Country Report Luxembourg 2012

Country Report Luxembourg

1.      Physician of trust (reference)

Since July 2012, the new Physician of Trust (reference) System “Vertrauensarztsystem” or “Médecin de confiance” is in place. The patient is free to choose a primary care physician of trust (mainly GPs or General Internists). The system is entirely voluntary for patients and physicians alike. The patient keeps all rights to access freely other primary care physicians or immediately secondary care medicine without restrictions whether direct (no gatekeeper) or indirect (no higher financial participation by the patient). The mission of the physician of trust, on one hand, is to discuss with his patient all matters of health, to inform about health hazards and to motivate lifestyle changes within a national prevention program for adults. On the other hand, the physician of trust will have “priority” access to the health data of his patient, keep records, discuss clinical pathways with his patient, keep an eye on patient-safety, and hand over to the patient at the end of every meeting an updated Patient Summary with all relevant data which accompanies the patient throughout the different services of other health professionals. The patient keeps the right not to give certain information to his physician, he can interfere with the wordings of the patient summary, but it must be done in presence of his physician of trust who will discuss the implications and has to agree. Therefore the term: Physician of Trust.

2.      Road Map Breast Cancer

The health ministry wants to create “artificial” centers of “excellence” (Brustkrebszentren) by imposing essentially minimal activity thresholds as gold standard for high quality care. Gynaecologists think that this is an unacceptable interference with their freedom of therapy.  As no end-point-outcome indicators are measured for being awarded the “quality label”, the risks are high that, especially in a small country, that this de facto monopoly situation will jeopardize “real” quality of care.

3.      Restrictions to Prescriptions

All restrictions to prescriptions have been abolished after a general uproar of GPs (including other specialists) and the intervention of our organisation AMMD. NOACs are now reimbursed by social security after prescription by GPs since September 2012.

4.      Patient’s rights & Physician’s duties law

The ministry of health prepares a bill where the patient will get a lot of “new” rights. This goes from good patient information to access to health records and up to the right being accompanied by a person who will also discuss the health of the patient with the doctor. The bill introduces the reverted burden of proof principle for patient information. The physician has to deliver proof that the patient has been thoroughly briefed in detail before any medical interventions. In other words, the medical accidents that are foreseeable but inevitable will be in the realm of the physician’s liability when the patient states afterwards that he did not understand the doctor and therefore lost a chance to avoid this hazard. Our position is that the inversion of the proof of information is not acceptable unless the law gives precisions as to content and scope of information that must be given beforehand and that the law also introduces the principle that medical accidents (all events that are not avoidable) are covered through public funding.

Dr Claude Schummer

AMMD, Luxembourg