POLITICS & INSTITUTIONS - INSTITUTIONS

Reimbursements

LCGB calls for more modern health fund



With hope of a way out of the health crisis on the horizon, the LCGB has decided to dig out files that were already pending before the pandemic, including the modernisation of the services of the National Health Fund.  (Photo: Caroline Martin)

With hope of a way out of the health crisis on the horizon, the LCGB has decided to dig out files that were already pending before the pandemic, including the modernisation of the services of the National Health Fund.  (Photo: Caroline Martin)

Labour union LCGB on Thursday presented its demands for modernising Luxembourg’s national health fund, the CNS, shortly after social security minister Romain Schneider (LSAP) announced his political retirement in 2023.  

The LCGB had made healthcare a priority issue for the new school year,  presenting a set of demands from the government on Thursday. But the conference was overshadowed by fears that Schneider might not finish his mandate after announcing he would not stand for election in 2023.

"We have a minister of health who is also minister delegate for social security. We don't know what minister Romain Schneider's intentions are until the next elections. If he decides to leave before the end of his mandate, he will be replaced by another person and we will lose six months for this person to get to know the files. It is up to the government to clarify the situation in order to move forward," said Christophe Knebeler, LCGB deputy secretary general.

With the health system recovering from the pandemic, the LCGB decided to resurface issues that were already pending before the March 2020 coronavirus outbreak,  including the modernisation of CNS services.

And the list is long, from updating the nomenclature for the reimbursement of care, particularly dental care, to the need to extend social third-party payment pending the general implementation of the system in 2023.

Last year, out of 879,932 insured persons affiliated to the national healthcare and maternity insurance scheme, 5,367 people benefitted from the social third-party payment scheme, including 2,222 to cover dental treatment. This means they do not have to bills up-front to be reimbursed, but the CNS covers treatment straight away.

"If all goes well, this is planned for 2023,” Knebeler said of the third-party payer principle. “But in the meantime, what should we say to people who cannot afford to go to the dentist, because they have to pay a lot of money in advance? Wait until 2023?! We have already told the government that we need to find intermediate solutions for people who have financial problems. This is a long-term issue. Dental problems are often accompanied by other, sometimes very serious, health problems. In other words, this generates additional health problems for the CNS, because the insured person is not in a financial position to go to a dental consultation.”

If we don't act now, it will be too late in three to four years.

Christophe KnebelerDeputy secretary generalLCGB

The trade unionist went on to list a number of other demands, such as the abolition of the 78-week limit on sickness (beyond which the employee's contract of employment is automatically terminated), a rapid and effective revision of medical nomenclatures, and an effective national strategy for the digitalisation of health care, an assessment and legal framework for remote consultations, improving the processing time of reimbursements, a common solution for residents and cross-border commuters in the area of electronic incapacity to work certificates (e-CIT), or salary continuation for insured persons declared able to work but unfit for their previous job.

The LCGB also asked for more transparency and precision on the financial impact of the 19 “Gesondheetsdësch” projects. The “Gesondheetsdësch” is an initiative by the governement with healthcare providers and other partners to assess the state of the health system and identify issues that need to be tackled.

Knebeler also worries about finances and a decrease in the CNS budget linked to extra pandemic expenses. "If we don't act now, it will be too late in three to four years. That is why we are asking the government to act now. On our side, we don't have a legislative deadline. We are asking for changes now or never," said the LCGB's deputy secretary general.

The flop of the shared medical file

Knebeler also addressed the electronic shared medical file (dossier de soins partagé – DSP). "The DSP was announced as a great success, but in reality it is a flop,” he said. "We all received a letter giving us access to the DSP. But nobody has created their access, or very few. According to statistics, almost 90% of people have not created their access. And for those who have, there is no real health benefit. From the professionals' side, the feedback we have is that it is difficult to use. It is complicated and not well thought out. In the end, nobody uses it. Most of the documents that you find in your PHR are PCR tests. It's nice to have a collection of PCR tests, but I don't think that was the purpose of the DSP. The only advantage is not having to keep the hard copy. But what is the benefit to my health? It is dramatic to see such a result on a file we have worked on for years, and then say that it is a success when it is not," Knebeler said.

Last June, according to the ministers of health and social security, only 12% of the holders of one of the 915,000 shared medical files had activated it, and 0.16% had asked for it to be closed.

This story was first published in French on Paperjam. It has been translated and edited for Delano.