What do the figures tell us? Firstly, that life expectancy in Luxembourg remains among the highest in the EU at 83.4 years. That's 1.9 years more than the EU average, putting Luxembourg, together with Sweden, just behind Italy, Spain and Malta. And if we live longer, we also live longer in good health. In 2023, women aged 65 could expect to live 9.8 extra years in good health - the EU average being 9.2 years - while men could expect to live 9.7 extra years in good health, more than 0.8 years above the EU average.
Mortality in Luxembourg (860 deaths per 100,000 inhabitants) is 20% lower than the European average (1,073 deaths per 100,000 inhabitants) in 2021, with mortality from circulatory disease and cancer among the lowest in Europe. For the same year, the rates of mortality avoidable by prevention (133 deaths per 100,000 inhabitants) and by treatment (55 deaths per 100,000 inhabitants) are among the best in Europe.
The OECD believes that these good figures can be attributed to prevention policies. Good figures that can also be attributed to public spending. At €4,316 per capita, compared with €4,182 a year earlier, this spending is among the highest in the EU, where the average is €3,533, even though it represents a relatively small proportion of Luxembourg's GDP (5.6%). This makes it possible to offer the population very good health cover: in 2022, household expenditure on healthcare represented 1.7% of total household expenditure, compared with 3.2% on average in Europe. Lastly, 61% of the population is fairly confident in the government's ability to manage crises.
Expectation and availability
This does not mean that the health minister 's job will be an easy one.
However, there is no shortage of cause for concern. The OECD in 2023 singled out two "major" and recurring points: waiting times for medical care and the system's dependence on foreign professionals.
With regard to waiting times for medical care, "particularly for specialist care, diagnostic tests, emergency hospital services and cancer care", a number of solutions have been put in place over the years. "Patient triage and care pathways in emergency departments, as well as the decentralisation of diagnostic services in four hospital centres, aim to reduce waiting times", the OECD stated.
That said, in 2023, only 0.5% of Luxembourg residents said they had unmet medical care needs, whether due to cost, distance or waiting times, in 2022. This percentage is 2.2% on average in the EU. The same applies to unmet need for dental care: 0.8% compared with an EU average of 3.4%.
The issue of access to healthcare also includes the financial aspect. In 2023, the state covered around 85% of healthcare costs. But while reimbursement times are falling - from an average of 56 days to 46 days - they are still long. Faced with this situation, the government is betting on digitisation and the growth of the Direct Immediate Payment system. In November, more than 600 of the country's 2,762 registered doctors had signed up to the DIP scheme. 20% of services are paid for using this system.
The strategy for the overall digital transformation of the healthcare system targets telemedicine solutions for remote medical monitoring of patients and the establishment of a digital register of healthcare professionals. Among the areas where progress is needed is the digitisation of hospital IT systems, where interoperability remains perfectible, according to observers. In terms of digital health, the OECD stressed the need to boost the interconnectivity of national databases in order to increase efficiency in crisis situations.
Worrying dependence on foreign countries
The second cause for concern is the system's dependence on foreign sources. To address this structural dependence, the country has created new education and training programmes - including the healthcareers.lu platform launched in 2022 - and is also seeking to attract more people to the medical and nursing professions. Meanwhile, according to the Idea Foundation, a thinktank, in 2023, 44% of net new jobs created over one year in the sector were filled by cross-border commuters, even though they account for only 30% of employment in the sector.
According to the latest Copas study, "in view of the ageing of the population, the need for care staff is increasing considerably and will continue to grow in the years to come". Copas, the care and health aid service providers association, put a figure on these needs: in 2026, more than 150 full-time equivalent (FTE) posts currently occupied in the care and support sector will be vacant due to retirement, including more than 100 for nurses and care assistants. Over the next decade, this figure could even exceed 200 FTEs per year.
Copas says that 900 nursing posts will need to be filled within the next five years. This figure is beyond the capacity of the Luxembourg education system, which in the 2023-2024 school year graduated 68 people with a BTS certificate in nursing. To underline these tensions, overtime has exploded in the social and health sectors. From 240,486 hours in 2021, this has risen to 387,714 in 2022 and 362,359 in 2023.
