Luxembourg’s population benefits from high healthcare coverage rates and reports high levels of satisfaction with the system, but fragmented decision-making, lack of data and difficult access to care for some need to be addressed, a report by the European Observatory on Health Systems and Policies found.
The Luxembourg Health system summary 2024, released on Wednesday and based on the Luxembourg Health System Review published in 2024, analysed the country’s health landscape and looked at what works and what needs fixing.
The country overall received a good evaluation, with positive results on global health. Healthcare coverage is high and reports of unmet needs were among the lowest in Europe for insured people, and preventable and treatable mortality rates were low. Patients are also free to choose their healthcare providers.
Household out-of-pocket payments were significantly lower than in other EU countries, and the national health insurance covered 91.8% of the resident population.
The country also had one of the highest levels of health expenditure per capita – $7,515 per year in purchasing-power-parity terms– ranking fifth among 55 WHO European Region countries.
Access to healthcare not equal
There is, however, room for much improvement, the report stated.
For one, access to healthcare remains difficult for some individuals, like those without an official address and declared employment. A universal healthcare coverage exists – the CUSS – but lack of human resources and red tape make access difficult.
Though the health ministry over the past years has encouraged doctors to implement the PID – the immediate direct payment – the adoption rate of the measure has evolved at a slow pace. As a result, many patients still have to pay the full cost of treatment upfront and wait for reimbursement.
In addition, Luxembourg continues to have a below-average density of physicians – 298 practicing doctors per 100,000 population compared to 377 on average in the EU. The country relies heavily on doctors and nurses from abroad to care for Luxembourg patients.
Recent efforts have been made to solve this, with the development of more courses in medicine at the national university.
Though centralised care is needed, the report pointed out that some services, like psychiatric rehabilitation, are only available in one part of the country, which could make it difficult to access them for some residents.
Lack of strategy
The country also lacks an overarching strategic plan dedicated to prevention and public health, as risk behaviours like smoking and drinking alcohol remain frequent in Luxembourg.
And though free choice of doctors is “a key strength of Luxembourg’s primary health care system,” “the absence of a gatekeeping system may hamper coordination and planning within primary care,” the report said.
The health ministry on Thursday launched a campaign to solve this. The “I love my Housedokter” campaign aims to put the GP or family doctor at the heart of patients’ healthcare, and hopes that by promoting the profession, it will reduce the number of patients going immediately and unnecessarily to a specialist.
In a recent interview with the Luxembourg Times, Health Minister Martine Deprez also spoke of the ministry’s intention to push preventative healthcare to the forefront.
Stricter frameworks
The report also criticised the dental care system, saying that “despite existing legislation, Luxembourg’s dental sector lacks robust enforcement standards and operates without a supervisory body. Hence, breaches in regulations often go undetected or without legal consequences (such as advertising practices).”
There also needs to be more actions against unhealthy habits and products like tobacco, the report found. Buying cigarettes in Luxembourg remains far cheaper than in neighbouring countries for instance.