The National Health Fund (CNS) is facing a financial deficit, and according to forecasts, its reserves will become so low next year that contribution rates will have to be increased.
As agreed at the quadripartite meeting, task forces will continue their work until the autumn to develop measures aimed at curbing the rise in expenditure. In an interview with RTL, CNS director José Balanzategui explained two parallel objectives: the system must become more efficient in order to avoid an increase in contributions, without this coming at the expense of patients.
According to the president and director of the CNS, waste in foreign health systems is estimated at between 15% and 20%. Balanzategui questions why the situation would be any different in Luxembourg. Did the CNS need to show deficits for the country to stop throwing money down the drain? "We didn't wait to get to that point", he asserted. As early as 2015–2016, certain budget items had already "gotten out of hand", and countermeasures were taken. The CNS director cites physiotherapy and laboratory analyses as particular examples. He acknowledges, however, that this was "clearly" not enough, while noting that needs are increasing with an ageing population and that new therapeutic options and effective drugs are constantly being introduced.
The "search for causes" continues in order to act in a "targeted" manner. One example: why does the number of sick-leave cases that are taken over by the CNS after 77 days continue to increase? Balanzategui stressed that he has no "factual indication" that people are on sick leave because they prefer to stay at home. According to him, "the cases that generate the most costs, so to speak, are long-term ones. It is not short-term sick leave." All sectors are affected, but the health and construction sectors in particular. Alongside prevention and more targeted checks – though Balanzategui again made clear that he has no indication that people are taking long-term sick leave when they could be working – he mentioned the possibility of asking doctors to provide more precise coding of causes on their certificates. The same applies to another example: physiotherapy, where expenditure has continued to rise despite countermeasures.
The list of budget items to be examined is long, ranging from the length of hospital stays to the prescription of generic drugs instead of more expensive medicines. The largest item, however, remains physician remuneration. On this subject, RTL asked why the amounts received by radiologists have skyrocketed, rising from €600,000 five years ago to nearly €950,000. The CNS director replied that a process to modernise the nomenclature is under way. The CNS negotiates tariffs with the specialists concerned, and it will soon be the radiologists' turn.
"It is no longer the radiology of 30 years ago; it has become a different job", Balanzategui explained, "I think that, in this context, we must indeed review the coefficients of their procedures." This would offer an opportunity to identify, "with them," where "price distortions" could be corrected within the nomenclature.
Is this likely to provoke opposition from doctors? Especially when the Association of Doctors and Dentists (AMMD) is already in conflict with the government and has revoked its agreements with the CNS? According to the CNS director, "as soon as it's a question of money" – whether lower revenues or correspondingly smaller increases – "it's obviously never a pleasant discussion." Conflicts could arise, but he says he is "very hopeful" about the possibility of finding compromises, as has been the case with other specialists.
The AMMD has made several demands, including the withdrawal of the "personal convenience" clause from the agreements with the CNS, given that this fee supplement is not reimbursed. The CNS director is convinced that this would de facto lead to a two-tier healthcare system – an outcome that Prime Minister Luc Frieden nonetheless ruled out in his state of the nation address. It therefore seems that Luxembourg is moving towards a Grand-Ducal regulation that will replace the agreements.
The AMMD also wants to attract more doctors to Luxembourg in order to reduce waiting times. The CNS director points out, first, that the "medical population" in Luxembourg is increasing. Additionally, he believes waiting times are relative and depend on the specialty: "anyone can put it to the test." He considers that there is no widespread "access problem" to medicine in Luxembourg, with the exception of psychiatry, where – as in other countries – there is a shortage.
When asked the provocative question of whether the CNS respects the Hippocratic Oath or functions like a bank, Balanzategui replied calmly: "We are certainly not a bank." The CNS must ensure that policyholders, when ill, receive the right care at the right time, but also "at the best price." He also endorsed the statement by Health Minister Martine Deprez that the healthcare system will not become any less expensive.
