Luxembourg: Health System Review.

Abstract

This review of Luxembourg's health system analyses the country's health organization and governance, financing, health care provision, recent developments and reforms, as well as the system's performance. Luxembourg's statutory health insurance system ensures a comprehensive benefits basket for a large share of the population. Although health care accessibility is high in Luxembourg, administrative considerations, such as the requirement to possess an official address or the lack of automatic third-party payment mechanisms for several services, still constitute significant barriers for vulnerable populations to access care. Overall, Luxembourg performs well on health outcomes, although indicators on behavioural risk factors and socioeconomic disparities remain sources of concern given their adverse impact on population health. Historically, Luxembourg's health system legislation has been fragmented but the recent merger in 2023 of two ministries to compose the Ministry of Health and Social Security (known by the abbreviation M3S) sets a path towards more cohesive health care planning, legislation and financing. Nevertheless, elements of accountability and transparency in health policy-making still pose important challenges. Considering its small size, Luxembourg's health care system is highly centralized and the health infrastructure is well distributed. However, the country relies heavily on a foreign-trained health workforce, which raises concerns about the accessibility of care and may undermine the maintenance of high standards of quality of care for complex medical procedures if the retention of skilled medical professionals is not safeguarded. Hence, Luxembourg has been focusing on developing further initial education programmes for its health professionals, as well as developing a digital health care workforce registry and legal framework to encourage multiprofessional collaboration and task-shifting opportunities. Finally, despite efforts to enhance the sustainability of the health system via reforms for better cost containment, increased investments in preventive services and refinement of hospital services, overall efficiency could be improved. Luxembourg has one of the highest per capita expenditures on health compared with other countries with similar health system and population health outcomes and lacks a mechanism for priority setting in budget allocation, incentives for efficiency improvements, and an enhanced focus on prevention.