The ongoing dispute between doctors and the National Health Fund (CNS) has kept politicians busy reiterating the importance of Luxembourg’s convention-based healthcare model.
This comes even as the current conventions between the Medical Association (AMMD) and CNS are set to expire at the end of the month, meaning reimbursements will then have to be managed through regulatory measures rather than a negotiated agreement.
Meanwhile, psychotherapists have already been working under a ministerial regulation for four years, which, according to their association Fapsylux, is functioning adequately.
As a result, Fapsylux does not feel pressed to sign the ready-to-go convention with the CNS, even though the document has been finalised and is simply waiting in a drawer.
This situation has persisted for two years, not just recently. Officially, the CNS maintains that the convention still needs to be reviewed by the health fund’s legal service, a process that appears to be taking considerable time.
According to Alain Massen, treasurer of Fapsylux, there have been no new developments communicated to the association.
Fapsylux followed up on the matter before the summer and was told that the process would require more time.
The association is now waiting to see what happens with the AMMD negotiations before taking further steps, and there has been no contact since then.
When asked whether Fapsylux itself is pushing for the convention to be signed, Massen explained that negotiations had been concluded and a way forward with CNS had already been found.
Despite following up multiple times, Fapsylux members are able to work under the existing regulation, so the association is not actively pursuing the convention. Any new proposals from CNS would be reviewed and discussed before making a decision.
The current ministerial regulation, in place since 2015 when psychotherapists were granted legal recognition, provides practitioners with a certain amount of flexibility.
In the current tense political climate, Fapsylux does not wish to be misinterpreted; the association is not fundamentally opposed to a negotiated convention.
Massen emphasised that the convention does have its benefits, and Fapsylux is not against having such an agreement in principle.
One significant benefit of a convention would be the ability to guarantee quality control and allow patients to settle their bills using PID (immediate direct payment).
Up to now, Fapsylux has always been told that PID is only available if a convention is in place.
It remains to be seen what will happen if the doctors’ convention lapses or is replaced—specifically, whether PID will be rolled back or if it will become possible to use it without a convention.
Should PID remain available for doctors without a convention, Fapsylux intends to argue that the same should apply to psychotherapists, resolving this question even without an agreement.
Negotiations between Fapsylux and the CNS have a long history. In 2022, following years of unsuccessful talks over session fees, then-Minister of Social Security Claude Haagen intervened and set a fixed fee by regulation.
This supplement is now no longer available, and although the rates have increased with indexation in recent years, they remain below the €175 per hour that Fapsylux originally demanded during protracted negotiations with the CNS.
The initial concern from the CNS that high session fees would lead to a flood of psychotherapists setting up practice in Luxembourg has not come to pass, according to Massen.
In fact, Fapsylux is grateful for every psychotherapist who chooses to settle in the Grand Duchy.
Currently, the demand for psychotherapists far outstrips supply. Many practitioners are not accepting new patients, as clearly stated on their websites.
The waiting time for a first appointment as a new patient is still around six months, which is no improvement on the situation faced by psychiatrists, where such delays have persisted for years.
This comes at a time when mental health is a significant concern, particularly during the current Mental Health Week.
