Qu’est-ce que la médecine à deux vitesses – et pourquoi elle est dangereuse

13.11.2025

More and more often, in Luxembourg and other European countries, the term two-tier healthcare system is being discussed. It refers to a healthcare system in which not all patients have the same access to medical care. Instead, the quality or speed of treatment depends on how much someone is able to pay

Two classes in the healthcare system

In a solidarity-based healthcare system, everyone should have the same right to medical care – regardless of income.
But in practice, a growing divide can be observed:

• People who can afford additional services – such as private supplementary insurance, CP surcharges for preferred appointment times, or a private hospital room – often receive treatment faster or with more comfort.
• Others, who rely solely on the regular national health insurance (CNS), often have to wait longer for appointments or give up certain services because they cannot afford the extra costs.
• Tiers-payant social patients are not accepted by every doctor.

Why does a two-tier healthcare system develop?

There are many causes. On the one hand, doctors and hospitals are under financial pressure. Additional services and private fees become a way to secure income.
On the other hand, some patients themselves request special conditions – such as treatment at a specific time, in luxurious large rooms, or in a private clinic.

Step by step, a system emerges in which money influences access to medical care.

The risks for the healthcare system

A two-tier healthcare system is not only a question of money — it is a threat to solidarity and trust in the entire system.

• Growing inequality: If wealthy people can buy better healthcare while others have to wait, social division increases.
• Loss of trust: Patients feel disadvantaged and begin to doubt the fairness of doctors and institutions.
• Pressure on the public system: If doctors reserve more time for private patients, care through the regular insurance system becomes weaker.
• Healthcare becomes a commodity: Medical care must not become a luxury item — it is a fundamental right.

What can be done?

• Transparency: Doctors must clearly explain when a service is not covered by the CNS.
• Equal treatment: Patients must not be treated differently because of their financial situation.
• Political responsibility: The government must ensure that the healthcare system remains solidarity-based and that no one is excluded.
• Information: Organisations like Patiente Vertriedung (#PVL) help people understand their rights and report injustices.

A two-tier healthcare system undermines the very foundation of a solidarity-based healthcare system.

Healthcare must not depend on money — it must remain equally accessible and of high quality for everyone.