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State of Health in the EU Country Health Profile 2017

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on Health Systems and Policies a partnership hosted by WHO The Country Health Profile series Contents The of Health in the EU profiles provide a concise and 1 • HIGHLIGHTS 1 policy-relevant overview of health and health systems in the EU 2 • HEALTH IN LUXEMBOURG 2 Member States, emphasising the particular characteristics and 3 • RISK FACTORS 4 challenges in each country. They are designed to support the efforts of Member States in their evidence-based policy making. 4 • THE HEALTH SYSTEM 6 5 • PERFORMANCE OF THE HEALTH SYSTEM 8 The Country Health Profiles are the joint work of the OECD and 5.1 Effectiveness 8 the European Observatory on Health Systems and Policies, in 5.2 Accessibility 11 cooperation with the . The team is grateful for the valuable comments and suggestions provided by Member 5.3 Resilience 13 States and the Health Systems and Policy Monitor network. 6 • KEY FINDINGS 16

Data and information sources The data and information in these Country Health Profiles are The calculated EU averages are weighted averages of the based mainly on national official statistics provided to 28 Member States unless otherwise noted. and the OECD, which were validated in 2017 to ensure the highest standards of data comparability. The sources and To download the Excel spreadsheet matching all the tables methods underlying these data are available in the Eurostat and graphs in this profile, just type the following Database and the OECD health database. Some additional data StatLinks into your Internet browser: also come from the Institute for Health Metrics and Evaluation http://dx.doi.org/10.1787/888933593684 (IHME), the European Centre for Disease Prevention and Control (ECDC), the Health Behaviour in School-Aged Children (HBSC) surveys and the Health Organization (WHO), as well as other national sources.

Demographic and socioeconomic context in Luxembourg, 2015

Luxembourg EU

Demographic factors Population size (thousands) 570 509 394 Share of population over age 65 (%) 14.2 18.9 Fertility rate¹ 1.5 1.6

Socioeconomic factors GDP per capita (EUR PPP2) 77 800 28 900 Relative poverty rate3 (%) 8.2 10.8 Unemployment rate (%) 6.4 9.4

1. Number of children born per woman aged 15–49. 2. (PPP) is defined as the rate of currency conversion that equalises the purchasing power of different currencies by eliminating the differences in price levels between countries. 3. Percentage of persons living with less than 50% of median equivalised disposable income.

Source: Eurostat Database.

Disclaimer: The opinions expressed and arguments employed herein are solely those of the authors any territory, to the delimitation of international frontiers and boundaries and to the name of any and do not necessarily reflect the official views of the OECD or of its member countries, or of the territory, city or . European Observatory on Health Systems and Policies or any of its Partners. The views expressed Additional disclaimers for WHO are visible at http://www.who.int/bulletin/disclaimer/en/ herein can in no way be taken to reflect the official opinion of the . This document, as well as any data and map included herein, are without prejudice to the status of or sovereignty over

© OECD and World Health Organization (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies) 82.4 82.4 PPP) (EUR spending capita Per threatening conditions. threatening life- treating in is effective system the that show rates mortality low amenable Very Effectiveness awareness about the efficiency of the health system and from 2010 led to reform and cost-containment policies. cost-containment and reform from and to 2010led system health the of efficiency the about awareness triggered have sustainability fiscal around However, concerns decade. last over the substantially changed not has system health The health. good in 65 age after years additional the spend always not do but Europeans most than longer live Luxembourg in People 100 120 140 Amenable mortality per 100 000 population 000 100 per mortality Amenable €2 000 €3 000 €5 000 €1 000 €4 000 80 2011 1 YEARS 138 2005 104 Highlights Binge drinking Binge Life expectancy at birth, years at birth, expectancy Life Overweight/ 2007 Smoking obese % of adults in 2014 in adults % of 2009 80 77 82 79 83 78 81 2000 2011 78.0 77.3 15% 15% 2013 LU LU LU LU 80.6 82.4 126 87 2015 35% 2015 EU EU 2014 EU EU Health systemperformance Health system Risk factors Health status these are still the leading cause of death among women, while second to cancer for men. cancer to second while women, among of death cause leading the still are these However, diseases. cardiovascular from of deaths of areduction result the are and of 65 age the after been have life in expectancy gains of the Most average. EU the above well is and 2000 in years 78.0 to 2015, in compared years 82.4 was at birth expectancy Life EU LU groups. income between variation little and care for medical needs unmet reporting of people low numbers with is good, Luxembourg in care health to Access Access package. benefits agenerous covers insurance Health EU. the in lowest of the is one spending out-of-pocket and funded is publicly spending of GDP. of health 82% 6.0% Some equals 2797. of EUR average EU This the to compared care, health on head per 5090 EUR spent 2015, In Luxembourg countries. EU among highest is the Luxembourg in spending Health 2005. since rise the on been has 15-year-olds of obese share the but average, EU the to close are adults among rates Obesity EU. the in highest the is among drinking binge but decreased has adult per consumption alcohol Overall 2005. in 23% day, from every down tobacco smoked 2014, Luxembourg In in of adults 15% 0% % reporting unmet medical needs, 2015 needs, medical unmet % reporting High income All 3% Low income STATE OFHEALTH INTHE EU: COUNTRY HEALTH PROFILE2017 – 6% assessment. performance systematic out carry to fail they yet appropriately challenges health to respond to seem arrangements Governance efficiency. improve to efforts with costs, growing over concerns are there funding, stable Despite Resilience Highlights LUXEMBOURG . 1

