Health and social security: Reliable medical care in all regions
The DP advocates for an innovative, efficient and accessible health system with sustainable, transparent financing.
We want to give everyone quick access to high-quality care close to home. We need a clear vision for future development, with defined objectives and a coherent strategy.
Thanks to medical progress, outpatient care is continuously improving. Today, a large part of the medical services can be provided outside the hospital. By making outpatient care a central pillar of our health system, we are committed to ensuring that progress consistently benefits patients.
The Corona pandemic has shown us how valuable a solid health system is. Thanks to a great wave of solidarity and willingness to help, as well as the self-sacrificing commitment of the entire health staff, the Corona crisis was managed relatively well. In addition to the strengths of our health care system, the well-known weaknesses of our system were also ruthlessly exposed: Acute shortage of skilled workers, dependence on foreign countries for personnel and materials, lack of networking and cooperation between stakeholders, forced postponement of important preventive examinations. We will learn lessons from these experiences and improve the resilience of our health system.
The DP will pay special attention to the fight against the shortage of skilled workers. Demographic developments, especially increasing life expectancy, will place increasing demands on our health care system in the coming years. However, the shortage of qualified medical professionals is already being felt by many patients: Overworked staff, full waiting rooms in the emergency room, long waiting times for a specialist appointment or imaging (IRM examination, mammography), or the temporary closure of the maternity clinic in Ettelbrück are direct consequences of this development within the framework of a failed planned economy health policy.
Prevention must become a fundamental principle in health policy. To this end, we want to significantly increase the value of individual health promotion in all areas. Our goal is for a greater number of people to remain healthy for as long as possible.
To increase the attractiveness of our health location, the DP will create new framework conditions that will pave the way for innovative and demand-oriented medical care. In doing so, we will increasingly make use of the possibilities of digitisation. At the same time, we will upgrade the health system for all health professions and expand training opportunities.
At the same time, the DP will secure our social security system in the long term through stable and fair financing.
Prevention
For the DP, health prevention must become the guiding principle of our actions. We will change the perspective of the health system and raise prevention and early detection to the same level as curative medicine. In this sense, we support the development and implementation of a comprehensive national prevention strategy. In this context, we will subject all currently existing national screening and early detection programmes to a quality and efficiency review and, if necessary, adapt them to the new strategy. It goes without saying that the examination capacities for prevention and early detection must meet the demand in order to avoid waiting times.
We firmly believe that timely screening and early detection not only reduce individual health risks, but can also lead to significant cost savings in the health care system in the long term. For this reason, the DP will create a number of incentives to increase participation in screening and thus improve the chances of early disease detection.
As part of the prevention strategy, the DP will advocate for the introduction of regular and free health check-ups with the GP from the age of 30. The goal of this screening service is to identify potential risks for various diseases such as heart attacks, coronary heart disease or type 2 diabetes at an early stage. This is done through a thorough medical history and laboratory tests.
Currently, many pharmacies in this country offer a free screening test for diabetes. The DP will expand the range of services and offer screening tests for colorectal cancer or streptococci, for example.
To be tested for sexually transmitted diseases in Luxembourg, you have to go to a specific place for a medical examination. This is a potential barrier for some people – out of shame or fear – and can lead to them not getting tested. Self-testing, which can be done from home, removes existing barriers in the current system. Depending on the test, this can be done by a simple saliva, blood or urine sample sent by post to a laboratory. The results are then communicated digitally by e-mail or SMS. Furthermore, a test subscription is to be introduced, with which one can automatically have a test kit sent to one quarterly. People with changing sexual contacts should be encouraged to get tested regularly. Simplified and regular testing options provide reliable data on potential contagions. These in turn protect society as a whole.
We continue to place great emphasis on expanding school-based medical services, especially paediatric pre-examinations, in order to identify disease risks or mental health problems in children at an early stage. We will embed orthodox medicine in our overall strategy in the sense of coherent prevention and early detection from birth to old age.
