Health System in Transition Report Presented

On Wednesday 5 February 2025, Luxembourg’s National Health Observatory, together with the European Observatory on Health Systems and Policies, presented the "Health System in Transition (HiT) - Luxembourg" report at the Chamber of Commerce in Luxembourg-Kirchberg.

The report outlined an analysis of Luxembourg’s health system, including its organisation, health policies, recent reforms and policy initiatives.

The HiT report analyses differences in health systems between countries including structures, reforms and political decisions affecting the delivery of health systems. It shows that there are many positives in the Luxembourg Health system but also some challenges, including socio-economic factors.

Key topics addressed included the organisation of Luxembourg’s Health System in which statutory health insurance is mandatory.

Dr Françoise Berthet, President of the National Health Observatory, opened the event by stating that it has been 25 years since the first and only production of a HiT report in Luxembourg.

Luxembourg's Minister of Health and Social Security, Martine Deprez, gave the opening address prior to the presentation of the report. Minister Deprez stated that it is necessary for the country to review the health system on an annual basis in comparison to other countries. This can allow for the implementation of best practises and subsequent future changes. She added that priorities include developing a health system that is constructed around the patient and social security needs. She spoke of the importance of integrating primary care and of the progress regarding the digitalisation of the health system.

Three members of the European Observatory on Health Systems and Policies representatives, Suszy Lessof, Michelle Falkenbach and Béatrice Durvy, then spoke on the topic “Learning about health systems: monitoring, evaluating and comparing”.

Suszy Lessof, Coordinator of the Observatory, outlined the workings of Observatory, explaining a WHO partnership collects and presents evidence to present in an understandable manner to policy makers.

Michelle Falkenbach, Technical Officer at the Observatory discussed how country-monitoring standardised templates allow for comparison between performance, strengths and weaknesses in each country. She spoke of HiT being a flagship portfolio and thanked Luxembourg for producing the same.

She explained that HiT reviews are carried out every three to six years. HiTs allow for comparison not just between countries but also, for example, comparing countries for pharmaceutical regulations.

Policy makers use HiT to examine different approaches, highlight strengths and weakness, describe institutional frameworks, use as an information tool and to establish a baseline for the assessment of impact of reforms, as well as identifying emerging trends.

Béatrice Durvy, Research fellow and co-author of Luxembourg Hit review stated that there is an increasing need for timely information. She referenced the recently launched new monitoring tool, Health Reform Tracker, in which experts report on the top three reforms in a country.

This was followed by a presentation on “The Luxembourg health system: overview, main results and lessons” by Katharina Rausch and Catherine Goetzinger of the National Health Observatory,  two of the authors of the report, the third author being Anne-Charlotte Lorcy. 

Health Status Main Points:

Life expectancy at birth in Luxembourg is 83yrs, which is higher than the European average. Females live approximately 4.4 years longer than males.

The leading cause of death is reported to be circulatory diseases at 26% and cancer at 25%. However, recent studies indicate cancer is now the leading cause.

Avoidable mortality rate has reduced in the last decade in Luxembourg. Luxembourg  has a low preventative mortality rate and is also among the countries with the lowest treatable mortalities.

Behavioural risk factors risk are accounted for a one third of deaths in 2021. Luxembourg ranks third in Europe for excess alcohol intake, and one in five adults are daily smokers. 31% are overweight with 16% reported as obese. Behavioural risk factors remain a concern.

81% of those with a higher education level are happy with their health compared to just under 10% of those with a lower educational level.

Overview of Health systems organisation and governance Main Points:

Key principles including mandatory social health insurance, income based contributions and universal access to care were discussed.

Luxembourg’s health system is centrally organised, but there is almost no delegation to regional and local levels. The system is reported to be fragmented, with different actors having different responsibilities. Fragmentation in health system organisations is not unique to Luxembourg.

Luxembourg’s health system is mainly covered by social security and health codes. However, there is no cohesive approach to health, according to the authors. Planning is limited to the hospital sector and pharmacies.

Person-centred care is regulated by law. There are many and various sources of information on health systems available, but these are not always readily accessible or known to those they target and not always in the language required.

Financing Main Points:

87% of health sector expenditure comes from public financing. In this regard, Luxembourg ranks third within the WHO countries. Public financing is composed of government schemes and statutory health insurance (SHI). Luxembourg consistently ranks in the top of the EU average and reported a 60% increase in expenditure in 2022 compared to 2012. Out of pocket expense is very low, with the highest out of pocket expense on pharmaceuticals.

Luxembourg has good health coverage and is one of four countries that permits retrospective reimbursement. The country presents good health outcomes for treatable mortalities and is reported to spend more on health than most other countries. However, countries with equal outcomes to Luxembourg e.g. France, Belgium and Netherlands spend less per capita.

Resources Main Points:

Human and physical resources within the health system were discussed. Luxembourg’s health system ranks in third position for accessibility and a good distribution of services was reported, which also reflects the size of the country.

The ratio of hospital beds per capita has decreased and is lower than the EU average. Luxembourg also reports higher than average lengths of hospital stays.

No direct planning of human resources was discussed, but there is no internationally comparable data on health care workforce available. Luxembourg has a high reliance on cross border and foreign workers. 42% of health staff are made up of cross-border workers. Luxembourg also has a high number of nurses and low number of doctors.

Provision of services Main Points:

Primary care is considered as the first point of contact. The parameters between GPs and specialists is reported as being somewhat blurred. Luxembourg has a high number of avoidable hospital admission rates which could be as a result of lack of cooperation between inpatient and outpatients systems. The Luxembourg system is reported as being hospital centric. A higher than average length of hospital stay is reported; , i.e. 7.3 days in Luxembourg compared to 6.3 in Belgium.

The governance and financing of Long Term Care (LTC) was reported as being very fragmented, with four service provider types. LTC insurance was reported as being comprehensive and among the most generous in Europe.

Key insights and way forward: 

The merger of the Ministry of Health and the Ministry of Social Security, etc., S )has led to relatively good health outcomes in Luxembourg.,

A round table discussion “How can we support sustainable planning of the health system's resources?” followed, moderated by Anne-Charlotte Lorcy of the National Health Observatory. Panel members included Jean-Paul Freichel, Ministry of Health and Social Security, Suszy Lessof, European Observatory on Health Systems and Policies, Dr. Marc Berna, Robert Schuman Hospitals, Shirley Feider, Circle of Patient Associations, Anne-Marie Hanff, National Association of Nurses of Luxembourg, and Dr Françoise Berthet.

HOM