You currently appear to be in a bit of a cyclone, with accusations from both the Association of Doctors and Dentists (AMMD) and the CSV. Both of them tackle more or less the same themes (shortage of doctors, ambulatory care, waiting times, etc.). Do you understand the criticism?
Why not?
In July, when we presented the main lines of the national health plan, we called on the players in the sector to give us their observations, but also to see what they needed. That's how I like to move forward, through dialogue. We are still waiting for a response from the AMMD... In the same vein, we organised a Gesondheetsdesch [health round table] on 12 October. Everyone attended, with one exception...
THE AMMD?
They were holding their general assembly on the same day. We then offered them different time slots so that they could still come and talk, without success... So, you understand that when people say that I am the one who does not want to talk... I notice, on the other hand, that they like to do it, but externally.
Is the problem with public health policy structural?
No. The health system is a continuous process, which must be updated and reviewed regularly. You have to bear in mind that our country has grown very quickly. Not so long ago, the population was still below 500,000. And it is not always easy to adapt everything to the same rhythm when the latter is high.
The shortage of human resources is not unique to Luxembourg, nor even to the health sector
But not everything should be seen in black. The recent OECD report shows how resilient Luxembourg has been in managing the covid-19 crisis. If our health system was bad, it would certainly not have been so positive. We simply face the same challenges as our neighbours. The shortage of human resources is not unique to Luxembourg, or even to the health sector. When I meet my European counterparts, it is always THE issue. The shortage of manpower is widespread.
What are the solutions?
We had this shortage related to the training of doctors and, beyond that, to all functions in the health sector. Not having a university was a problem. Because students tend to stick to their place of study. Now, in Belval, we have a Bachelor's degree in medicine [the possibility of a Master's degree is under discussion]. This takes time to set up. You don't open a complete course overnight. But we are making progress. Just as we do by listening to the students. They can provide good ideas. For example, it has come to our attention that in Switzerland, the last year of study is paid for. This is financially attractive for future doctors. And this attracts a lot of students.
By saying this kind of sentence, the AMMD is not being critical, but polemical
Society has evolved. We need to be able to put in place incentives like these. It is also in this sense that another bill, providing for the extension of the right of association between doctors and/or health professionals, has come into being. This had been a demand of the AMMD for years. It resurfaced at a health roundtable and has now been translated into a bill. The Association of Physicians and Dentists can therefore hardly say that I am not listening to it...
At the general meeting of the latter, we heard that "patients have been abandoned by the health policy of the last 15 years." This is an indirect criticism of your party, the LSAP, which has held this ministry since 2004. Wouldn't a certain alternation be necessary at times?
"In view of the OECD report I mentioned, Luxembourg can be proud to have had the LSAP at the helm for all these years! This has meant that we do not have an underfunded health system, as we have seen in other countries, where different political colours have held these positions.
You know, at the OECD, they are not exactly choirboys. They are even rather dry in their evaluations. So, if they say that we have done well, it is difficult to say afterwards that our patients have been abandoned. At the height of the health crisis, we did not see long queues in front of hospital doors or patients being treated in makeshift facilities. By saying this, the AMMD is not being critical, but polemical. Or let them give clear examples of what they consider to be patient abandonment.
The LSAP has ensured that we do not have an underfunded health system, as we have seen in other countries, where different political colours have held these positions.
The finger is often pointed at particularly long waiting times...
This is a concern that has indeed arisen with the increase in population. But we are taking action to resolve it. What's more, the bill on the shift to ambulatory care will open up a number of possibilities.
If I take the case of radiological examinations, for example, we realised the problem and we increased the capacity by more than 50%, with the appearance of four new centres [from 7 to 11, editor's note] set up at the beginning of the health crisis. A lot of backlog was built up during the crisis. If we wanted to be intellectually honest, we would have to let a year pass after the pandemic to see how the delays were absorbed.
Afterwards, at the level of the doctors, we try to objectify things with, in particular, a tool like Doctena. The delays seem to vary from one speciality to another. But we lack data. I don't deny that there is a problem, but here too we need to discuss it with the AMMD. In order to go into detail to assess where the problems lie. Is it a question of fees? Is it a question of the difficulty of the studies? Or is it related to other factors?
The resignation of the six cardiologists? The AMMD used it to proclaim that doctors were fleeing Luxembourg. When in fact they did not leave the country and just went into business for themselves
At the level of doctors, the most significant event was the simultaneous resignation of six cardiologists from the Centre hospitalier du Nord (CHDN) in Ettelbruck...
This came as a bit of a shock to me too. Even if, with hindsight, I have the impression that it was dramatised and instrumentalised. The AMMD, for example, used it to proclaim that doctors were fleeing Luxembourg. In fact, they did not leave the country, they just set up their own practice, outside the hospital. According to my information, less than 15 days after the publication of the job offers, three candidates have already applied. There will be a problem if, in December, the CHDN is really in a problematic position. But it is not heading in that direction.
The low compensation of doctors for legally imposed on-call duty is another factor that is often cited...
The negotiations were not easy, but an envelope of €44 million was made available. A 24-hour shift represents an amount of around €2,300. This is in addition to what the doctor charges for the procedures he performs on those days. That is €96 per extra hour. While the hour of on-call duty is fixed at €40. The latter amount is what a doctor gets for simply being available when needed. I must admit that I find it hard to understand when people talk about low compensation. You have to realise that some people work for a month to earn the equivalent of two days on call.
This story was first published in French on Paperjam. It has been translated and edited for Delano.