Outpatient care
The DP strives to realise the full potential of outpatient care and to significantly increase its importance in the health care system. More than 80% of medical services can be provided outside hospitals today. We are committed to ensuring that this medical progress benefits patients across the board. The advantages of decentralised care are obvious: patients have shorter journeys and shorter waiting times, and thus better access to medicine, especially in rural areas. At the same time, the hospitals are relieved and can concentrate on their core tasks in the care of serious emergencies and complex clinical pictures.
The pandemic has made the movement of vaccination scepticism, which rejects the vaccination of under-age children against the corona virus, also clearly visible in Luxembourg. For this reason, we welcome the fact that minors aged 16 and over can decide for themselves to be vaccinated and that, for children aged 12 to 15, only the consent of one parent is required. However, the medical self-determination of minors should not only apply to vaccination, but also to other medical interventions and treatments.
Medical practices form the basis for comprehensive medical care close to home. The DP will take measures to make it more attractive for GPs and specialists to set up practices and thus expand primary health care in the country. In addition, we will improve the various incentives to promote group practices.
The reference doctor (“médecin référent”) should know the patients best and be their first contact in case of health problems. Unfortunately, the model has not caught on as hoped since its introduction almost twelve years ago. Both the number of insured people using the model and the participation of doctors in it are rather disappointing. The DP will review the reference doctor’s concept for its usefulness and adapt it if necessary.
The DP continues to advocate for the opening of at least one“Maison médicale” in the East district. In view of the population growth, we will review and, if necessary, adjust the number of these on-call houses for the general medical emergency service in the other districts.
To save parents and their children long journeys to the capital in case of an emergency, the DP is planning to establish more paediatric centres, including in the Northern District. The expansion of these centres will ensure better regional availability of medical care for children. This allows parents to more easily access specialised paediatric services when needed without having to travel long distances.
The demand for home health care is growing, especially among people with chronic diseases or disabilities. We want to enable patients to be cared for in their familiar surroundings for as long as possible. To this end, the DP will develop and implement an “out-of-hospital” action plan.
The DP will examine whether GPs on call in medical emergencies should be allowed to make use of a blue light to get to the scene as quickly as possible. In particular, patients in more rural areas who live further away from the nearest hospital could benefit from this measure.
The DP supports the establishment of birth centres. We want to offer women giving birth an alternative to giving birth in a clinic by allowing them to give birth to their children in a more intimate and familiar environment, accompanied by their midwife. However, the birth centre should be located near a hospital and networked with it to be able to provide medical help quickly in an emergency.
Digitisation
The DP advocates for a rapid digitisation of the health sector, taking into account the civil liberties of citizens and patients. For this, it is elementary that the legal and technical framework guarantees the highest protection and security of health data. We will promote the standardisation of data formats and the interoperability of technical solutions, thus laying the foundation for a regulated ecosystem in which patients and healthcare providers can communicate securely with each other. The DSP must be further developed in this sense and can become an important platform for exchange. By having a standard format of data, validated with an electronic signature by the healthcare provider, patients can build their own patient records, either within the DSP, or with a provider of their choice, and make them partially or fully accessible to the respective healthcare provider.
The DP recognises the potential of telemedicine as an essential component of the future health system. There are many possible applications, from remote diagnostics via transmission of medical images (telepathology) to home monitoring of patients. In future, we want to make greater use of the opportunities offered by digitisation to ensure better, more efficient and more flexible care for patients.
In the context of inpatient care in hospitals, but also in the monitoring of critical patients in nursing homes or at home, we intend to enable direct data collection and documentation “at the bedside” through the consistent use of digital aids and mobile devices. This part of the digital transformation of healthcare can help to significantly reduce the bureaucracy and workload of healthcare staff, while enabling more efficient collection and management of patient data. The time saved by digital tools will directly benefit patient care.
Similar to other European countries, we also want to introduce the digital doctor’s prescription in Luxembourg. In future, the prescriptions are to be stored together with the patient’s data, the doctor’s results and analyses in a digital dossier to which the entire health sector will have access. After identifying the patient, the pharmacist can immediately access the digital prescription that the doctor has saved in the dossier in advance. The patient should also be given the opportunity to digitally request a repeat of their medication. The e-prescription also offers the advantage that possible allergies can be automatically compared with the possible side effects of a medicine before the medicine is dispensed to the patient.
