In Luxembourg: Health and maternity insurance falls into the red again

“I am an optimist by nature.” Martine Deprez, Minister of Health and Social Security, was all smiles this Wednesday at the Opderschmelz Cultural Center in Dudelange, at the end of the annual meeting of the quadripartite committee on health and maternity insurance.

In terms of methodology, this traditional meeting, provided for in the legal framework, consists of “discussing avenues to rework, before possibly meeting again in May to discuss the alternatives to put in place, and decide whether or not to raise the contribution level. We have not discussed any scenario today,” the minister likes to say.

But beyond this facade formalism, this quadripartite committee is above all an opportunity to take stock of a theme likely to create tensions: the scanning of the financial situation of the National Health Fund (CNS). “The 2023 financial year ended with a bonus of 100.1 million euros” in terms of current operations, says Martine Deprez. According to estimates “which remain to be verified, we are counting on a deficit of around 37.9 million euros for 2024,” she continues.

A figure which is explained by an increase in expenses of 9.1% to reach 4,581.3 million euros, while revenues only increased by 5.1%, to settle at 4,543. 4 million euros. This means that the overall cumulative balance, i.e. the CNS reserves, will increase from 961.7 million euros in 2023 to 923.8 million euros in 2024 (i.e. 20.2% of all current expenditure, a rate significantly higher than the legal minimum of 10%).

For Martine Deprez, this numerical development is “due to a reduction in the payroll which leads to a reduction in the volume of contributions. “They are no longer able to provide the services that will be delivered.” As for the projections for 2025, they show “a deficit of around 160.7 million euros, because the increase in expenditure remains high”, according to the minister.

Thus, she continues, “the cumulative overall balance would decrease to 763.1 million euros. The forecasts confirm the trend towards a financial imbalance for current operations in the medium and long term at the level of the health and maternity insurance budget. Also present at the meeting of the quadripartite committee, the unions, as a united front, had aired their grievances in advance. And among these, a plea for a refocusing of CNS spending on its main activity, and in particular a shift from maternity coverage and costs linked to hospital infrastructure to the state budget.

On a purely financial level, “the state budget already provides 20 million euros in transfers, which can be increased up to 38 million, for maternity benefits, and between 10 and 20 million for infrastructure hospitable. These are therefore not enormous sums, but they are relatively important for the CNS.

On the other hand, it is more the legal basis which is stuck on these two subjects. “I will try to see if it is possible to change the legal basis and transfer them to the state budget. This is work that I will tackle in the coming months, and I will deliver my conclusions in this regard to the social partners in May.

Also demanded by the unions, a possible improvement in dental care services “does not fall within the ministerial decision-making sphere,” says Martine Deprez. “It is the responsibility of the CNS board of directors to decide what it wishes to improve or not, an exercise carried out constantly since 2016. I have no leverage on this point.”