Doctors and Dentists End Agreements with CNS, Citing Loss of Professional Freedom

Doctors and dentists in Luxembourg have made a major move against the country’s healthcare system by officially ending their agreements with the National Health Fund (Caisse nationale de santé, CNS). The decision, taken by a large majority of members of the Association of Physicians and Dentists (AMMD), was finalized on October 30, 2025, with the delivery of a registered termination letter to the CNS.

The AMMD described the decision as “historic,” saying it marks the end of a system that no longer reflects the realities of modern medicine. According to the association, the current framework undermines the constitutional principle of professional freedom and the right to adequate social protection. Doctors and dentists argue that they can “no longer accept” the existing legal and regulatory constraints, which they call a “straitjacket” that restricts professional independence and delays patient access to timely care. They also criticize the system for unilaterally imposing service values without fair negotiation.

The Ministry of Health and Social Security confirmed the move on Friday evening, noting that while either party has the right to terminate the agreement with a 12-month notice period, nothing will immediately change for insured patients. During the notice period, all existing conditions for medical reimbursements remain in effect.

Under the law, new negotiations between the CNS and the AMMD must begin within two months of the termination notice. If no agreement is reached within six months, a mediation process will follow. Should that also fail within three months, a “non-agreement protocol” will be established, and the case will be referred to the Minister for Social Security. The government may then impose mandatory provisions by Grand-Ducal decree, which would be binding on all healthcare providers.

This escalation follows months of mounting tension between doctors and the ministry, primarily over the reassessment of medical act pricing. These reviews are meant to take place every two years, but the most recent negotiations broke down over the government’s proposed increase. While doctors demanded the maximum adjustment of 2.68%, the ministry offered just 1.34%, representing an additional €12 million in costs instead of €24 million. The AMMD viewed this as unacceptable, calling it insufficient to meet the economic pressures facing medical professionals.

According to MP and doctor Gérard Schockmel, the dispute highlights broader frustrations within the medical community regarding the government’s handling of healthcare financing and regulation. Despite earlier mediation attempts, tensions have not eased.

In response, the Ministry of Health and Social Security emphasized that it remains committed to dialogue, stating that its goal is to “ensure the continuity of patient care and the proper functioning of the healthcare system.”

The AMMD’s withdrawal from the agreements represents one of the most significant challenges to Luxembourg’s public health structure in recent years, raising uncertainty about the future of patient reimbursements and the relationship between independent practitioners and the state. While the next 12 months will see continued negotiations, the outcome could reshape how healthcare services are valued and delivered across the country.

Read More : Médecins et dentistes résilient leurs conventions avec la CNS - L'essentiel

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