In the medium and long term, it should also be possible to redeem e-prescriptions across EU countries, as is already the case between Estonia and Finland.
In the run-up, we will ensure that all IT systems of doctors, hospitals, pharmacies and other health stakeholders are harmonised with each other to enable fast and secure data exchange.
The variety of health apps on the market is constantly growing. A wide range of apps for physical activity and health promotion can be found in the app stores. The DP will explore and, where appropriate, support the possibility of reimbursement for certain quality-assessed health apps prescribed by a doctor.
The DP wants to set up a medical video hotline for remote consultations to get in touch with a doctor at night and on weekends. This can ensure rapid initial diagnosis and referral, while reducing crowding in hospital emergency departments.
The DP is committed to realising the full potential of personalised medicine and to continuing to support research at the University of Luxembourg (Uni.lu) in this promising field. Access to more precise diagnoses and tailored treatment approaches will make a decisive contribution to improving medical care for patients.
At the moment, there is insufficient networking and a lack of interoperability between clinics, doctors’ practices, pharmacies, laboratories and the health insurance fund in Luxembourg. By introducing a uniform information system, relevant data and patient findings can be better recorded. This leads to an increase in cost and time efficiency in the health sector. It also enables the efficient processing of scientific data and counteracts misuse. DP attaches the highest importance to data protection and data security, which are guaranteed by appropriate legal and technical measures.
Miscellaneous
The DP wants to adopt a pandemic law based on the experience of the past years that will prepare our country in the best possible way for future epidemics and pandemics. The law is intended to provide clear guidelines to act quickly and effectively in the event of an outbreak, while ensuring sufficient flexibility to respond appropriately to the specific conditions of each crisis. We emphasise as a liberal party that the spirit of such a law must in any case be compatible with the inalienable liberties of every individual.
The DP will work to ensure that each hospital group has a residential home for health professionals. This dormitory is intended to benefit people who are still in training or are doing a temporary internship at the clinic. It is also intended to serve working people who have to travel longer or more tiring distances to work at times. Furthermore, the dormitory is to be available to people who are on call during the night. The goal of this measure is to counteract the shortage of medical professionals and to increase the attractiveness of both training and professional practice in the health sector. The ideal location of the residence is close to the main clinic of the respective hospital group, where the main emergency room is located.
The DP will work for a better integration of the liberal health professions (e.g. osteopathy, chiropractic, kinésithérapie, psychotherapy, etc.) into the national health system. The service catalogue of the respective health professions is to be continuously evaluated and supplemented if necessary. The goal is to create an overall concept nationally with the goal of establishing the greatest possible complementarity and cooperation between all health care professions. Clear quality criteria will serve to ensure an optimal treatment outcome. The independence of the liberal health professions should be preserved.
Larger emergency departments have the necessary diagnostic equipment (laboratory, radiology), human resources (doctors of different specialities, nurses, laboratory and radiology staff) and infrastructure to provide the necessary assistance quickly in an emergency. There are currently four major emergency departments in the hospitals. The DP will advocate for these to be supplemented by the creation of three additional larger emergency departments. The goal is to establish a larger emergency department for approximately 100,000 inhabitants. The three additional larger emergency departments will be set up in new structures yet to be created outside the hospitals and will be open daily from 6 am to around 11 pm. It will be ensured that the treating physicians are not exposed to any prescribing and treatment pressure. The nursing staff will be employed on similar conditions as in the hospitals. The establishment and operation of the laboratory and radiology infrastructures will be taken over by private sponsors in each case. To ensure a sufficient volume of activities, each major emergency department to be built will be attached to a medical centre.
Every citizen of our country has a right to health care that meets the highest standards. To ensure this, the DP will advocate for the creation of centres of excellence for each of the major clinical specialities, which on the one hand define the national minimum standards in their field, and on the other hand create national databases in which the treatment results of all patients are documented in a structured manner.
