Unions and opposition parties have voiced concerns that the solidarity-based healthcare system in Luxembourg could be undermined following the decision by the Luxembourg Association of Doctors and Dentists (AMMD) to reject a new agreement with the National Health Fund (CNS). However, both the unions and the opposition acknowledge that the current system needs reform, particularly in the area of medical practice and remuneration.
The current agreement between doctors and the CNS is set to expire in October. With AMMD unwilling to sign a new deal, the government intends to set the legal framework through a Grand Ducal regulation.
According to the AMMD, this situation is the result of negotiations during which neither political leaders nor the CNS were prepared to make necessary changes. The doctors' association has cited issues with the modernisation of medical practice and the revaluation of tariffs as major sticking points.
For the Independent Luxembourg Trade Union Confederation (OGBL), the dispute goes beyond a failed negotiation.
OGBL president Nora Back has described it as a "black day for healthcare in Luxembourg", warning that today, healthcare is no longer guaranteed. She emphasises that their initial response is that this situation is dangerous and not beneficial, neither for insured persons nor for the security of the entire system.
The OGBL fears that, without an agreement, Luxembourg could move towards a two-tier healthcare system. The AMMD, however, has rejected this accusation, insisting the core issue is the need for greater freedom in organising medical practice and setting tariffs.
The Luxembourg Confederation of Christian Trade Unions (LCGB) has so far declined to comment on the issue, simply acknowledging that the agreement will not be signed by the AMMD.
The Association of Salaried Hospital Doctors (MSH) has also expressed disappointment at the current situation.
According to its representative, Monique Reiff, the positions of the different parties have hardened in recent months. She emphasised the need to restore communication to ensure progress for the healthcare system.
The MSH said it can understand some of the doctors' criticism. In particular, communication regarding the revaluation of the 'lettres-clés' – the key indicators that determine medical tariffs – was problematic. The proposed 1.34% increase was rejected due to demands for the maximum rate, ultimately resulting in no revaluation.
Reiff said that this was unfortunate communication, adding that such revaluations have a direct impact on hospitals' functioning.
At the same time, Reiff noted it is difficult to accept that tariffs and the issue of 'convenance personnelle' – additional charges doctors may bill to patients beyond the official tariff –should be central to the current dispute.
From a hospital perspective, she argued, far more fundamental questions should be addressed, such as the development of medical practice, new scientific knowledge, university medical education and a teaching hospital, as well as digitalisation. She stressed that they want to pursue a path of digitalisation and regrets that currently, none of these issues are even being discussed despite it being the perfect time to address them.
Luxembourg Socialist Workers' Party (LSAP) MP Mars Di Bartolomeo has also raised concerns about the AMMD's decision, regretting a departure from a system based on dialogue. He warns the risk now is that the government will ultimately set the rules by regulation.
He is particularly opposed to the idea of greater freedom for doctors to set their own rates. Tariffs, he said, must remain transparent for patients. If doctors were free to set prices and the CNS only defined what is reimbursed, this could lead to greater financial inequality among patients. He argued that what the tariff is and what the patient’s own contribution is must be clear and visible for patients. In his view, such a system could pave the way for a two-tier healthcare system.
Di Bartolomeo also pointed out that there are already significant income differences among doctors. He argued that the distribution of overall revenue should also be debated, and that tariffs should be regularly adjusted to reflect the complexity and time required for medical procedures.
When it comes to attributing blame for the current impasse, Nora Back is reluctant to take sides. She noted that, on the one hand, the government had made promises in the past that it has now been unable to keep, angering doctors and the AMMD. On the other hand, the doctors’ association has, in the eyes of the union, "to a certain extent radicalised", and it is not clear if the AMMD represents the views of all doctors.
The MSH does not only view the termination of the current agreement as a problem; it could also be an opportunity to modernise the system. The existing agreement dates back to 1993 and has only been supplemented by various addenda since then.
Both the medical system and Luxembourg society have evolved considerably since then, so it would make sense to negotiate a new, more modern agreement. The MSH is therefore seeking to resume talks with all relevant parties: the AMMD, the CNS, and the Ministry of Health. Mars Di Bartolomeo also hopes that the door to dialogue remains open. Despite the challenges facing the healthcare system, he believes empty chair politics is not the answer. He stresses that these problems can only be solved together, not by assigning blame.
The current agreement will expire in October. For patients, nothing will change immediately. Tariffs and reimbursements are expected to remain the same for the time being, even after the agreement ends.