Luxembourg 2 . Health in Luxembourg

2 Health in Luxembourg Luxembourg Life expectancy at birth is rising and is nearly Growing mortality from pancreatic cancer two years above the EU average and diabetes give cause for concern Life expectancy at birth in Luxembourg is among the highest in Despite reductions since 2006, cardiovascular diseases are the , with only three other EU countries recording higher rates leading cause of death among women in Luxembourg, and second (Figure 1). It increased by more than four years between 2000 to cancer for men (Figure 2). Looking at more specific causes of and 2015, to 82.4 years, which is nearly two years above the EU death, lung cancer is the main cause after ischaemic and other heart average. Similar to other Member States, a substantial gap persists diseases, replacing stroke in the ‘top three’ of the ranking (Figure 3). between men and women, with men (80.0) living, on average, The number of people dying from Alzheimer’s and other dementias nearly five years less than women (84.7 years). has more than doubled since 2000 and standardised death rates stood above the EU average between 2004 and 2013. This rise is Most of the gains in life expectancy in Luxembourg since 2000 caused by population ageing, better diagnosis and lack of effective have been after the age of 65, with the life expectancy of women treatments. The numbers of deaths caused by pancreatic cancer at age 65 reaching 21.8 years in 2015 (up from 20.1 years in and by diabetes have also grown since 2005, with death rates for 2000) and that of men reaching 18.9 years (up from 15.5 years in pancreatic cancer the highest in the EU in 2014. 2000). At age 65, men can expect to live approximately 11 years of their remaining years of disability, while women can expect to live only nine years of their remaining years in good health.1

1. These are based on the indicator of ‘healthy life years’, which measures the number of years that people can expect to live free of disability at different ages.

Figure 1. Life expectancy at birth in Luxembourg is the fourth highest in Europe Luxembourg Years 2015 2000 90 82.4years of age

EU Average 80.6 years of age

85 83.0 82.7 82.4 82.4 82.2 81.9 81.8 81.6 81.6 81.5 81.3 81.3 81.1 81.1 81.0 80.9 80.8 80.7 80.6

80 78.7 78.0 77.5 77.5 76.7 75.7 75.0 74.8 74.7 75 74.6

70

65

60 EU Ireland Luxembourg Czech Slovak Republic

Source: Eurostat Database.

STATE OF HEALTH IN THE EU: COUNTRY HEALTH PROFILE 2017 – LUXEMBOURG Health in Luxembourg . 3

Figure 2. Cardiovascular diseases and cancer account for the majority of all deaths

Women Men (Number of deaths: 1 814) (Number of deaths: 1 988) Luxembourg

18% Cardiovascular diseases 17% Cancer 28% 5% 35% Nervous system (incl. dementia) 8% Respiratory diseases 7% External causes 7% Other causes 9% 6% 33% 26%

Note: The data are presented by broad ICD chapter. Dementia was added to the nervous system diseases’ chapter to include it with Alzheimer’s disease (the main form of dementia).

Source: Eurostat Database (data refer to 2014).

Figure 3. Heart diseases remain the most common cause of death, followed by lung cancer and stroke

2000 ranking 2014 ranking % of all deaths in 2014 1 1 Other heart diseases 12% 2 2 Ischaemic heart diseases 9% 3 3 Lung cancer 7% 4 4 Stroke 6% 5 5 Alzheimer and other dementia 5% 6 6 Lower respiratory diseases 3% 7 7 Colorectal cancer 3% 8 8 Pancreatic cancer 2% 9 9 Diabetes 2% 10 10 Breast cancer 2%

14 12 Pneumonia 2% 15 13 Liver diseases 2%

Source: Eurostat Database.

Many chronic conditions are among the people in Luxembourg lives with chronic depression, one in fourteen leading contributors to poor health lives with asthma, and one in six lives with hypertension. People with the lowest level of education3 are 15% more likely to live Second to the burden caused by cardiovascular diseases are with hypertension, compared to people with the highest level of musculoskeletal problems (including low back and neck pain), education.4 which are an important and increasing contributor to disability- adjusted life years2 (DALYs) (IHME, 2016). According to data from the European Health Interview Survey (EHIS), nearly one in ten 3. Lower education levels refer to people with less than primary, primary or lower secondary education (ISCED levels 0–2) while higher education levels refer to people with tertiary education (ISCED levels 5–8).

4. Inequalities by education may partially be attributed to the higher proportion of 2. DALY is an indicator used to estimate the total number of years lost due to specific older people with lower educational levels; however, this alone does not account for all diseases and risk factors. One DALY equals one year of healthy life lost (IHME).. socioeconomic disparities.

