Failed negotiations over increasing consultation rates with the CNS were the straw that broke the camel’s back for the doctors’ association AMMD. After months of frustration with what it sees as delays by the CSV–DP government in implementing announced reforms, such as support for certain activities in practices outside hospitals or a review of the governance of the CNS, the association announced at the end of October that it would terminate its agreement with the CNS.
With demands including selective contracting and greater rate autonomy, AMMD President Dr Chris Roller and Vice-President Dr Carlo Ahlborn have not only drawn criticism from politicians, trade unions, and patient representatives. Opposition has also emerged within the CNS board of directors, while a significant number of doctors have made it clear that they do not want a two-tier healthcare system, weakened hospitals or the entry of external investors into medical practices. This is despite the government seeking to create a new legal framework to allow such developments, after withdrawing the one introduced by former health minister Paulette Lenert.
Adding further fuel to the debate is the Findel Clinic project, revealed by an article in Land. The initiative is backed by former AMMD officials Dr Alain Schmit and Dr Philippe Wilmes. Together with partners from the property and business sectors, they plan to open a multidisciplinary group practice for up to 15 doctors.
The two doctors, who are seen as having an entrepreneurial approach, reject accusations of pursuing a political agenda or seeking quick profits. Despite its name, the Findel Clinic would neither be a private clinic nor a hospital. Instead, it aims to attract doctors from abroad and make it easier for them to establish themselves in Luxembourg and work in a professional network.
“This has nothing to do with a political agenda. It is simply based on the observation that there are not enough doctors in Luxembourg and that access to the profession is difficult. We are simply trying to do something about it”, Dr Schmit said in an RTL interview.
The controversy has even prompted the Medical Council to intervene. In a statement, the profession’s senior body warned of “perverse developments” in the sector, where profitability risks being placed above the principles of the Hippocratic Oath.
While the AMMD has since sought to row back and reaffirm its commitment to a solidarity-based system, it continues to advocate what it describes as a two-speed approach. What is clear is that the association has opened a fundamental debate about the direction of Luxembourg’s healthcare system, but in doing so has weakened its own position. The MSH trade union, which represents salaried hospital doctors, is even amending its statutes to be able to represent self-employed colleagues working in clinics. A growing number of doctors say they no longer feel represented by the AMMD.
The AMMD has now agreed to include a representative of hospital doctors as an observer in its negotiations with the CNS. However, the convention itself is only part of the issue. According to AMMD president Dr Chris Roller, the wider legal framework must also be discussed directly with the Minister for Health and the Prime Minister.
In parallel, changes to the Hospital Act were adopted by parliament shortly before the Christmas recess. These now allow certain outpatient treatments – notably in dermatology and for cataracts – to be carried out outside hospital settings. At its final meeting before Christmas, the Council of Government also approved a bill on medical societies, allowing it to move forward in the legislative process.
The debate is far from over. Discussions on the future of Luxembourg’s healthcare system are set to continue well into 2026.
