«The healthcare challenge of small Luxembourg for Europe: stronger on drug prices»

TrendSanità in conversation with Xavier Schoubben, a professional with twenty years of experience in the Luxembourg healthcare system

«The shortage of academic institutions in the medical and pharmaceutical sectors represents a significant challenge that requires continuous attention»

Luxembourg emerges as an interesting and peculiar case when discussing European healthcare services. With a population of around 653 thousand inhabitants, significantly increasing over the last twenty years, the country faces challenges and opportunities related to managing healthcare services in a context of dynamic growth and social transformation. It is worth noting that Luxembourg is the first country in Europe in terms of per capita healthcare spending, but with 5.7% in the ratio of healthcare spending to GDP, it ranks last on this parameter.

TrendSanità discusses this with pharmacist Xavier Schoubben, a professional with twenty years of experience in the Luxembourg healthcare system. Schoubben shares strengths and weaknesses of the country’s healthcare system, offering an insider’s perspective on access to medical care, financial challenges, and future prospects.

Luxembourg’s healthcare service is based on a mandatory health insurance system known as the Caisse d’Assurance Maladie. A key element of this system is represented by the Caisse Nationale de Santé (CNS), or National Health Fund, which ensures mandatory health insurance for every citizen. The system provides automatic affiliation for employed workers, managed by employers, while there are specific provisions for those outside the labor market.

Money and accessibility, the country’s strengths

Xavier Schoubben

Schoubben highlights the significant financial advantage resulting from population growth and the contribution of cross-border workers, who contribute to the healthcare system without fully burdening its resources: “Around 700 thousand people live in Luxembourg, 20 years ago there were only 450 thousand (+55%). Additionally, about 226 thousand people cross the border every day. These people contribute to the healthcare system and pay taxes but do not live in the country – continues the pharmacist -. These cross-border workers can use the healthcare system, but for example, their children do not go to school in Luxembourg, they do not use the infrastructure because they leave the country every evening for their country of origin (among the most common, Belgium, France, and Germany). So, the amount of money available for the healthcare system is certainly higher compared to other European countries”.

Furthermore, the country guarantees universal accessibility to medical care “even if you don’t have a job, you can still be covered by the healthcare system. If you are outside the system, there are also some associations that help vulnerable groups”, explains the healthcare professional.

Despite the financial advantages, Schoubben identifies the lack of a long-standing medical tradition in Luxembourg as one of the weaknesses of the healthcare system. The lack of academic institutions in the medical and pharmaceutical sectors represents a significant challenge that requires ongoing attention: “The medical tradition in Luxembourg is not as established as in other European countries. In Luxembourg, there are no faculties of medicine or pharmacy, for example”.

Financial sustainability and logistical challenge

In the last two years, with the country facing a budget deficit, the government faces new challenges. However, Schoubben states: “This is a new problem for Luxembourg; the government is observing the situation’s evolution and its recovery because the budget has been in deficit for only two years”. Considering other issues the government is reflecting on, such as the hot topic of medical care reimbursements, “the only solution being proposed is to reduce the price the patient has to pay when visiting the doctor. The patient is still reimbursed within two weeks, but some people have liquidity problems, and advancing those sums is becoming an issue – adds the pharmacist -. The CNS would like to have the same system for doctors as it has for pharmacies: the patient pays only their part, which is automatically and immediately reimbursed. But the government is still discussing this with doctors. It should be done in the next two or at most three years”.

Despite its modest size, Luxembourg, with an area twice that of Rome, faces an interesting logistical challenge in ensuring fair access to healthcare services throughout the national territory: “Population density is quite high in Luxembourg. Most citizens live in the center and south of the country; it might be more difficult to find a hospital in the north… – Schoubben continues -. But I would like to remind you of the size of the country, more or less 2600 square kilometers, maximum 55 km from west to east and 110 km from north to south. Luxembourg has 13 hospitals. A hospital will never be so unreachable”.

In tomorrow’s Europe, let’s not leave pharmacists behind

Looking to the future, every country emphasizes the importance of efficiency in the healthcare system, encouraging patients to be more responsible in their use of medications and promoting a more sustainable and collaborative approach to ensuring high-quality medical care for all citizens. In one of the concluding notes, Schoubben emphasizes: “Let’s not forget about pharmacists. We played a key role during the COVID-19 pandemic; now more than ever, we need to encourage patients to be more responsible in their use of medications, think about the use of antibiotics and the growing danger of antibiotic resistance. A challenge for tomorrow’s Europe”.

Finally, the issue of drug supply and medicine in the European dimension is worth highlighting, all aspects that have emerged clearly during the pandemic. Crucial knots to be addressed with determination and vision on which Schoubben concludes his considerations: “For drugs, the competition among European states is too great. Pharmaceutical companies can sell the same products at very different prices in each country; this mechanism will continue to favor countries where the companies’ interests are greater. Europe should be stronger – as it was during the pandemic – by continuing to insist on a European price for drugs. Medicine should not be a commercial value. Every patient in Europe should have the same opportunities”.

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Carmine Iorio
Laureato in Farmacia. Dottorando in Etica della Comunicazione, della ricerca scientifica e dell’innovazione tecnologica, Università degli Studi di Perugia