STATE OF HEALTH IN THE EU: COUNTRY HEALTH PROFILE 2017 – LUXEMBOURG Luxembourg STATE OFHEALTH INTHE EU: COUNTRY HEALTH PROFILE2017 – Source: EurostatDatabase,based onEU-SILC (datarefer to2015). 2. Thesharesfor the totalpopulationandthehigh-incomeareroughlysame. 1. Thesharesfor the totalpopulationandthelow-income populationareroughlythesame. groups by income disparities are there but health, good in being report Luxembourg in people Most 4. Figure in thelowestincomequintile(Figure4). that theyareingoodhealth,comparedwith64%ofthepopulation status, with80%ofpeopleinthehighestincomequintilereporting EU countries,thereisagapinself-ratedhealthbysocioeconomic in 2015),higherthantheEUaverage(67%).However,asother Most peopleinLuxembourgreportbeinggoodhealth(70.5% a gapexistsbetweenincomegroups Most peoplereportbeingingoodhealth,but 4 . Slovak Republic United Kingdom Health inLuxembourg Luxembourg Netherlands Lithuania Germany Denmark Romania² Slovenia Portugal Hungary Bulgaria Belgium Sweden Finland Estonia Croatia Austria Poland Ireland Greece¹ Cyprus France Latvia Malta Spain¹ Italy¹ EU 20 Low income 30 % ofadultsreportingtobeingoodhealth 40 50 Total population 60 70 LUXEMBOURG High income 80 90 100 less pronouncedfor 15-year-olds,inparticularfor girls. now amongthelowest (15.3%)intheEU(2014).Thisdeclinewas decreased sharplyby nearly8percentagepointssince2005,andis The shareofregularsmokers amongadultsinLuxembourghas problem continue todeclinebutbingedrinkingisa Smoking ratesandalcoholconsumption contributing themost(IHME,2016). use, diet,andphysicalinactivity,withsmokingdietaryrisks attributed tobehaviouralriskfactors–includingsmoking,alcohol in Luxembourg2015(measuredtermsofDALYs) couldbe estimate thatslightlyover 25%oftheoverall burdenofdisease Data fromtheInstitutefor HealthMetricsandEvaluation(IHME) health issuesinLuxembourg Behavioural riskfactorsaremajorpublic 3 Riskfactors Figure 5. Luxembourg shows mixed results on behavioural health risk factors factors risk health behavioural on results mixed shows 5.Luxembourg Figure and secondlowest for girls(seealsoFigure 5). (2013–14), whichisthelowest rateamongEUcountriesfor boys old boys reportedhavingbeendrunkatleasttwiceintheirlife encouragingly, only14%of15-year-oldgirlsand15%15-year- compared totheEUaverage(20%and31%respectively).More single occasion,atleast onceamonthover thepastyear. 5. Bingedrinkingbehaviourisdefinedasconsuming sixormorealcoholicbeveragesina Luxembourg wereobesein2014,whichequalstheEUaverage. true prevalenceofobesity),closetooneinsevenadults(15%) Based onself-reporteddata(whichtendtounder-estimatethe children maypresentafuturechallenge Rising ratesofoverweight andobesity among as youngadults(18–24years,41%)engageinbingedrinking in 2014.Moreover, muchlargersharesofadults(35%)aswell above theEUaverage,withadultsconsuming11.1litrespercapita Although alcoholconsumptionhasbeenfalling,itisstill1litre control laws(seeSection5.1). rising, Luxembourghasmadefurtherefforts tostrengthentobacco leading causeofdeath,andmortalityfromlungcancerinwomenis 14% atEUlevelin2013–14.Becauselungcanceristhethird Nearly everyfifthgirlwasaregularsmoker (18%)comparedto Physical activity,15-year-olds Physical activity,adults Obesity, adults Overweight/obesity, 15-year-olds Smoking, 15-year-olds 5

focus onchildrenandtheyoung. and promotingphysicalactivityhealthydiet,withaparticular national strategiesonnutrition,preventingandtreatingobesity, this challenge,tenyearsagoLuxembourgstartedtoimplement is astrongpredictorofcontinuingintoadulthood.Respondingto worrying giventhatbeingoverweight orobeseduringchildhood over 40%between2005–06and2013–14.Thisisparticularly 15-year-olds alsoremainsclosetotheEUaverage,itgrew While theprevalenceofoverweight andobesityamongst level ofeducation. education isnearlythreetimeshigherthanthosewiththehighest level ofobesityamongthepopulationwithlowest levelof those withthelowest levelofeducation.Moredramatically,the The prevalenceofsmokingismorethantwiceashighamong which isslightlymoreprevalentinhighlyeducatedpeople. education, withtheexceptionofbingedrinkingamongadults prevalent amongpopulationsdisadvantagedby incomeor Many behaviouralriskfactorsinLuxembourgaremuchmore common amongdisadvantagedpopulations Many behaviouralriskfactorsaremore Health Statistics and HBSC survey in 2013–14. (Chart design: Laboratorio MeS). Laboratorio design: (Chart 2013–14. in survey HBSC and Statistics Health 2014), OECD around or in (EHIS Database Eurostat on based calculations OECD Source: Luxembourg. for available not are adults among activity physical of measure acomprehensive on data Comparable areas. all in countries all in progress for room is there as area’ ‘target white the in is country No countries. EU other to compared performs country the better the centre the to is dot the closer Note: The STATE OFHEALTH INTHE EU: COUNTRY HEALTH PROFILE2017 – Binge drinking,adults Smoking, adults Drunkenness, 15-year-olds Risk factors LUXEMBOURG . 5

Luxembourg Luxembourg (see Figure 6). However, asashareofGDP,Luxembourgspent highest intheEUandwas82%higherthanaverage2015 significant increase,percapitaspendinghasconsistentlybeenthe Luxembourg’s healthsystemisexpensive.Since2012,whichsawa health systeminEurope Luxembourg hasby farthemostexpensive funding healthcare,sicknessleaveandlong-termcare. is responsiblefor socialpolicyandoversees publicinstitutions finances publichealthprogrammes.TheMinistryofSocialSecurity of care,authoriseslargehospitalinvestmentsanddirectlyco- Health developshealthpolicyandlegislation,organisesthedelivery are jointlyresponsiblefor healthsystemgovernance. TheMinistryof insurance. TheMinistryofSocialSecurityandtheHealth this, CNSisalsoresponsiblefor thefinancingoflong-termcare health careinsuranceandsicknessleaveinsurance.Ontopof National HealthInsurance,CNS)isresponsiblefor twoschemes: central budget.Thesingle-payerfund(CaisseNationaldeSanté– social insurancesystemrelyingonsubstantialinputsfromthe Luxembourg’s healthsystemischaracterisedby acompulsory single payersocialinsurancesystem Two ministriessharethegovernance ofa STATE OFHEALTH INTHE EU: COUNTRY HEALTH PROFILE2017 – 6 Source: EU the in spending health capita of level per highest the has Luxembourg 6. Figure 1 000 2 000 3 000 4 000 5 000 6 000 EUR PPP . The healthsystem 4 0 OECD Health Statistics, Eurostat Database, WHO Global Health Expenditure Database (data refer to 2015). to refer (data Database Expenditure Health Global WHO Database, Eurostat Statistics, Health OECD Thehealthsystem Luxembourg Germany Netherlands Ireland Sweden Austria Denmark Belgium France United Kingdom LUXEMBOURG Per capita(le axis) Finland EU Italy Spain performance. compared to9.9%ofGDPinEU),whichreflectsitsstrongeconomic significantly lessonhealththanmostotherEUcountries(6.0% of thesystem(seeSection5.2). Commission aswellresidentsworkingabroadwhoarenotpart of uninsuredseemstorelatepeopleworkingfor theEuropean outside thecountry(Box1;ADEM,2017;IGSS,2016).Thenumber employees, onethirdofthoseinsuredwiththeCNSactuallylive (VHI). AsnearlyhalfofLuxembourg’s workforce arecross-border population havingcomplementaryVoluntary HealthInsurance compulsory healthinsurancescheme,withmorethanhalfofthe In 2015,95.2%oftheresidentpopulationwerecovered by the Insurance covers non-residents rest beingsharedbetweentheinsuredpopulationandemployers. shared chargeswith40%ofcontributionspaidby thestate andthe in 2015.Financing ofhealthcareinsuranceisbasedonasystem EU share ofpublicspendingonhealthstillranksfifth(82.0%)inthe Even afterdecreasingcontinuously(ifgradually)since2008,the Malta (non-resident) cross-borderworkers andtheirfamilies(seeBox1). Luxembourg healthcareinsurancefinancesservices for ahighandincreasingnumberof the capacitytopayfor healthcare.However, oneshouldtake intoaccountthatthe exported, theGrossNationalIncome(GNI)maybeamoremeaningfulmeasurefor 6. BecauseasignificantproportionofGDPinLuxembourgrefers toprofitsthatare

