Defending the viability of the sickness and maternity insurance system


UEL’s leitmotiv is to guarantee an efficient and accessible healthcare system, while ensuring its financial sustainability and promoting the accountability of all stakeholders.

A high-performing, accessible and sustainable healthcare system is the key to meeting the challenges it faces, including an ageing population and access to quality care for all. Health, well-being at work, social protection and solidarity between generations are all factors that contribute to economic and social attractiveness and underpin social peace.

In line with our previous publication on the busy social calendar, UEL takes a closer look at the 2023 budget for maternity and sickness insurance (AMM), approved on 9 November by the CNS Board of Directors.

The trend in the AMM’s financial situation is alarming, as illustrated by the multi-year budget forecasts determined by an uncertain geopolitical, economic and social environment. Since 2018, structural expenditure has been increasing faster than revenue. A detailed and transparent analysis of the efficiency of expenditure is urgently needed and is the subject of a working group decided at the Quadripartite meeting in May 2022.

For UEL, a reversal of this undesirable situation would first require clarification of governance and of the missions and roles of the various players necessary for the proper functioning of the healthcare system. It is important to promote transparent, balanced and independent representation of all interests, and to continue to ensure that funding for marketing authorisations is decoupled from short-term political decisions.

In its 2022 report on the AMM’s financial situation, the General Inspectorate of Social Security also called for “caution in all actions aimed at making even minor structural changes to the organisation of the AMM, both in terms of the reimbursement of services and in terms of revenue“.

With a view to preserving the system’s financial health in the long term, steering instruments need to be improved – for example, through self-regulation mechanisms for expenditure – and this would enable the players involved to comply with the concept set out in article 23 of the Social Security Code:

The benefits payable by the health insurance scheme as a result of medical prescriptions and orders must correspond as closely as possible to the insured person’s state of health. The benefits paid by the health insurance scheme may not exceed what is necessary and useful, and must be provided with the strictest economy compatible with the effectiveness of the treatment and in accordance with scientific knowledge and medical ethics“.

It is in this spirit that a number of avenues advocated by a UEL are taking shape:

  • Clear, consistent, representative and independent governance
  • A national health strategy with an action plan and a roadmap
  • Close collaboration between all social security and health institutions, with a focus on complementarity between the various players.
  • Accelerated digitisation and accessibility of health data
  • Transparency of healthcare services and prescribers
  • An assessment of what is useful and what is necessary in the context of medical progress
  • Severe penalties for refusal to cooperate and for combating abuse
  • Assessment and capping of the use of certain services

Recent discussions about the shift to out-of-hospital care and the high financial expectations of certain healthcare professionals point to growing tensions around the AMM budget and give rise to fears that principles such as generalised contractual agreements, which have proved their worth, are reaching their limits. The decision-makers gathered around the Gesondheetsdësch will have to consider a new, more selective approach to the supply and demand of services, coupled with quality control.

The various measures to be adopted must strike the right balance between equal access to quality care, the needs of patients, the shortage of healthcare professionals and the viability of the system.