The government has unveiled a new hospital reform, bill 8760, to ease burdens on the country’s hospitals.
The proposed law would allow doctors to set up outpatient structures linked to hospitals, while requiring these doctors to participate in the hospital on-call system, in an effort to avoid direct competition between hospitals and independent practices.
However, Dr Monique Reiff, president of the Association of Hospital Doctors, told RTL the reform still leaves "a lot of questions that are not yet resolved". She pointed out that, from the hospital doctors’ perspective, the distinction between existing hospital satellite centres and the proposed new doctor associations must be made clearer, particularly regarding the nature of agreements or conventions with hospitals.
"What is the difference between a hospital satellite and a doctors’ association, especially if there is an agreement with a hospital? Is the hospital even interested in entering such an agreement? And what if a doctors’ association forms, but the hospital does not want to sign?" she asked, emphasising that "there are still many open questions".
Dr Reiff also highlighted the need to clarify how such agreements would work in practice, particularly given the variety of working models in Luxembourg’s hospitals and practices.
She noted that, for instance, salaried doctors in public hospitals and those in liberal group practices already collaborate in different ways, raising questions about how the new structures would interact with existing ones.
A core concern for Dr Reiff is the financial impact of the reform. She explained that under the current "tarification à l’acte" system, hospitals are reimbursed per medical act, but complex and time-intensive cases are not adequately compensated.
"We all know that the time factor and the complexity factor are currently not remunerated in the system", she observed. Dr Reiff warned that if hospitals are left only with the most difficult and time-consuming cases, this could complicate funding and potentially harm hospital budgets.
When asked directly if she fears a funding shortfall, Dr Reiff replied that while she herself does not feel immediate fear, these are pressing concerns for hospital administrations and other stakeholders such as the hospital federation and the medical councils. She underlined the many remaining uncertainties around agreements between different types of doctors and institutions .
Dr Reiff remains skeptical about integrating doctors from the new outpatient associations into hospital on-call duties. "How can a doctor who mainly works in a private practice take on hospital on-call shifts if they are not part of the hospital system, do not know the procedures or the computer programmes, and are unfamiliar with the internal processes?", she asked.
She also pointed out that understanding complex procedures and patient pathways requires close integration with the hospital.
Instead, Dr Reiff argued it would be more sensible for these new associations to set up their own on-call system within their practices, especially on weekends, so that patients are cared for by doctors that they know. Otherwise, she warned, patients would end up in hospital emergency departments, exacerbating existing overcrowding.
Dr Reiff supports the demands of the Luxembourg Association of Nurses (ANIL) and advocates for reforming the system of medical tariffs and nomenclature to better reflect the time spent on complex cases, which she believes would improve patient care.
On the issue of expanding nurses’ competencies, Dr Reiff stated that hospital doctors generally support granting nurses greater autonomy, including the ability to conduct certain procedures independently.
She welcomed the allocation of new competencies in the nursing profession, including specialised consultations, calling this a major added value within multidisciplinary patient care. Dr Reiff noted that as the medical profession becomes more specialised, so should the nursing profession, with increased autonomy and responsibility.
The reform bill also foresees the creation of four new competence networks: for Long Covid, endometriosis, menopause, and neurodevelopmental disorders. Dr Reiff welcomed these initiatives, saying "it is very important that these pathologies are discussed and taken more seriously", notably in the fields of women's health and post-infectious fatigue.
However, she flagged a shortage of specialised staff such as neuropediatricians to analyse neurological development in young people and described practical implementation as still inherently complex.
Asked about the proposal for a university hospital, Dr Reiff described the idea as realistic, but called for extensive planning and close cooperation with the four major hospitals in the country to better coordinate education, research, and further training.
The cooperation with the University of Luxembourg should be set in place to ensure proper medical education, a unified administration, and a harmonised recognition of qualifications.
On artificial intelligence in hospitals, Dr Reiff noted that AI is already being used in some specialities, such as radiology, but remains in its early stages. She welcomed the use of AI in a safe, protected setting, and suggested it could help by making documentation and administrative processes more efficient, freeing doctors' time for patient care.
There would be no such thing as a hospital ChatGPT, but rather a system that is fed with scientific data. Particularly when it comes to documentation, AI could make paperwork easier, allowing consultations to be documented immediately.
At the same time, she warns of the limits of current systems. AI may save doctors some time, but, with patients often coming in with AI-generated questions, consultations end up being longer and may even increase confusion among patients, since AI still makes many mistakes, Dr Reiff remarked.
