Yuriko Backes, Minister of Finance; Paulette Lenert, Deputy Prime Minister, Minister of Health, Minister Delegate for Social Security; Credit: MSS

On Wednesday 4 May 2022, the quadripartite committee met at the Domaine Thermal in Mondorf-les-Bains under the chairmanship of Luxembourg's Deputy Prime Minister, Minister Delegate for Social Security and Minister of Health, Paulette Lenert, in close collaboration with Minister of Finance, Yuriko Backes.

The quadripartite committee first examined the financial situation of the health-maternity insurance, including the financial contribution of the State for the COVID-19 measures covered by the health-maternity insurance. Subsequently, the financial forecasts for the year 2022 were presented.

The quadripartite committee also took stock of the state of play with regard to improvements in care in dentistry as well as the progress of Gesondheetsdësch projects.

State participation in financing measures related to the COVID-19 health crisis

As part of the fight against the pandemic due to COVID-19 and its consequences, health insurance has had to finance certain measures, mainly extended leave for family reasons, a measure which is still applicable.

For measures going beyond health and maternity insurance, the Ministers of Social Security and Finance had undertaken to propose full financing of these measures by the State. This commitment was materialised by the special law of 15 December 2020 which sets the State's participation at a total amount of €386 million spread over four financial years: €200 million in 2020, then €62 million per year for 2021 to 2023.

As of 31 March 2022, all the COVID-19 measures covered by the National Health Fund (Caisse nationale de santé - CNS), but reimbursed by the State, had an overall cost of €417.5 million (net of charges advanced by the State for the CNS for an amount of €14 million). In 2021, extended leave for family reasons had cost €50 million, while the same device had a cost of €238 million in 2020. In 2022 (data as of 31 March), the cost was €11 million.

Ministers Lenert and Backes recalled the commitment made at the last meetings of the Quadripartite Committee on the subject, and underlined the difference between the cost borne at this stage by the CNS and the amount which already appears in the special law of funding. The latter will be analysed in more detail as part of the establishment of the State expenditure and revenue budget for the 2023 financial year with a view to proposing an adaptation of the special law.

In 2020 the government undertook to transfer to the CNS the amounts for measures related to the pandemic due to COVID-19, which was done via a special law at the end of 2020. Given the current situation, we are going to make a new financial point with the Minister of Finance so that the expenditure of the measures in 2021 and 2022 is also taken into account for the establishment of the 2023 State budget, whereas they are, initially, advanced by the CNS" commented Minister Lenert.

Financial situation of health-maternity insurance

The statement for the year 2021 shows that, despite the financial participation of the State in the measures linked to the COVID-19 health crisis at this stage amounting to €386 million, the financial situation of health and maternity insurance generates a negative operating result of €55.7 million, while the initial 2021 budget showed a deficit of €100.8 million. This difference is explained by slightly higher revenues (up €32.4 million) and slightly lower expenses than expected (down €12.6 million). However, the deficit of €55.7 million does not yet take into account an additional reimbursement by the State for the COVID-19 measures.

Non-negligible expenses linked to COVID-19 fall on health and maternity insurance (PCR tests on medical prescription, additional hospital costs, exemptions for pregnant women, etc.) and the evolution of expenses continues to be high to reach €3,632.0 million.

Although the economic context, the evolution of employment and therefore of the number of insured persons, is more favorable than initially forecast for 2021, the receipts, which were €3,576.3 million, cannot entirely compensate the evolution of expenditure in 2021.

The overall cumulative balance (global reserve) thus increases from €958.9 million in 2020 (25.4% of current expenditure) to €903.2 million in 2021 (24.9% of current expenditure). The reserve nevertheless remains well above the minimum limit of 10% set in the Social Security Code.

For the 2022 financial year, the latest estimates show a deficit of around €48.1 million for current operations. The overall cumulative balance should thus decrease to €855.2 million (excluding additional state participation for COVID-19 measures), i.e. 22.1% of estimated current expenditure for 2022.

The forecasts therefore confirm a trend of a deficit in current operations in the medium and long term of the health and maternity insurance budget. The quadripartite committee thus decided, on the proposal of Minister Lenert, to create a working group made up of the Ministry of Social Security, the National Health Fund, the social partners, the General Inspectorate of Social Security and the General Inspectorate of Finance, in order to analyse and propose possible avenues which should make it possible to ensure financial balance. The conclusions of this work will be presented and discussed during the quadripartite committee in the fall.

Minister Lenert welcomed this decision and underlined: “the commitments made in the past in terms of improving the management of benefits, part of which still remains to be implemented, are not called into question. Beyond that, policyholders should not be penalised by a deficit situation. The sickness-maternity insurance reserve makes it possible to cover the deficit for the years to come. This provides enough time to analyse and discuss different leads in good time".

Improved dental care benefits

As announced during the last meetings of the quadripartite committee, Minister Lenert recalled that “improvements in the management of dental medicine are being developed to be presented at the next meeting of the committee. They will then be implemented as soon as possible".

These improvements complement the measures already implemented. The latest is the adaptation of the practical arrangements for the reimbursement of the second scaling, which have been made more flexible since the beginning of the year in order to allow everyone to benefit from a reimbursement of two scaling sessions per year.

Finally, Minister Lenert took stock of the progress of the Gesondheetsdësch and the quadripartite committee discussed the priorities in this area.