No Deal

The Luxembourg Association of Doctors and Dentists, the AMMD, will not sign a new agreement with the National Health Fund, the CNS. The existing agreements were terminated in October 2025 and expire at the end of October 2026. After months of negotiations, the AMMD walked away.

In a newsletter to its members, the association said the current system for liberal healthcare is fundamentally broken and no longer serves the interests of doctors or patients. That is a strong statement from the organisation representing most of the country's doctors and dentists.

The points of contention are specific. The AMMD wants more opportunities to provide medical services outside of hospitals, fair negotiations over tariffs, and tariff adjustments to reflect actual operating costs. The CNS, according to the AMMD, consistently referred to current legislation during talks and ultimately presented a convention text the AMMD was unwilling to sign.

The AMMD accused the CNS of an inflexible stance and a refusal to adapt the healthcare system to new medical challenges. It also accused the CNS of using what it considers pressure tactics against doctors. The association requested a meeting with the Prime Minister. It concluded, after discussions with the government, that the political will for reform is lacking.

So what happens in October? The current deal expires. A government regulation is expected to set rules in most areas. This is a shift from a system where doctors are partners of the CNS to one where the state more directly defines conditions. The AMMD does not see this as a viable long-term solution. It says the government will eventually have to undertake a fundamental reform and develop a model that fits the 21st century. Not complete liberalisation, not the current system where the CNS makes unilateral decisions. Something else.

The AMMD's position is that neither side got what it wanted. The CNS did not get a signed agreement. The AMMD did not get tariff reform or flexibility. The government did not get a deal it could announce. The patient, as usual, is not consulted.

What makes this notable is the timing. The heatwave has put emergency services under strain. The prison system is overcrowded. The foreign population is diversifying. And now the doctors are walking away from the negotiating table. October is two months away. If no agreement is reached and the regulatory fallback is insufficient, the question is whether doctors will accept the state's terms or push back in ways that affect patients. The AMMD has not threatened a strike. But it has said the system is broken, and it has refused to sign the fix.