The standoff between the National Health Fund (CNS) and doctors has reached a new stage. On Friday 14 August, the mediator responsible for negotiations on the doctors’ collective agreement drew up a report stating that no agreement had been reached. The CNS says it “regrets the failure” of the mediation, whilst pointing out that the Association of Doctors and Dentists (AMMD) had announced, as soon as the agreement was terminated, that it would not sign a new one without prior amendments to the legal framework.
This announcement comes three days after the AMMD confirmed, according to RTL, that it refused to sign a new agreement with the CNS. The current agreement, which was terminated last October, is due to expire in October 2026. The association’s president, Chris Roller, criticised the CNS in particular for maintaining throughout the mediation process that it was not interested in amending the legal framework. He also highlighted the lack of political will to reform the system.
The CNS now states that several of the doctors’ demands simply fall outside its remit. According to the CNS, the agreement can, in particular, regulate the flow of information between healthcare providers, insured persons and institutions; the digitisation of billing processes; interest payable in the event of late payments; and activity reports. However, the organisation of the outpatient sector, greater pricing autonomy for doctors, a review of the current agreement system, and the practice of medicine within medical practices fall within the remit of the government or the Parliament.
Referral to the four-party committee
It is precisely on these issues that the conflict has come to a head. In particular, the AMMD is calling for more opportunities to carry out minor or lower-risk procedures outside hospitals. It is also calling for changes to the system for setting fees and for a more automated approach to fee increases. According to RTL, Chris Roller said this week that such a reform could help relieve pressure on clinics, MRI departments and operating theatres, whilst reducing the CNS’s expenditure.
For its part, the CNS emphasises the difference in the roles of the two bodies. The AMMD defends the professional interests of its members, whilst the CNS administers a compulsory scheme for all contributors. Above all, it highlights the financial implications of this responsibility: the state funds 40% of contributions and, under the general scheme, the remaining 60% is shared equally between insured persons and employers.
Accuracy is no trivial matter, particularly as an increase in contributions may be under discussion at the four-party meeting in the autumn. The CNS refers discussions likely to lead to legislative changes to the healthcare system to this very body. The quadripartite committee brings together the state, healthcare providers and representatives of employees and employers, but the CNS points out that it is not itself institutionally represented on the committee.
The ball is now in the politicians’ court
For insured persons, however, the scenario of a termination of the agreement must not result in a disruption to their cover. In the absence of an agreement, the Social Security Code provides that the mandatory provisions of the agreement are to be laid down by Grand Ducal regulation. “Consultations are taking place under the same conditions as before,” states the CNS, which rules out any interruption to care or reimbursements solely as a result of the AMMD’s decision.
The disagreement stems less from an imminent legal vacuum than from a reform over which no common ground can be found. With just over two months to go before the current agreement expires, the CNS says it remains willing to negotiate within the limits of its remit. The AMMD, for its part, has already made it clear that it no longer wants a new agreement without a change to the legal framework. The ball is, therefore, very much in the politicians’ court.
