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Key reforms and challenges for the Luxembourg health system

Authors:
  • European Observatory on Health Systems and Policies, Technische Universität Berlin

Abstract and Figures

Luxembourg has the highest per capita health spending in the WHO Europe Region and the highest share of patients seeking care abroad in the European Union (EU) in 2012. Major reforms in 2008 and 2010 aimed at cost-containment and increasing quality by establishing a single health insurance fund which includes maternity benefits and long-term care insurance. Furthermore, the strengthening of patients' rights and the development of a national e-health infrastructure has only recently occurred as the latter is only in its pilot stage and is not fully developed. This article gives an overview of this relatively little known health system in light of the Luxembourg Presidency of the Council of the EU.
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Eurohealth SYST EMS AND POL ICIE S
Eurohealth incorporating Euro Observer Vol.21 | No.3 | 2015
43
KEY REFORMS AND
CHALLENGES
LUXEMBOURG

Summary: Luxembourg has the highest per capita health spending in
the WHO Europe Region and the highest share of patients seeking care
abroad in the European Union (EU) in 2012. Major reforms in 2008 and
2010 aimed at cost-containment and increasing quality by establishing
a single health insurance fund which includes maternity benefits and
long-term care insurance. Furthermore, the strengthening of patients’
rights and the development of a national e-health infrastructure has
only recently occurred as the latter is only in its pilot stage and is not
fully developed. This article gives an overview of this relatively little
known health system in light of the Luxembourg Presidency of the
Council of the EU.

Anne Spranger is a researcher at
the Berlin University of Technology,
Germany; Anne Calteux is Senior
Counsellor at the Ministry of Health,
Luxembourg, in charge of EU
Coordination; Fr ançoise Berthet
is head of the division for curative
medicine, Health Directorate,
Ministry of Health, Luxembourg ;
Ewout van Ginneken is senior
researcher at the Berlin University
of Technology, Germany. Email :
anne.spranger@tu-berlin.de
Introduction



















 3 

















Eurohealth SYST EMS AND POL ICIE S
Eurohealth incorporating Euro Observer Vol.21 | No.3 | 2015
44
A key role for government































 2 3















 4
Predominantly publicly funded,
low OOPs










































Low on doctors, high on nurses




















Figure 1: Number of physicians and nurses per 100,000 population in the EU-28,
2011 or latest available year
Sourc e: 3
Eurohealth SYST EMS AND POL ICIE S
Eurohealth incorporating Euro Observer Vol.21 | No.3 | 2015
45





see Figure 1














Lack of training in some areas

















Weak gatekeeping










 5 






High percentage of care
provided abroad



























 4 6
Room for efficiency improvements
in hospitals



















see Table 1




















Table 1: Hospital indicators in Luxembourg and selected countries, 2011
Bed occupancy rates in
acute care hospitals
(%)
Beds in acute care
hospitals per 100,000
population
ALOS for acute care
hospitals
Austria 85.5 544.7 6.6
France 75 353 5.1
Germany 79 530.8 7.9
The Netherlands 48.6 333.9 5.8
Luxembourg 71.5 396 ° 7.3
EU 15 76.6 * 345 * 6.5
Sourc e: 1
Notes : * indicate s 2010 data, ° nationa l data for 2012.
Eurohealth SYST EMS AND POL ICIE S
Eurohealth incorporating Euro Observer Vol.21 | No.3 | 2015
46
A future with e-health and
empowered patients














































Good health outcomes, but at
high costs















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A suitable definition of primary care to capture the variety of prevailing international organisation and service-delivery models is lacking. Evaluation of strength of primary care in Europe. International comparative cross-sectional study performed in 2009-2010, involving 27 EU member states, plus Iceland, Norway, Switzerland, and Turkey. Outcome measures covered three dimensions of primary care structure: primary care governance, economic conditions of primary care, and primary care workforce development; and four dimensions of primary care service-delivery process: accessibility, comprehensiveness, continuity, and coordination of primary care. The primary care dimensions were operationalised by a total of 77 indicators for which data were collected in 31 countries. Data sources included national and international literature, governmental publications, statistical databases, and experts' consultations. Countries with relatively strong primary care are Belgium, Denmark, Estonia, Finland, Lithuania, the Netherlands, Portugal, Slovenia, Spain, and the UK. Countries either have many primary care policies and regulations in place, combined with good financial coverage and resources, and adequate primary care workforce conditions, or have consistently only few of these primary care structures in place. There is no correlation between the access, continuity, coordination, and comprehensiveness of primary care of countries. Variation is shown in the strength of primary care across Europe, indicating a discrepancy in the responsibility given to primary care in national and international policy initiatives and the needed investments in primary care to solve, for example, future shortages of workforce. Countries are consistent in their primary care focus on all important structure dimensions. Countries need to improve their primary care information infrastructure to facilitate primary care performance management.