Luxembourg's National Health Fund (CNS) reported record activity and rapid digital progress in 2024, but warned that the country's public health insurance system faces growing financial strain.
The National Health Fund (CNS) reported record activity levels and a continued digital transformation in its 2024 annual report, while warning of mounting financial pressure on Luxembourg's public health insurance system. With nearly 1 million people insured, the CNS processed more than 965,000 certificates of incapacity and reimbursed over 735,000 medical sessions via its newly launched Paiement immédiat direct (PID) scheme.
The service allows patients to avoid upfront payments, with CNS paying providers directly. By mid-2025, over 2 million sessions had been reimbursed through the PID, amounting to €185 million in costs covered directly by the fund.
The PID system, introduced at the end of 2023 and expanded throughout 2024, now includes over 1,700 participating doctors and dentists. According to CNS President Christian Oberlé, the digital shift has simplified procedures for patients and providers alike, and will be rolled out to more medical professionals in 2025.
Further digital reforms are underway: an amendment to the convention between the CNS and the Association of Doctors and Dentists (AMMD) requires healthcare providers to adopt electronic billing by 2026, including digital certificates of incapacity and prescriptions.
Despite digital gains, in-person agency visits rose by 12.7% in 2024. CNS emphasised the importance of maintaining human contact and improved services with measures like mandatory appointments and expanded virtual consultation options.
Financial situation deemed 'alarming'
Still, the report also acknowledges serious financial challenges. The financial situation of the health insurance system is described as "alarming", including calls for "rigorous" corrective action.
In 2024, the sickness-maternity branch recorded a deficit of €25.8 million, with revenues reaching €4.52 billion against €4.55 billion in expenditures. This shortfall led to a reduction in the CNS' overall reserve to €936 million, or 20.6% of annual expenses – which is still above the legal minimum reserve of 10% (€455 million).
A working group led by Minister of Health and Social Security Martine Deprez is currently assessing recovery measures.
To contain costs, CNS has limited growth in operating expenses despite surging demand. The workforce shrank slightly to 515.65 full-time equivalents by year-end, while over 9.4 million pages were viewed on its website – up 15% from 2023.
Efforts to combat fraud also intensified. The CNS opened over 560 investigations in 2024, including 119 cases involving fake medical leave certificates obtained online.
Fraud controls, according to the report, prevented €5.4 million in potential losses.
Looking ahead, CNS plans to expand digital services, improve preventive care, and support ageing demographics while reinforcing its financial sustainability.
The full report, which also details strategic planning, HR developments, and service metrics, is available via the CNS website.