Complex infectious diseases occur in all specialities of medicine and surgery. If these infectious diseases are not treated properly, the affected patients often face a long period of suffering. The optimal treatment of complex infections requires a profound microbiological-internistic know-how as is inherent to the specialist in infectiology. The treatment concept is determined in a collegial exchange between the infectious disease specialist and the attending physicians. The DP will work to ensure that each hospital group has its own infectious disease specialist.
In the case of seriously injured patients, trauma surgery often decides not only between life and death, but also, in the case of survival, how the injuries will affect the accident victim’s quality of life and ability to work in the longer term. Trauma surgery and the way it is organised must therefore meet the highest quality standards. The DP will work to ensure that both the organisational process and the quality level of medical care in trauma surgery meet the highest criteria in future.
In its report on the pandemic response, the OECD praised a “rapid and agile response” to the unforeseen virus. For example, the excess mortality rate was lower than in other countries. Nevertheless, the OECD report also highlighted the challenges facing Luxembourg. The strong dependence on neighbouring countries and the low physician density were named as structural weaknesses of the health system. In order to be better prepared for a pandemic and its effects in the future, the DP will implement the individual recommendations of the OECD.
The DP will take measures to mitigate the risk of nosocomial infections in hospitals. There is a special focus on infection prevention. Guidelines and protocols are developed and implemented to minimise the occurrence and spread of nosocomial infections. In addition, the DP will ensure that specialised nurses are trained to monitor infection control compliance and implement best practices in this area. In addition, each hospital group is to receive its own specialist for infection prevention and control. These measures are intended to reduce nosocomial infections and increase patient safety in hospitals.
In emergencies, patients should not have to travel long distances. The DP will secure the locations of the regional emergency polyclinics in Wiltz, Niederkorn, Düdelingen and the Zitha Clinic (HRS) in the long term. This relieves the burden on the larger emergency departments and contributes to improved emergency care in both urban and rural areas.
All women have the right to bodily self-determination. We will strengthen this right by abolishing the three-day period after the compulsory counselling interview. In addition, we want to conduct a broad campaign and spread knowledge about medication abortion (“morning-after pill”) and its availability to all sections of the population so that the women concerned are spared the trauma of a surgical abortion.
The impact of rare diseases on the lives of those affected is often not sufficiently known in general society. This often leads to prejudice, from which sufferers suffer additionally. The DP will raise awareness among citizens about rare diseases and their impact in collaboration with stakeholders from the field. This includes the renewal of the National Plan on Rare Diseases for the period 2024-2029. In this context, the DP will also analyse to what extent the early detection of rare diseases in children can be expanded, create a register for rare diseases and investigate the introduction of a statute for long-term diseases.
Drones can facilitate the transport of cells, organs or blood transfusions. Defibrillators can also be flown to more rural areas with the help of drones, so that they can intervene more quickly in an emergency. The DP recognises the great advantages of technological progress and wants to examine the areas of application and the benefits of drones in this country.
The DP will establish a public fund to compensate unexpected incidents that are not due to malpractice by healthcare providers (so-called “aléa thérapeutique”). This strengthens the rights of patients. The fund is intended to make it possible to compensate patients whose treatment has resulted in an accident that is not due to a civil law error and thus cannot be tried in court. As it is currently the Red Cross that is liable should problems arise in connection with blood donations, this compensation fund will also help to finally put an end to discrimination against homosexual men when donating blood – a concern that has long been close to the DP’s heart.
The DP demands an end to discrimination against bi- and homosexual people. Access to blood donation should be based on the principle of “individual risk assessment” and independent of the donor’s sexual orientation.
In order to be able to react correctly in an emergency, everyone should know the basics of first aid. The DP proposes to expand the offer of first aid courses.
For doctors and other health professionals, participation in continuing education is mandatory, but there is no recognised system for providing evidence of the continuing education undertaken. We will work to introduce an internationally recognised system of “credit points” in the context of continuing education.