Slovenia Share ofGDP(rightaxis) Portugal

Czech Republic 6 Greece Cyprus Slovak Republic Hungary Estonia Lithuania Poland Croatia Bulgaria Latvia % ofGDP Romania 10 12 4 0 2 6 8 formula for specifichospitalservices. budgets basedonthenumberofpatientdaysandotherallocation services, laboratoryanalyses,drugs,etc.,arefinancedfromglobal high costs.Allotherhospitalservices,like hospitalstays,nursing or controlcostandhelpexplainthehighvolumeoftreatment Fee-for-service paymentscreate noincentivestomoderateactivity hospital afee-for-service for allthemedicalservicestheyprovide. are salariedby thehospitalandeventhenCNSpays Hospitalier duLuxembourg(CHL)andtwootherinpatientfacilities their own outpatientpractice.OnlyphysiciansworkingintheCentre fee-for-service, irrespective of whether theypractice in hospital or in Nearly alldoctorsinthecountryareself-employed andarepaidby fee-for-service Service paymentisdominatedby supply issuesintheyearstocome (IGSS,2016). specialists 52(in2015),suggesting thattheremaybefurther is ageing,withtheaverageageof GPsbeing50andthatof available inthecountry. Inaddition,thephysicianworkforce there isnoeducationinmedicine(nordentistryorpharmacy) dependence onforeign-trained doctorsisexplainedby thefactthat the EUaveragein2015(2.9per1 000versus3.6).Luxembourg’s The numberofpractisingdoctorsperpopulationremainedbelow trained doctors foreign-national nursesand onforeign- The workforce isheavilydependenton 435 million, representing 20.7% of the CNS’s total costs. total CNS’s of the 20.7% representing 435 million, EUR to amounted 2015, In costs abroad. care pre-authorising in generous is very CNS the general in and countries neighbouring in treated are They transplant). organ care, cancer paediatric (e.g. Luxembourg in unavailable are that services health group comprises Luxembourg residents who seek specialised smaller much and second The patients. of cross-border share largest the represents group This of residence. country their in mostly care seek they understandably, but, CNS the with insured automatically are they Luxembourg in work they As . border French-Belgian-German the from workers border cross- of non-resident number alarge attracts Luxembourg First, distinguished. be 2015). can TwoCommission, groups (European EU the in share highest by far the abroad, care sought CNS the with insured 2014,In of 16% patients BOX 1. 1. BOX TREATED ABROAD CNS-INSURED INDIVIDUALS AREMANY are attractedby thehigherwagesandgoodworkingconditions. 2014). Luxembourgattractsbothstudentandqualifiednurses,who nationals in2008andnearlyhalfwereforeign-trained (Maieretal., increasing. Approximatelytwothirdsofactivenurseswereforeign- per population,whichisoneofthehighestinEU(Figure 7) and The low numberofphysicianscontrastswiththenurses Unfortunately, implementationofthisinitiative hasstagnated. the needsofpeoplewithmultimorbidity andwithspecificdiseases. networks’ bridgingprimaryandsecondary carethatwouldfocus on The reform alsoenvisagedthecreationofspecial‘competence organising theircarepathway,ensuring ‘joinedup’medicalrecords. GP whowouldactasapersonalcare coordinatorresponsiblefor especially for chronicpatients.Thisallowed patientstochoosea and introducedapilotprogrammeaimedatcoordinatingcare, In 2010,reform legislationsoughttostrengthenprimarycare Kringos etal,2013). coordination andcomprehensivenessofcare(Kringosetal.,2015; has beenjudgedtoberelativelyeffective to andefficientinregard levels relativetospecialists.Morepositively,theprimarycaresystem underdevelopment oftheprimarycareworkforce withlow income inspection, supportiveprimarycarepolicies).Thereisalsorelative (5.8 in2015)andweakprimarycaregovernance (e.g.lackofstate specialist directly. Thereare low outpatientcontactsperperson no gatekeeping systemtheycanalsochoosetovisitanymedical primary caresystem.Patients canchooseanyGPbutasthereis Luxembourg isoneofthefew olderMemberStateswitha‘weak’ primary care Efforts areunderwaytostrengthen STATE OFHEALTH INTHE EU: COUNTRY HEALTH PROFILE2017 – The healthsystem LUXEMBOURG . 7

