Trade unions and MPs voice serious concerns over Luxembourg's healthcare reforms, warning that plans to liberalise the system and enable private clinics risk undermining public care and placing added burdens on patients.
Over the weekend, the Union of Trade Unions sent an open letter to PM Luc Frieden. This time, the criticism focused on Health and Social Security Minister Martine Deprez, accusing her of not taking unions seriously during pension reform discussions and now risking the integrity of the healthcare system.
President of the Independent Luxembourg Trade Union Confederation (OGBL) Nora Back said the situation had reached a breaking point. She described current developments in the health sector as a dangerous step towards privatisation and commercialisation, warning that the unions could not accept this direction and felt compelled to act.
The unions' stance directly opposes that of the Luxembourg Association of Doctors and Dentists (AMMD), which terminated its agreement with the National Health Fund (CNS). Back cautioned that if this withdrawal from the national agreement proceeds, and private investors are allowed into the system, it would open the door for public money to be exploited for profit, ultimately harming patients. She stressed that the unions would not stand for such a scenario.
The President of the Christian Social People's Party (CSV) parliamentary group, Marc Spautz, rejected calls from the AMMD for a broad liberalisation of the healthcare system. MP Spautz insisted that any doctor wishing to practice in Luxembourg in future must continue to be affiliated with the CNS, as has been the case up to now.
His message was not only directed at the AMMD but also at his coalition partners in the Democratic Party (DP). He emphasised that the coalition agreement clearly supports maintaining the CNS agreement framework and expects this position to apply across the coalition.
Last week, Minister of Health and Social Security Martine Deprez told RTL that if the CNS and AMMD failed to agree on a new agreement within 12 months, the issue could be resolved through regulation, much like the reimbursement model for psychotherapy.
However, Paulette Lenert, former Health Minister and MP of the Luxembourg Socialist People's Party (LSAP), saw a significant problem with that approach. She pointed out that while a fixed reimbursement amount might be set, any difference between that and what doctors actually charge would fall on patients. In other words, people could end up paying far more out of pocket if doctors bill above the regulated rate.
Regarding union concerns that private investors could enter the health sector via proposed doctor-led companies, Spautz attempted to allay fears. He expressed confidence that the forthcoming legislation would ensure a clear separation between medical practice and commercial interests, similar to existing rules for legal firms.
Lenert remained unconvinced, arguing that it is difficult to assess the direction of the current coalition's healthcare policy due to the lack of concrete legislative texts. This uncertainty extends to Deprez's plans to enable outpatient treatment in smaller, non-hospital facilities, a move Back firmly opposed, insisting that such services must remain integrated within hospitals.
Lenert was less absolute in her stance but underlined the need to examine under what conditions services might be moved outside hospitals. She stressed that patient safety and cooperation with hospitals must remain central considerations.
Spautz also raised concerns about service continuity and emergency care, stating that if doctors could ensure 24/7 availability, he would be open to the idea of non-hospital centres, but only with full round-the-clock coverage to avoid risks to patients. He added that any new facility functioning like a hospital should be subject to the same working conditions and collective labour agreements currently applied in public hospitals.
Lenert echoed union fears that outsourcing lucrative procedures could create favourable working conditions outside hospitals, drawing staff away from the hospital system and making it harder to maintain on-call coverage.
Finally, Back questioned how Deprez could consider expanding private clinics when the CNS is already facing a precarious financial situation. She said unions have been warning about the fragility of the CNS for years, and that the proposal to open private alternatives could create new financial burdens without a clear cost assessment.