In order for the longer life expectancy to turn into more fulfilling and active years of life, the most important thing for the DP is to stay healthy or to recover as quickly as possible in the event of illness. In this context, the DP focuses on strengthening age-specific diagnostic and treatment services. In addition, we want to train specialist nurses for clinical geriatrics.
The DP will liberalise the currently strictly regulated pharmacy sector to improve access to prescription drugs. In this context, the DP will be guided by the proposals of the national competition authority in this regard. For example, the regulations regarding establishment are to be made less restrictive. In addition, the possibility should also be created to sell non-prescription medicines freely outside pharmacies, such as in supermarkets.
In a European comparison, Luxembourg is only in the middle of the pack when it comes to the availability of medicines for patients. The DP will work intensively on the approval process of medicines in Luxembourg in order to improve the availability of medicines for patients. We will also work to increase the use of generic medicines to minimise bottlenecks in the supply of medicines. We also advocate for better security of supply of medicines at the European level.
To improve the monitoring of medicines, the DP will intensify cooperation with pharmacists and push for the establishment of a medicines agency in Luxembourg.
Since January 2020, an agreement between the Ministry of Health and the Association of Insurance Companies regulates the right to be forgotten. Among other things, this has made life insurance more accessible to people who have survived cancer. The DP will assess the impact of this agreement and consider whether it should be extended to other disease patterns.
A pilot project on universal health coverage is currently under way. The DP will await the analysis of the pilot project and, if it is positive, will provide a legal basis for universal health coverage.
Since 2022, women in Luxembourg have had the option of having antenatal care with a midwife. However, the state ante-natal allowance is currently still linked to the perception of several medical examinations by a gynaecologist. In order to support expectant mothers in their decision to have antenatal care provided by a midwife, the DP will also allow the payment of the antenatal allowance to women who receive care exclusively from a midwife.
Every person with a life-limiting illness needs appreciative and professional medical care. Quality of life is strongly influenced by physical, psychological and social aspects.
The DP’s mission is to assist people in need of help and to support them with specialist staff. Be it in a familiar home environment or in a professional facility.
It is close to the DP’s heart that people are informed more intensively for a living will as well as the appointment of a trusted person. The DP will advocate for improved and more comprehensive palliative care to meet the needs of those affected.
In order to make the last stage of life of seriously ill children as loving as possible, the DP wants to examine to what extent it is possible to adapt the existing palliative structures to the needs of children. We will also promote appropriate education and training.
Euthanasia has been legal in Luxembourg since 2009. The DP will work to improve access to information. This includes strengthening the secretariat of the National Control and Evaluation Commission and establishing focal points in hospitals and the Ministry of Health. In addition, doctors who refuse euthanasia will be obliged to refer patients to these contact points. In this way, we want to ensure that those affected and their families receive comprehensive and clear information and receive appropriate support when making end-of-life decisions.
The Ministry of Higher Education has introduced several degree programmes in nursing at the University of Luxembourg. These include a bachelor’s degree in general nursing, four bachelor’s degrees in specialised nursing, a bachelor’s degree in midwifery, and a bachelor’s degree in “medical-technical assistant for radiology”. This is Luxembourg’s contribution to health education in the Greater Region.
As these bachelor’s degrees start at different academic years (the first one started in 2022/2023), the Democratic Party will analyse the progress of these new courses and make adjustments if necessary.
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Mental health
The DP sees mental health as a fundamental pillar of a fulfilled and healthy life. In the wake of the COVID-19 pandemic, the mental health of the population was severely tested. The supply situation received special attention. Luxembourg has several gaps in mental health care. For example, infrastructural and conceptual deficits as well as a lack of specialised staff and specialists have become clearly visible. Challenges such as stigma, prejudice and lack of mental health awareness risk exacerbating deficits in the future.
We will raise the profile of mental health and expand mental health services. Following the presentation of the National Mental Health Plan, there should be a clear political prioritisation of the proposed actions.
Mental and social health is an important part of the overall health aspect, which was clearly visible after the COVID situation. The current global and economic context can lead to malaise and the development of psychological and social impairments. The DP will work on a prevention strategy for mental and social health.