Luxembourg Luxembourg STATE OFHEALTH INTHE EU: COUNTRY HEALTH PROFILE2017 – timely andeffective health care. 7. Amenablemortalityrefers toprematuredeathsthatcouldhavebeenavoided through mortality Luxembourg reportsthesecondbestoverall totalamenable EU, pointingtoveryeffective care Amenable mortalityisamongthebestin 5.1 EFFECTIVENESS Source: hospital. in working those includes only it as underestimated is nurses of number the Greece, and Note: of nurses numbers high but density alow physician 7. has Figure Luxembourg 8 threatening conditions. Luxembourg’s healthsystemisveryeffective intreating life- Europe andbelow theEUaverageof 11%.Thisshows thatoverall of allcausemortalityisseenasavoidable,onethebestratesin are consideredseparately(seeFigure 8). Furthermore,only10%

Practising nurses per 1 000 population, 2015 (or nearest year) . The healthsystem In Portugal and Greece, data refer to all doctors licensed to practice, resulting in a large overestimation of the number of practising doctors (e.g. of around 30% in Portugal). In Austria Austria In Portugal). in 30% around of (e.g. doctors practising of number the of overestimation alarge in resulting practice, to licensed doctors all to refer data Greece, and Portugal In 10 15 20 5 Eurostat Database. Eurostat 0 5 Performance ofthehealthsystem 7 1 intheEUafter France, andisthirdwhenmenwomen Nurses Low Doctors Low Nurses High Doctors Low 2 Practising doctorsper1000population,2015(ornearestyear) PL RO UK IE SI HR Luxembourg BE 3 LUXEMBOURG LV HU EU average:3.6 FI SK EE FR NL CY EU CZ DK ES IT MT the identification andnotificationofHIVcases. part ofthenationalHIVActionPlan 2012–2015.Thishasincreased and expandedscreeningcentres low-threshold testingfor HIVas in Luxembourg,thegovernment hassetuppublic healthcampaigns Similarly, acknowledging thatHIVinfection isapublichealthissue and programmesthatwilltargetdiabetespatientsmoreeffectively. (primary) healthcare,Luxembourgiscurrentlydevelopingstrategies that deathsfromdiabetescantypicallybepreventedwithtimely people withdiabetesishigherthaninmuchoftheEU.Recognising 2014. Furthermore,thenumberofavoidablehospitaladmissionsfor all neighbouringcountriesandsurpassingtheEUaverageslightlyin 2014 (seeSection 2),insharpcontrastwithadecreasingtrend Mortality duetodiabetesincreasedsubstantiallybetween2000and monitoring Diabetes careandHIVneedcareful 4 BG DE SE LT PT 5 AT 6 EU average:8.4 Doctors High EL Doctors High Nurses High Nurses Low 7 18. Luxembourg has also been comparatively late to transpose the 18. Luxembourghas alsobeencomparativelylateto transposethe government raisedthelegalagefor purchasingtobaccoproductsto neighbouring countriesanditwasnot untilJune2017thatthe Historically, tobaccotaxeshavebeen substantiallylower thanin among womeninpreviousgenerations. in men,reflectingthelong-termconsequencesofincreasedsmoking increased slightlyinthelastdecadecomparedtoadecreasingtrend and wasclosetotheEUaverage.However, inwomen,deathrates cancer death,hasremainedrelativelystableover thelastdecade rate inLuxembourgduetolungcancer,themostcommoncauseof public healthpolicies.Internationalcomparisonsshow thatthedeath it mightbeexpectedthatthesecouldpreventedthroughbetter lung cancer,transportinjuriesandalcohol-attributedmortality, Many deathsarerelatedtolifestyle andriskybehaviours,suchas public healthpolicy Tobacco controlhasbecomeaspearheadof Source: EU the in lowest third the are Luxembourg in rates mortality Amenable 8. Figure United Kingdom Slovak Republic Czech Republic Luxembourg Netherlands Lithuania Germany Denmark Eurostat Database (data refer to 2014). to refer (data Database Eurostat Romania Slovenia Hungary Portugal Bulgaria Belgium Sweden Estonia Finland Croatia Austria Greece Ireland Poland Cyprus France Latvia Malta Spain Italy EU 0 Women 64.4 64.9 67.7 69.3 74.1 100 77.4 79.4 80.7 79.7 83.0 83.9 88.2 85.5 85.4 88.7 92.3 94.4 98.7 97.5 119.9 121.5 Age-standardised ratesper100000population 147.8 152.5 168.2 200 192.3 196.3 207.1 214.9 239.5 300 400 500 lung cancerdeathratesremaintobeseenover thecomingdecades. and taxincreasesstartingfrom2018.Theeffects ofthesepolicieson Tobacco Plan2016–2020alsoinvolvespublicawarenesscampaigns to abanonsmokinginbarsandcafés (2014).Luxembourg’s Anti- (1989) andsmokingincertainpublicplaces(2006),extendingthis as aprincipalcauseofmortalityandprohibitedpublicadvertisement Nonetheless, thegovernment hasrecognisedtobaccoconsumption EU Tobacco ProductsDirective andtoregulatetheuseofe-. comparatively low excise taxonbeer,wineandspirits, whichmakes Section 3) remainsaconcernandmayalso bepartlydrivenby the alcohol consumptionamongadults andyoungadults(see the lastdecade,asinmostEUcountries. However, excessive above theEUaveragein2014,buthasbeendecreasing over The alcohol-relateddeathrateinLuxembourg wasslightly but excisetaxesonalcoholremainlow A nationalalcoholstrategyisbeingdeveloped United Kingdom Slovak Republic Czech Republic Luxembourg Netherlands STATE OFHEALTH INTHE EU: COUNTRY HEALTH PROFILE2017 – Lithuania Germany Denmark Romania Slovenia Hungary Portugal Bulgaria Belgium Sweden Estonia Finland Croatia Austria Greece Ireland Poland Cyprus France Latvia Malta Spain Italy EU 0 Men 92.1 96.4 107.9 108.2 110.5 113.7 115.1 117.0 117.2 133.0 138.0 139.1 139.6 149.0 152.1 154.4 158.2 Age-standardised ratesper100000population 160.3 168.2 200 Performance ofthehealthsystem 229.0 242.5 278.2 335.9 350.7 361.3 400 388.8 415.0 LUXEMBOURG 473.2 501.2 . 9 600

