The Luxembourg government is seeking to stabilise the finances of the National Health Fund (CNS) through a combination of higher social security contributions, stricter spending controls, and increased efforts to combat fraud.
On Thursday, Minister of Health and Social Affairs Martine Deprez stressed that neither preventive measures nor necessary treatments should face cutbacks, and reaffirmed her commitment to dialogue with doctors through dedicated working groups despite ongoing disputes.
During Wednesday’s quadripartite meeting, government officials and social partners reviewed the CNS’s financial situation. A provisional deficit of €133.3 million is expected for this year, with the shortfall projected to rise to nearly €190 million by 2027.
To address this, both employees and employers will see their contributions increase by 0.125 percentage points. For example, someone earning a gross monthly salary of €1,000 would pay €1.25 more per month, while a €5,000 salary would mean an extra €6.25.
Deprez described the increase as minimal and highlighted that the state will cover 40% of the additional costs.
In addition to raising contributions, the government aims to cut spending by €95 million in four main areas: medicines, medical oversight ("maîtrise médicalisée"), hospital care, and the fight against abuse and fraud.
To reduce waste in pharmaceuticals, the government plans to promote 'blistering', whereby patients receive medication dispensed in precise dosages in small packs or rolls, rather than large packs of 100 or 200 pills.
Minister Deprez also supports the adoption of international recommendations for biological tests, physiotherapy prescriptions, and certain medications.
She emphasised the importance of raising awareness that some medicines are available in more affordable forms but have the same effect.
When it comes to laboratory analysis, Deprez suggested reviewing the frequency of routine checks, considering whether three-month intervals are medically necessary or whether they could be extended to six or twelve months.
For patients requiring ongoing physiotherapy, the ministry plans to develop more coherent treatment pathways to reduce the need for repeated doctor visits solely to obtain fresh prescriptions.
Hospital spending will also be more closely scrutinised, including through the consolidation of certain services.
Efforts to fight fraud will be strengthened and better organised, with closer monitoring of health service providers with unusually high billing, and investigations into cases of unusually high healthcare consumption to determine their underlying causes.
Asked whether reducing analyses and prescriptions could undermine prevention, Minister Deprez reassured the public that the government does not intend to cut preventive measures and "no one will receive less".
The focus will remain on making case-by-case decisions about which examinations and treatments are appropriate, ensuring that patients continue to get the necessary care.
She insisted that patients would not receive less care as a result of the reforms.
Decisions also need to be taken as to which preventive expenditure should be covered by the CNS and which by the state budget.
Deprez stressed that doctors’ involvement is essential for the process, as reforms cannot be implemented without their input.
Absenteeism was another topic at the quadripartite, with the Luxembourg Employers’ Association (UEL) calling for a stronger focus on the issue.
According to Deprez, a dedicated working group is already active, and a position paper has been drafted for further discussion. No new measures were announced during the interview.
According to the scenarios presented at the quadripartite, the planned measures should secure the CNS’s finances until 2030.
A further meeting between the government and social partners is scheduled for spring 2028 to discuss more structural questions, including which costs should be covered by the health fund and which by the state. Preparatory discussions on these issues are to take place over the next 18 months.
As an example, Deprez cited hospital construction funding: currently, 80% is covered directly by the state and 20% by the CNS, but one option would be to fund the full amount through the "Fonds hospitalier" (hospital fund).
Similarly, IT costs not directly linked to patient care could be financed differently in the future.
Despite heightened tensions with the Luxembourg Association of Doctors and Dentists (AMMD), Minister Deprez confirmed that cooperation and participation in working groups continue, with AMMD representatives still present in all groups.
Responding to calls from Democratic Party (DP) MP Gérard Schockmel for greater compromise from the government, Deprez pointed out that two bills had already been tabled at AMMD’s request, and that doctors’ input remains necessary to finalise them.
Currently, five working groups are in place, including one dedicated to reducing waiting times in hospital emergency departments.
As regards the upcoming transition from the current convention-based system to new grand ducal regulations by the end of October, Deprez gave assurances that nothing will change for patients.
Tariffs and billing procedures will remain as they are, so people do not need to worry about their healthcare arrangements.
