The health of tomorrow and the accompanying strategic directions have already been the subject of a great deal of work by the Luxembourg hospital federation (Fédération des hôpitaux luxembourgeois or FHL), which drew up and presented a whitepaper and its “2030 vision” in February. Now it is again seeking politicians’ attention with a list of demands divided into six themes, the aim being to lay the foundations for a discussion on the decisions that will affect Luxembourg’s healthcare system in the future. This same healthcare system is at the heart of the national health plan by the health minister (LSAP).

“Our main objective is to contribute to a better state of health, and therefore a better quality of life, for the people of Luxembourg,” says FHL President Philippe Turk with satisfaction. “Since the start of our work, we have successfully embarked on a large number of projects.” Indeed, much has been done:

—agreement on a pilot project for on-call duty

—increase in MRI capacity

—creation of a working group on university medicine

—setting up of a steering committee for human resources initiatives, particularly in the hospital system

Concerning the care sector in general

The hospital federation’s first demand: “To make medicine in general and hospital care more attractive. The aim is to guarantee cutting-edge services, structure and promote multidisciplinary work, and expand contractual opportunities between hospitals, doctors, researchers and teachers.”

On this point, decision-makers seem to be moving in the same direction, describing in the national health plan their desire to “continue to improve the state of health of the population,” which must be achieved through concrete actions and measures, but also by strengthening communication and collaboration between citizens and professionals in the healthcare system. The introduction of a one-stop health service is mentioned.

The health plan also provides for the implementation of value-based healthcare principles and the strengthening of the role of scientific advisory bodies. The plan also aims to encourage a shift towards ambulatory care by enhancing the value of hospital medicine, strengthening the role of community practices and concentrating the main hospital sites for the management of complex cases. The feasibility of home hospitalisation also needs to be assessed. Two related bills are in the pipeline (bill 8009, already approved, and bill 8013, still in committee).

Patient pathways

The FHL makes it a point of ensuring that every patient has fair access to care, and of offering them structured care pathways that include all types of treatment. To achieve this, it would like to see a national plan put in place. As Turk has said on several occasions, patients will become players in their own care pathways. For this to work, inter-professional collaboration will need to be encouraged in the interests of the patient, and the exchange of information will need to be facilitated.

The national health plan provides for the implementation of the “referring doctor” concept and looks into the involvement of pharmacists in so-called primary care. For the most common pathologies, the plan seeks to develop certain strategies, notably for cardiovascular diseases, tumours and cancers, mental illnesses and neurodegenerative diseases, all in the interests of the patient.

Digitalisation

Digitalisation will be the keystone of tomorrow’s healthcare system. Hospitals are therefore calling for a comprehensive, integrated programme to digitise the healthcare system, with effective management and an appropriate legal framework. They want to be broadly represented in the governance and implementation of these programmes. This means providing the necessary human and financial resources.

Digitalisation is also a key strategic focus within the new national health plan, which provides for the implementation of the national eHealth strategy, a single, integrated IT system for the inpatient and outpatient sectors, as well as the establishment of a governance body for digital health--though it doesn’t reveal who will make up this body. The aim is to “lighten the administrative workload of healthcare professionals and make them more available to patients.”

In this context, Luxembourg’s national eHealth strategy will be aligned with the global digital health strategy adopted by the WHO in 2020. This will involve overhauling the shared healthcare record, speeding up the roll-out of electronic prescriptions, introducing rapid response solutions for emergency calls (e-ambulance) and accelerating the availability of a number of digital tools, including immediate direct payment (e-administration).

Data management

Digitalisation also means data management: hospitals are demanding greater transparency and would like to share patient data and information between all players in the healthcare system within a framework of trust, with the creation of a legal framework to ensure these exchanges.

This is the seventh strategic area of the national health plan: improving the collection, analysis and use of health data. The plan calls for the systematic monitoring of health indicators and the establishment of a documentation and classification system for the out-of-hospital sector.

In terms of performance, decision-makers are banking on the implementation of a national platform dedicated to innovation in healthcare. The introduction of a health map covering the entire healthcare system is also planned.

More generally, the ambition of the national plan is to develop a data-driven health system. The creation of a dedicated department for the governance of digital health within the ministry of health will make it possible to develop and oversee the implementation of the national digital health strategy. This body will be the main international point of contact (including the EU Health Data Space) as well as the decision-maker in terms of the main standards to be used.

Tackling the shortage of human resources

Setting up a conference on healthcare professions, with a view to introducing essential national management of quantitative and qualitative needs--this is another of the FHL’s proposals. And they are right to sound the alarm: Luxembourg currently has three doctors for every 1,000 inhabitants, which is 23% below the European average. The average age of general practitioners is currently 51, for specialists 52. According to estimates in the national health plan, by 2030 Luxembourg will need 1,262 more doctors and 3,827 more nurses. And one of the country’s problems is its lack of self-sufficiency in healthcare professionals, with almost 65% of its commuting in from neighbouring countries.

“Insofar as the aspirations of young healthcare professionals are changing and they are attracted by more flexible ways of practising, the renewal of professionals will be more complicated,” says the national health plan.

Training is the first step towards employment, but Luxembourg is currently at risk of losing students who choose to settle in the country where they studied. The aim is therefore to anticipate training needs and mitigate this risk by developing a range of training courses.

What about funding?

The FHL has a number of demands related to funding for the healthcare system. It would like to see indicators put in place to analyse efficiency in the medical environment, establishments given autonomy in their financial management and, of course, more financial resources allocated to supporting care pathways.

In 2019, €3.2bn--12% of general government expenditure--was earmarked for health functions (hospital services, reimbursement of medical consultations and pharmaceutical products, medical equipment) as well as almost €1bn for the dependency sector. Spending on health represents €5,502 per capita.

For its part, the national plan provides for the development of a strategic plan for adapting funding and exploring new instruments for funding prevention. In view of the ageing of the population, the increase in demand for healthcare services will lead to a rise in healthcare costs over the coming decades.

“In order to guarantee the sustainability of the system and to be able to implement the aforementioned strategic axes, the financing of the healthcare system needs to be rethought and adapted,” says the plan, adding: “an in-depth study is required to determine the exact funding arrangements.” A funding framework based more on results than on the means employed could ultimately meet this objective. The plan also states: “Hospitals will need to be given a certain amount of freedom to invest in innovation without jeopardising the advantages of resource planning.”

This article in Paperjam. It has been translated and edited for Delano.