in that sector by early 2026.
For doctors, the benefits are clear. "It saves us time and money", says Dr Sébastien Diederich, general practitioner and secretary general of the Doctors' and Dentists' Association (AMMD). "We no longer need to send out payment reminders, and patients benefit from not having to pay the full amount upfront."
Still, some challenges remain. Billing issues with anaesthesiologists are not yet resolved, and there is currently no functioning PID solution for the SAMU emergency medical service. Additionally, correcting billing errors, such as inputting an incorrect code, can be cumbersome.
Despite these issues, both the CNS and medical professionals agree: the reform is moving in the right direction, with clear advantages for both doctors and patients.
PID not compulsory, but digitalisation to be implemented
The PID system will remain voluntary for both patients and healthcare providers. While the PID reform has been widely welcomed, Oberlé emphasised that around 10% of medical services are incompatible with the system due to the need for prior review before reimbursement.
Some patients also prefer to avoid automatic reimbursement for personal reasons. "There are insured individuals who explicitly do not want a health fund to process their reimbursement in the background", Oberlé said. "We absolutely respect that, which is why PID cannot be made compulsory."
More and more doctors are opting for the PID, however, while another major reform is also on the horizon: beginning 1 January 2026 all doctors in Luxembourg will be required to have the digital infrastructure in place to issue electronic invoices – even if implemented as alternative to the PID.
Even patients who do not use PID will be able to benefit from faster reimbursements through the CNS app, using a digital invoice that can be submitted directly to the health fund.
Several doctors are already looking forward to the upcoming option of issuing digital invoices, according to Diederich. Under this system, patients would still pay the full amount upfront but receive a digital invoice via the CNS app, which they can then submit directly to the health insurance fund for faster reimbursement.
From the CNS' perspective, the technical infrastructure for this process is already in place. "Doctors now have six months to upgrade their systems", Oberlé explained. But Diederich cautions: "It’s going to be a challenge. I'm not sure everyone will manage in time…"
Looking ahead, the CNS plans to expand digitalisation even further. After e-invoicing, the next goals include launching a digital sick note, followed by digital prescriptions. A new CNS app, integrated with Guichet.lu, is expected by the end of the year.
