National Health Fund director says problems cannot be solved by CNS alone

Last week, Luxembourg's Association of Doctors and Dentists (AMMD) unanimously voted to terminate its convention with the National Health Fund (CNS). On Monday, numerous stakeholders met to tackle the issues currently plaguing the Grand Duchy's healthcare sector, including the CNS deficit.

To date, no official correspondence has been received from the AMMD, Oberlé commented on Friday, but the CNS is expecting to hear from them soon. The issues raised by the doctors should be taken seriously, but the CNS couldn't solve them alone, the director told RTL. Oberlé is set to leave his position on 1 November after seven years, to be replaced by current vice-president José Balazantegui.

In response to criticism that Luxembourg's health policies are too hospital-centric, Oberlé argued that hospitals account for around 1.5 billion euros of the budget, and therefore are the largest expenditure item. However, doctors are not far behind, with a budget of 900 million. If the current trends continue, the doctor budget is likely to overtake hospitals in 12 years.

A reaction born of frustration

The escalation of the dispute over the increase in the "key letters" was the straw that broke the camel's back, said Minister of Health and Social Security Martine Deprez. Oberlé agreed, and said that during the negotations on tariffs, other issues had been raised that should have been handled at quadripartite level. He said he understood the frustration behind it as there was a feeling of not being listened to, but that the negotiations had not been the right backdrop for the discussions.

12 months of "calm" for patients, not for the CNS

For patients insured by the CNS, nothing will change for 12 months if the AMMD goes ahead and cancels its agreement. However, a new one will need to be negotiated – a task which will fall to Oberlé's successor. In principle, the current president does not think it is bad for conventions to be renegotiated occasionally, and the current agreement dates back to 1992. But the timing is "not optimal" as there is much to be done in terms of more fundamental changes.

Budget deficit apparent from 2019

One acute challenge for the CNS is the poor financial situation, as the deficit is forecast to reach over 200 million next year. This year's deficit is estimated to be around 118.5 million euros. However, all this was evident as far back as 2019, Oberlé said, when the Fund decided on savings of 30 million euros. However, this was far from sufficient.

The quadripartite suggested increasing the government's participation and saving around 60 million euros in an initial phase of "medical controls", in terms of prescribing medicines, lab tests and physiotherapy. As a result, it would only pay for things that are "useful and necessary". The CNS has already decided that blood tests for vitamin D and B12 levels will no longer be reimbursed. As for thyroid tests, the initial tests look at just one value instead of all three at once. Oberlé said there are many areas where the system's efficiency could be improved without compromising on care.

If the savings targets were not achieved and there was no improvement in the economy and employment, then contributions would not be allowed to increase in 2027.

Video interview in Luxembourgish: