The State System
The state provides free basic health cover to all citizens and the Caisse de Maladie collects healthcare contributions. All employed citizens and their employers contribute to the system. Employers deduct each employee’s contributions directly from their salaries. The average contribution is around 5.44 percent of gross income, with a maximum contribution of 6,225 EUR. Employees and employers pay half each. Self-employed people must make their own contributions and the amount they pay depends upon their profession. Most manual workers and their employers pay 9.9 percent, divided equally between both parties. State benefits to vulnerable groups is paid net of healthcare contributions as thought the benefit authority was paying the contributions in a way an employer would. The rate amounts to 5.2 percent divided equally between the benefit authority and the beneficiary.
All dependant family members are covered by contributing family members. Students and unemployed children are covered up until 27 years of age.
State healthcare covers the majority of treatment provided by GPs and specialists as well as laboratory tests, pregnancy, childbirth, rehabilitation, prescriptions and hospitalisation.
Long-term care is financed through separate insurance called assurance dépendence.
Foreigners who wish to reside in the country without working (e.g. pensioners) must show proof of health insurance when they apply for their residence permit.
Private Health Insurance
Ninety-nine percent of the population are covered by the state health scheme, but many people take out additional private insurance to supplement the services offered by the state. This insurance is usually supplied through non-profit agencies or mutual associations called mutuelles. They are allied to the Ministry of Social Security. Some mutuelles pay for medical care outside of Luxembourg as well as optical and dental care. Fees for additional cover are low, but you have to pay for each dependant family member.
All medical fees in the country are decided by the Caisse de Maladie. Fees are revised on an annual basis in conjunction with the Union of Sickness Funds and those groups, which represent the healthcare professionals. By law, all healthcare providers must observe these fees and there are strict penalties for abuse of the system. Vulnerable groups are not obliged to pay any charges. Doctors’ appointments and referrals to a specialist are free. The patient has to pay all costs and then submit receipts to the Caisse de Maladie for reimbursement. The amount you will receive as a reimbursement varies from 80 percent to 100 percent. Thus, the first consultation is reimbursed at 80 percent and further consultations, which occur within 28 days are reimbursed at 95 percent.
Usually the reimbursement for prescription medicine is 78 percent, though there are four categories of reimbursement for prescription medicine and levels range from 0 percent to 100 percent.
Dental and optical treatment also qualifies for reimbursement, but some services must be pre-approved and may require you to have annual check-ups.
Emergency treatment in a neighbouring country may also qualify for reimbursement at the same rates as in Luxembourg.
Doctors and Health Centres
Citizens can register with the doctor of their choice, however, people seeking state medical care must make sure that their doctor is contracted into the state scheme. If you are treated by anyone other than a state funded doctor, you will have to pay the fees yourself. Doctors do not provide full explanations regarding medical conditions to their patients and do not expect a lot of questions or unease.
GPs have different hours to most countries (they are closed on Wednesday afternoons) and they either operate on an appointment basis known as a rendezvous, hold ‘walk-in’ surgeries or operate a combination of the two. There may be long queues for walk in surgeries and some doctors operate a supermarket style ticket system. Making an appointment with the GP is usually possible the same day.
Doctors will make house visits, and often prefer this than have you share your germs in the surgery. House visits are usually limited to a certain time of day.
GPs prescribe drugs, treat acute and chronic illnesses, and provide preventive care and health education.
Consultants are senior doctors who have completed a higher level of specialised training. You do not need a doctors’ referral to consult with a specialist doctor, but you must make an appointment first. There are numerous specialist fields of medicine in Luxembourg like gynaecology, oncology, paediatrics and dermatology.
Hospitals can be identified by the international sign of a blue background with a white ‘H’ on. Private hospitals do not exist in Luxembourg, all hospitals being run by the Caisse de Maladie. You must have a referral from your doctor for an admission to hospital if your case is not an emergency.
In addition to general hospitals, Luxembourg also has specialist hospitals. There are three groups of hospital service and the group you belong to depends on the insurance contributions you make or the private health cover you have. First class service entitles you to a private room, but you must pay part of the additional costs unless your insurance company covers you for this. Second class service entitles you to a room with two to three other patients. This is the most popular group in the country. Third class service entitles you to stay on a ward with over three patients.
Emergency care is provided by the emergency department at large hospitals and is known as cas d’urgence or spoedgeval. Treatment is free even if you have no insurance.
There is a rota for hospitals, which do not have regular emergency departments. You can find out which hospital is providing emergency care in your area by consulting the local newspapers, although each pharmacy displays the name of the duty hospital in its window.
Dentists are known as dentistes, in Luxembourg and treatment is of a very high standard. Citizens are free to register with the dentist of their choice, but levels of reimbursement will depend on whether your dentist has a contract with the Caisse de Maladie. Major dental work, like crowns and bridges, requires pre-approval from the Caisse de Maladie or your health insurer.
Pharmacies can be identified by a sign displaying a large luminous green cross. Pharmacies are strictly regulated in the sale of all drugs including over-the-counter medicines. Pharmacies are usually the only places that sell drugs and healthcare products.
The pharmacist may ask for a description of your symptoms before selling you over-the-counter medicine. Pharmacists are held responsible for selling drugs or remedies, which further illness or result in adverse side effects - even if the drugs concerned were prescribed by a doctor.
Only doctors and consultants can prescribe medicine. Non-prescription drugs are priced higher than prescription drugs. Under this system, you may pay less for a packet of aspirin if it has been prescribed by your doctor. Costs for prescription drugs are reimbursed through the national health system. Doctors are unable to provide prescriptions to the pharmacist over the phone, but the pharmacist may make changes after a telephone call to the doctor.
Pharmacies are usually open during normal working hours and some are closed at the weekend. There is always a duty chemist available for service out of hours and each pharmacy displays their details in the window. In addition, the local press publish the duty roster and the emergency services can also tell you who the duty chemist in your area is. You may have to pay additional costs for medicines purchased out of hours and this is non-reimbursable.