Luxembourg 10 . Performance of the health system

Luxembourg a destination for alcohol tourism. In 2012–14, the primary or specialist). This model ensures co-operation, coordination government established several small-scale programmes to fight and comprehensiveness of treatment (Kringos et al., 2013). excessive alcohol misuse among young adults through awareness-

Luxembourg raising activities which are part of the National Plan 2015– Similarly, the 30-day case fatality rate for stroke is below the 2019 in the fight against drugs and related addictions. A national average of countries for which data are available, indicating good alcohol strategy is currently under development. quality treatment in the acute sector. However, there seems to be room for improvement regarding care of acute myocardial infarction Alcohol is also the second leading cause of road accidents, with (AMI), as the 30-day case fatality rate is above the average. about 30% of fatal accidents in 2015 related to alcohol. The government tries to reduce the number of fatal road traffic accidents Integration and coordination of care for by awareness-raising campaigns in public places and a national chronic patients is still lagging behind day of road safety. In addition, a national injury surveillance system was established in 2013 to collect information on the causes and Luxembourg’s health system currently has no clinical pathways for circumstances of injuries presenting at the emergency departments patients with chronic conditions (e.g. diabetes and hypertension). of all hospitals, and is being used to estimate the burden of injuries The government has taken several steps to improve the quality in terms of morbidity by prevention domain. and effectiveness of care for people with chronic conditions in recent years, but implementation is slow and no formal evaluation Data indicate good quality of care in both the of the level of integration for this group of patients has been carried out. Nevertheless, a national electronic health record (DSP) primary and acute sectors was introduced in 2015 for patients who sign up with a care- Overall, health care quality indicators suggest effective primary care coordinating GP as part of primary care strengthening reforms in despite the weaknesses identified (see Section 4). The vaccination 2010 (see Section 4). The DSP enables patients and professionals coverage rate against DTP3, measles and Hepatitis B for infants to access all relevant medical data. It is currently in a pilot phase stood at 99% in 2015, while vaccination coverage for influenza involving patients with multimorbidity and chronic diseases before among people above 65 years stood at only 41%, but this is being extended to all insured people (see also Box 3 below). comparable to rates in neighbouring countries. Also, given the high death rate related to dementia (see Section 2), Moreover, primary care also seems to be effective in preventing there has been increased attention to the issue and the development unnecessary admissions: avoidable hospital admission rates for chronic of an interministerial Dementia Action Plan launched in 2014, obstructive pulmonary disease (COPD) and asthma are similar or below aiming at preventing and recognising early dementia as well as those in neighbouring countries (Figure 9). The rates might also be improving care for people living with the disease. A secondary explained by the fact that most hospital doctors also work in outpatient prevention programme for people with mild cognitive impairment practices and provide ambulatory (or outpatient) care (which may be was set up in 2015, with the objective to slow disease progression.

Figure 9. Luxembourg has lower avoidable hospital admissions than its neighbours

Age-sex standardised rate per 100 000 population Diabetes Asthma COPD 700 600 500 400 300 200 100 0 EU Italy Spain Malta Latvia France Poland Ireland Austria Finland Estonia Sweden Belgium Portugal Hungary Slovenia Denmark Germany Lithuania Netherlands Luxembourg Czech Republic Slovak Republic United Kingdom Note: Rates are not adjusted by health care needs and health risk factors.

Source: OECD Health Statistics (data refer to 2015 or latest year).

STATE OF HEALTH IN THE EU: COUNTRY HEALTH PROFILE 2017 – LUXEMBOURG Health in Luxembourg . 11

5.2 ACCESSIBILITY Figure 10. The low level of self-reported unmet needs also shows small variations across income groups There are low levels of unmet needs for High income Total population Low income medical care despite a nominal decrease in Estonia Luxembourg insurance coverage Greece Romania Luxembourg’s residents report very low levels of unmet needs for Latvia medical care due to cost, distance or waiting times. Overall, there is little Poland variation across income levels, with lower income groups reporting only Italy slightly higher levels of unmet needs (Figure 10). The compulsory social Bulgaria health insurance coverage rate stood at 95.2% in 2015, which reflects Finland a gradual but continuous decrease from nearly 99% in 2002. However, EU this is not perceived as a problem in the country, nor is it something Portugal that features on the agenda of policy-makers. It is most probably Lithuania due to residents working abroad and an increase in the numbers of Ireland people working for EU institutions who are outside the national health United Kingdom insurance scheme (CNS). Otherwise, only people working occasionally Hungary in Luxembourg, i.e. less than three months per calendar year, are Belgium Slovak Republic exempted from compulsory health insurance. These people may, Croatia however, choose to pay voluntary contributions to the statutory scheme. Cyprus Denmark Despite a generous benefits package, France more than half of the population has Sweden complementary Voluntary Health Insurance Luxembourg Czech Republic The compulsory health insurance entitles the insured population to a Malta very broad benefits package, which covers more services than those Spain in neighbouring countries (Box 2). Nonetheless, complementary VHI Germany is purchased by around 56% of the resident population to cover Netherlands expenses for cost sharing for certain types of hospital care, dental Slovenia treatment, visual aids and other services. Between 2008 and 2015 Austria health spending on VHI increased sharply and by 2015 represented 0 10 20 % reporting unmet medical need 6% of total health spending (Figure 11). This was a response to the Note: The data refer to unmet needs for a medical examination or treatment due to increases in cost sharing mandated in the compulsory insurance costs, distance to travel or waiting times. Caution is required in comparing the data across scheme as part of the cost-containment policies introduced in 2010 countries as there are some variations in the survey instrument used. (see Section 5.3; Box 3). Source: Eurostat Database, based on EU-SILC (data refer to 2015).