The big debate here is whether to create a master's degree in medicine within the university, a sine qua non for practising medicine. This would complement the bachelor's degree launched in 2020, the first graduation of which took place on 15 December 2023. At that time, 13 students graduated. The government coalition agreement provides for the bachelor's degree to be evaluated before moving on to the next stage. The results of this evaluation are expected by the end of 2025. Once the decision has been taken, the master's degree could begin in 2027. The University of Luxembourg and the hospital sector will then have to work together, as future doctors will have to be trained in hospitals.
An inventory of prevention programmes
A third challenge awaits the government: prevention. When it comes to health risk factors, adults in Luxembourg perform slightly better than the European average when it comes to physical activity, overweight and obesity. However, they eat less fruit, drink more alcohol and increased their tobacco consumption between 2012 and 2020. In terms of physical activity, fruit consumption and consumption of sugary drinks, Luxembourg's teenagers have less favourable values than the European average.
Generally speaking, more needs to be done to prevent smoking, alcohol consumption and certain eating habits, says the OECD. On this point, the government coalition agreement provides for an inventory of the national programmes and screening programmes currently in place and their evaluation. In addition, the coalition agreement proposes to introduce, from the age of 30, regular health check-ups with a general practitioner or referral doctor.
Legislative projects in progress
Since Deprez took office, the Ministry of Health has tabled several bills. These include Bill 8399, which establishes a central procurement and logistics service (Centrale nationale d'achat et de logistique or Cnal) as a public body. The ministry is also pursuing Bill 8333 transposing a European directive on tobacco control, which was tabled on 20 October 2023. The two bills are currently in committee. Bill 8331 on the compulsory declaration of certain diseases for the protection of public health has been withdrawn from the agenda. Bill 8013 on doctors' associations, tabled on 30 May 2022 was withdrawn from the Chamber of Deputies on 28 February 2024.
The creation of the Cnal is intended to address the problem of drug shortages. The idea is to pool purchasing, optimise deliveries, achieve economies of scale and have a central storage space that would replace those currently located in hospitals. This structure is not intended to supply pharmacies, but could offer possibilities in the event of stock shortages, according to the Ministry of Health. Once the law has been passed, the centre should be operational within six to seven years.
This project goes hand in hand with that of the Luxembourg medicins and health products agency (Agence luxembourgeoise des médicaments et produits de santé or ALMPS). This future agency, placed under the authority of the Minister for Health, is not a supervisory body for research, but a body managing the regulatory part relating to the marketing of medicines, equipment and services. Its aim is to guarantee a high level of health safety for all health products throughout their life cycle. Bill 7523 creating this agency was adopted by the cabinet on 20 December 2019. It is currently still being examined by a parliamentary committee.
Other projects will be launched in the coming weeks. Foremost among these are universal healthcare coverage (CUSS), for which the coalition agreement provides for the creation of a legal basis, and the reform of the school health service. The ministry also wants to speed up the creation of birthing centres. This project is awaiting an analysis by a scientific council appointed by the former minister for health, (LSAP), on the development of a framework for all births, both in and out of hospital.
Health in figures
At the end of 2022, according to Statec, 936,254 people were covered by Luxembourg’s sickness and maternity insurance scheme. In 2023, there were 99 public pharmacies, 5 hospital pharmacies and 13 hospitals offering 2,667 beds, or 4.2 beds per 1,000 inhabitants. According to the care providers confederation Copas, the health sector employed just over 15,000 people, including 2,762 registered doctors, according to Ministry of Health figures, and 4,344 qualified care assistants and 6,100 nurses.
€160.7m
The likely deficit in maternity and sickness insurance. This deficit would reduce the overall cumulative balance from the current €961.7 million to €763.1 million. This represents 15.4% of current expenditure estimated for 2025, a threshold that remains above the 10% limit set in the Social Security Code. Faced with expenditure rising faster than revenue, Martine Deprez, the current minister for health, has decided to enter into discussions with stakeholders to find solutions to remedy the situation.
This article was written for the released on 11 December 2024. .
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