Carte Sanitaire 2023;
Credit: National Health Observatory
On Wednesday 5 June 2024, Luxembourg's Ministry of Health and Social Security and the National Health Observatory unveiled the "health map" (Carte sanitaire) report on the hospital sector for 2023.
As the health authorities explained, this report draws up a detailed inventory of the hospital sector, including an inventory covering structural resources and their organisation and a statement of activities and utilisation rates of these structures. The health map aims to provide objective data for hospital planning, as well as to meet the objective of transparency regarding the provision of care, provide elements of trends and comparisons, and meet international reporting obligations (WHO, Eurostat, OECD).
This edition of the health map presents the structural hospital inventory for 2023 as well as the evolution of various indicators linked to hospitalisations and hospital medico-technical activities between 2012 and 2021.
Martine Deprez, Luxembourg's Minister of Health and Social Security, noted: "The 2023 health card demonstrates our commitment to efficient and transparent management of the hospital sector, as well as our desire to strengthen Luxembourg hospital establishments in their role of specialised and multidisciplinary care, in accordance with the [government] coalition agreement. This objective data allows us to anticipate the needs of the population, strengthen our capacities and ensure quality care for all, within a solid and resilient health system."
Looking at trends in the sector, Dr Françoise Berthet, President of the National Health Observatory, explained: "Over the last few years, the demographic growth of the resident population and the increase in the use of hospital care for non-resident insured persons have exerted increasing pressure on the hospital sector. The increasingly frequent adoption of day hospitalisation [outpatient] care arrangements has helped to alleviate this pressure.”
In 2023, there were ten hospitals in Luxembourg, including four hospital centres spread over eleven sites (one more site than in 2021) and six specialised hospital establishments, as well as an end-of-life (palliative care) reception centre, an establishment for thermal cures and a diagnostic centre.
In terms of reception capacities, there were 2,640 hospital beds (27 fewer beds than in 2021), including 2,022 acute care beds (20 fewer than in 2021), in Luxembourg in 2023. The health authorities noted that 95.2% of hospital beds authorised in 2019 (2,772 beds) were installed in 2023.
In total, the Grand Duchy had a ratio of 4.0 hospital beds per 1,000 inhabitants in 2023 (4.2 in 2021), respectively 3.04 for acute care beds. A total of 573 day hospitalisation beds were installed in 2023.
The equipment and devices subject to national planning according to the 2018 hospital law were all installed on 1 July 2023. For medical imaging, there were fifteen scanners (+2), twelve MRI machines (+1), eight gamma cameras (+1 ), seven mammography machines and one PET scanner.
The health authorities also presented the new provisions of the hospital law and ministerial authorisations, highlighting the increase in bed and hospital equipment capacities from 1 January 2024. In accordance with the law of 22 December 2023 amending the 2018 hospital law and the ministerial authorisations extending the operation of hospital establishments, the total number of planned and authorised beds has increased (or will increase) as follows:
- increase the maximum number of planned beds nationally to 3,153 from 1 January 2024. This includes 2,346 acute care beds, representing a 5.0% increase in total capacity of such beds;
- as of 1 January 2024, 2,786 hospital beds have been authorised, including 2,124 acute care beds, 575 mid-stay beds, and 87 long-term care beds. A total of 743 day hospital beds have been authorised.
As of 1 January 2024, the maximum number of PET scans that can be authorised nationally is now set at two, while that of bone densitometries is limited to three, compared to one previously.
Looking at the activities of hospital centres in 2021 and their evolution since 2012, the health authorities noted that hospital centres recorded 139,352 stays in 2021 (including 51.9% inpatient hospitalisation stays and 48.1% day/outpatient hospitalisation stays), with an average duration of 7.3 days or 593,528 days of hospitalisation, corresponding to an occupancy rate of 71.2%:
- the number of hospital stays has increased, particularly that of day hospitalisations; inpatient hospitalisation stays dropped slightly;
- the ambulatory shift continues to develop. Day hospitalisation has shown significant growth over the last decade (+4.9% per year between 2012 and 2021), both for medical and surgical activity. Chemotherapy and dialysis sessions progressed respectively by +2.9% and +3.1% per year on average between 2012 and 2021, and outpatient surgical activity for tracer procedures increased from 58.9% in 2017 to 74.7% in 2021;
- hospitalisation days decreased slightly. Over the same period, the number of hospital stays increased; in other words, hospitalisations increased but lasted less time;
- the average length of stay for hospitalizations with overnight stays remained stable;
- (bed occupancy) between 2017 and 2021, the annual occupancy rate of acute care beds varied between 67.9% and 78.1%.
Keeping the cross-border aspect in mind, the health map showed that non-residents represented 8.8% of total hospital stays in 2021 and 17.3% of maternity deliveries in 2022. Non-residents making use of medico-technical activities was also notable in terms of medical imaging (MRI and PET scan included), in vitro fertilisation and urgent and unscheduled care in emergency departments and outpatient clinics.
The 2023 edition of the health map has been published online in a format offering direct access to data presented in the form of downloadable tables and graphs. The full report (in French) is available online at https://sante.public.lu/fr/espace-obsante/carte-sanitaire/carte-sanitaire2023.html.
As the health authorities recalled, the health map is established and updated every two years by the National Health Observatory, in accordance with the provisions of the amended law of 8 March 2018 relating to hospital establishments. "Soon" to be added is a supplement on paediatric hospitalisation activity, which completes the "Eng gesond Zukunft" (a healthy future) report, based on data from the DCSH (documentation and classification of hospital stays), as well as a booklet presenting a first series of indicators relating to the quality of care and the performance of the health system.