Figure 11. Despite recent rises in cost sharing, private expenditure on health is low Luxembourg EU 1% 1%

6% 5%

11% 15% Public/Compulsary health insurance Out-of-pocket Voluntary health 82% insurance 79% Other

Source: OECD Health Statistics, Eurostat Database (data refer to 2015).

STATE OF HEALTH IN THE EU: COUNTRY HEALTH PROFILE 2017 – LUXEMBOURG 12 . Performance of the health system

Luxembourg has the second lowest level in BOX 2. THE BROAD BENEFITS PACKAGE OFFERS out-of-pocket spending but some early signs COMPREHENSIVE SERVICES, ESPECIALLY FOR DENTAL CARE Luxembourg of rising inequalities The health system is based on reimbursement: costs for outpatient The benefits package of compulsory insurance is very health services are paid by the insured to the providers and are generous. It includes primary, secondary and tertiary then reimbursed by the CNS covering 60% to 100% of total costs. care, laboratory tests, medical imagery, medical devices, Hospital treatment costs are paid directly by the CNS, with the psychiatric and geriatric functional rehabilitation, spa exemption of a per diem levied on all adults (EUR 21, except for therapies, and patient transportation, as well as palliative childbirth). The CNS also directly pays the costs for laboratory care. Preventive medicine programmes cover services for tests, pharmaceuticals and long-term care. If cost sharing exceeds specific population groups (prenatal and postnatal care, 2.5% of annual gross income, it is covered by the CNS. Because free contraceptive services for women under 25, smoking of the generally low level of cost sharing and the important role cessation, back pain treatment, etc.). of complementary VHI, out-of-pocket spending as a share of total Dental care is covered for preservative treatment, extractions, expenditure decreased from 13% in 2006 to 11% in 2015. As a orthodontic treatment, and prostheses. These services are share of final consumption, it is now the lowest in the reimbursed at an 88% cost-sharing rate after the first EUR 60 EU, together with France (Figure 12). is also paid by health insurance. Preventive dental services and dental care for children are exempted from cost-sharing. However, this low share of out-of-pocket spending is only an average. Prostheses are 100% covered, unless the insured person did The share of people within the lowest income quintile reporting not consult a dentist regularly for routine preventive care. unmet needs for medical care due to financial reasons has increased, Supplements for prostheses and benefits that go beyond from 0.6% to 2.0% in the same period (2006–15). Although it is still what is deemed useful and necessary are not covered. In far below the EU average (4.1%), this needs to be closely monitored. 2017, the benefits package will be slightly enlarged, mainly by reimbursement of additional dental services and visual aids. There is good availability of health services despite the reliance on specialised care in Drugs included in a positive list are reimbursed at three different rates (100%, 80% and 40%), using criteria such as neighbouring countries severity of illness, availability of substitutes, the importance Availability of health care services seems to be very good, in the therapeutic process and financial burden. although many complex treatments and diagnostic procedures are routinely provided in neighbouring countries because the size of Luxembourg’s population makes it inefficient to offer services medical care due to reasons of distance or waiting times is very domestically (see Section 4; Box 1). The share of people in the low, which is partly due to the good availability of services outside highest and lowest income quintiles reporting unmet needs for of the country and the coverage of medical transport costs.

Figure 12. People in Luxembourg spend the second least in terms of final household budget on medical care

% of household budget 7

6

5 4

3

2 1

0 EU Italy Spain Malta Latvia France Cyprus Poland Ireland Greece Austria Croatia Finland Estonia Sweden Belgium Bulgaria Portugal Hungary Slovenia Romania Denmark Germany Lithuania Netherlands Luxembourg Czech Republic Slovak Republic United Kingdom Source: OECD Health Statistics, Eurostat Database (data refer to 2015).

STATE OF HEALTH IN THE EU: COUNTRY HEALTH PROFILE 2017 – LUXEMBOURG Performance of the health system . 13