The DP advocates for the mental health and well-being of doctors and nurses who face challenging and stressful situations on a daily basis. In this context, we would like to make the right to mental health training and individual psychological counselling accessible to them in order to promote their own mental health. We are firmly convinced that these measures will not only benefit the professionals themselves, but will also noticeably improve the quality of care for patients.
The DP wants to make greater use of preventive measures. Since their launch in October 2020, the Mental Health First Aid courses have received a positive response and have seen significant success. We will therefore provide the necessary funds to expand this course offer in line with demand.
The DP wants to expand the continuing education programme for health professionals. The goal is to sharpen the ability to recognise warning signs of depression and suicidal danger in patients at an early stage and to react adequately.
The DP wants to launch a comprehensive awareness campaign on the topic of “Postnatal Depression”. We want to include not only mothers but also fathers. Our goal is to provide in-depth information and support to promote and deepen awareness and understanding of this important issue.
Psychiatric emergency rooms are overcrowded and there are hardly enough hospital beds for all patients. To improve this situation, the DP wants to conduct an analysis of the emergency rooms and their needs. Crisis centres with specialised staff and adequate infrastructure should be implemented. Possible regional/national synergies should be promoted. In addition, we want to expand the supply of hospital beds in both the acute and rehabilitation sectors in line with demand. In doing so, we will take greater account of demographic developments and also the needs of particularly vulnerable people. The outpatient conventional sector should be expanded and offer attractive working conditions for specialised staff and doctors.
In addition to existing inpatient services and outpatient child and adolescent psychiatric/psychotherapeutic practices, the DP is also committed to creating regional, out-of-hospital, multidisciplinary counselling centres. With this approach, we want to ensure holistic, needs-based and timely care and provide comprehensive support in the familiar surroundings of the young patients and their families or environment. Special needs should also be met according to need e.g. transitional psychiatry
In 2015, the law regulating the profession of psychotherapist was passed by parliament. The DP, in cooperation with all parties involved, is planning a review to determine whether the law has achieved its goals or whether specific adjustments are needed.
Luxembourg is one of the last countries in the EU where the profession of psychologist is not regulated. The DP wants to ensure high-quality psychological care and thus protect citizens from inadequately trained “pseudo-psychologists”. We will therefore advocate for the regulation of the profession.
Social security
The DP will simplify the lengthy procedures of the Nomenclature Commission and adapt the list of medical, dental and technical medical treatments more frequently to current developments in medicine.
Hospitals in Luxembourg are financed with an annual budget of over one billion euros, which corresponds to about 50% of CNS health expenditure. Unfortunately, the current budget framework is not transparent enough. To change this, the DP plans to revise hospital financing to ensure more transparent budgeting. In addition, it is considered whether activity-based funding, as practised in the liberal health professions, would be more sustainable for our health system in the long run.
In the event of a recall of a medical device, the affected patients must be informed immediately in order to avoid risks to their health. The DP will improve the procedures for monitoring the medical material and make them more transparent. Absolutely necessary data must be available in such situations. The Data Protection Regulation must not become an insurmountable barrier in the case of circumstances that endanger health.
The DP is committed to improving communication with all social security administrations. Particular care is taken to ensure that the messages are multilingual and easy to understand in order to avoid unnecessary queries and the loss of human resources. Because all too often, social security notifications are very complicated and confusing, which leads to delays in the processing procedure and thus to unnecessary costs.
The Democratic Party advocates suspending the 78-week sick leave count in the case of therapeutic leave on a half-time basis, as the effort of progressive return to work should not be penalised.
Various diseases – first and foremost cancer – not only require a long recovery phase, but are unfortunately always accompanied by relapses. Cancer patients are therefore increasingly exposed to the risk of exceeding the maximum limit of 78 weeks of sick leave within a two-year period, which leads to the loss of social insurance. The DP wants to establish special rules that protect patients in case of relapse and prevent the loss of social security.
Music and zoo therapy are used for mental disorders as well as for people with dementia, autism or specific physical illnesses. Music therapy is already legally recognised in eight European countries. The DP will promote the recognition of music and zoo therapy in Luxembourg.
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