5.3 RESILIENCE8 BOX 3. THE 2010 REFORM ON COST CONTAINMENT Luxembourg enjoys strong medium-term SOUGHT TO IMPROVE EFFICIENCY AND PREVENT FINANCIAL INSTABILITY fiscal stability but expenditure growth needs Luxembourg careful monitoring The health reform law of 2010 aimed to improve the efficiency of the health system and contain increasing Currently, Luxembourg performs very well economically with costs. Cost-containment measures focused on capping continuous job growth, a fiscal surplus, and above EU average GDP hospital expenditure by introducing global hospital budgets, growth. The contribution from the central budget to the CNS is substituting pharmaceuticals with less expensive alternatives legally determined at 40% of its total resources (with no budget and temporary freezing of service providers’ tariffs. There were cap). Given the resilience of public finances and the favourable also steps to increase: cost-sharing rates; the contribution labour situation, the financial resources for health care are rate (from 5.4% to 5.6% of gross income); and state funding expected to be stable in the medium term. However, a major health of Social Health Insurance (to 40%). Combined, these efforts reform in 2010 introduced a number of cost-containment measures contributed to balancing the CNS budget. to prevent shortfalls in the health insurance budget that had been projected (Box 3). Despite this, Luxembourg’s economy weathered Efficiency improvements mandated by the 2010 health reform the financial crisis quite well and revenue from health insurance included greater care coordination, transparency on hospital contributions increased more than expected. As a result, the CNS activity with the introduction of a national information system experienced a surplus throughout 2014 to 2016, so that in 2016 its for inpatient care, and the creation of a medical expert board reserve amounted to 23.6% of its current expenditure. that regularly reviews proposed additions and modifications to the benefits basket. In this context the National eHealth Despite a favourable economic climate, public health expenditure agency (eSanté) was created and has been working on the as a share of GDP is expected to increase in the coming shared electronic health records (DSP) pilot since 2011. decades. Moreover, public long-term care spending is projected to rise steeply from 1.6% in 2020 to 3.2% of GDP in 2060 as a consequence of the growing number of older people in need of The health system’s cost-effectiveness could care, faster than in many other EU countries (European Commission be improved, particularly with greater use of and Economic Policy Committee, 2015). This could pose risks to fiscal sustainability in the medium and long term. The long-term generics care reform to be adopted in 2018 aims to sustain the current Although Luxembourg’s amenable mortality is among the best in expenditure levels and to introduce regular assessment of eligibility Europe, its health system is comparatively expensive. In comparison, criteria. relative to levels of health spending, a number of countries such as Spain and France achieve similar or even lower amenable mortality Dependency on foreign health professionals rates at much lower costs per capita (Figure 13), albeit on this measure it is not possible to effectively disentangle the role of could pose a problem as the workforce ages health behaviours and other determinants irrespective of the health Luxembourg relies heavily on the recruitment of nursing staff from care system in influencing the level of amenable mortality. France, Belgium and Germany. Its medical doctors are also recruited from abroad (because there is no medical school in Luxembourg) Luxembourg’s low penetration of generics in the pharmaceutical and are ageing. Although Luxembourg residents tend to come back sector is a good example of how cost-effectiveness could be after professional education and training abroad, this creates a improved. The country has by far the lowest penetration of strong dependency on neighbouring countries and competition for generic drugs in the EU (11% of the total volume of reimbursed scarce health professionals. pharmaceuticals versus 49% in Member States with available data in 2015) (Figure 14). To increase the use of generics, the Ministry of Health introduced a generic substitution policy in late 2014. Two pharmacotherapeutic groups for approximately 400 medical products (accounting for nearly 10% of the total expenses of the CNS) were specified eligible for generic substitution. This new policy led to a modest increase (4%) of the reimbursement of generics

8. Resilience refers to health systems’ capacity to adapt effectively to changing between 2013 and 2016. environments, sudden shocks or crises.

STATE OF HEALTH IN THE EU: COUNTRY HEALTH PROFILE 2017 – LUXEMBOURG 14 . Performance of the health system

Figure 13. Luxembourg has low amenable mortality but at very high cost

Health expenditure per capita, EUR PPP 6 000 Luxembourg

Luxembourg 5 000

NL 4 000 SE DE DK IE AT FR BE 3 000 FI UK IT ES MT 2 000 PT SI CZ CY EL SK HU HR EE LT PL BG LV 1 000 RO

0 0 50 100 150 200 250 300 350 Amenable mortality per 100 000 population Sources: OECD Health Statistics, Eurostat Database, WHO Global Health Expenditure Database (data refer to 2014).

Figure 14. Luxembourg has the lowest market share for generics among EU countries

Luxembourg Belgium France Germany Netherlands % 90

80

70

60

50

40

30

20

10

0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Note: Data for Belgium, Germany, Luxembourg and the Netherlands are for reimbursed pharmaceutical market; data for France are for total pharmaceutical market. Source: OECD Health Statistics 2017.

STATE OF HEALTH IN THE EU: COUNTRY HEALTH PROFILE 2017 – LUXEMBOURG Performance of the health system . 15

Hospital indicators signal room to improve Improvements to efficiency and efficiency and treat more people in day care accountability are needed

9 Hospital care in Luxembourg is provided by 10 hospitals with 482 Several attempts to improve transparency, accountability, Luxembourg beds per 100 000 population (compared to the EU average of 515 documentation of service costs and the efficiency of service beds). Although there is no gatekeeping and outpatient contacts provision in hospitals have failed in recent years. In particular, the are low, it does not seem to lead to elevated numbers of hospital setting of classifications and standards for accurate description cases. On the contrary, the number of hospital beds per 1 000 of hospital services were, until recently, consistently met with population for Luxembourg decreased by 25% between 2004 opposition from medical doctors. Consequently, implementation of and 2015 (Figure 15), mostly due to . Hospital proposed reforms, including the introduction of case-based (DRG) discharges also declined by 20% in the same period, and became payments, lags behind. However, one initiative, the establishment among the lowest in the EU, contributing to a relatively low bed of the Carte Sanitaire, provides an inventory of all hospitals, their occupancy (72% versus 77% at EU level). These low utilisation services, resources, equipment, etc., and is expected to contribute to levels in inpatient and ambulatory care do reflect, however, the high developing a future hospital plan. share of patients seeking care abroad. Information systems and performance That said, the average length of stay (ALOS) in Luxembourg’s hospitals assessment are lacking has remained stable over the last ten years (Figure 15), in contrast to decreasing ALOS in neighbouring countries, and is among the highest A comprehensive information system is needed that can help in the EU in 2015. The absence of DRG-based payment and the improve monitoring of health system resources, costs and underdevelopment of day case surgery are likely contributors to this. quality of care. Most importantly, there is currently no systematic For example, although the share for cataract surgery performed as performance evaluation of the health system. Having such ambulatory cases (79%) is slightly below the EU average, ambulatory assessments done periodically could inform policy-making and tonsillectomy care (7%) is among the lowest in Europe. help achieve the shift that is needed from excessive capacity and overprovision of inpatient care towards services at ambulatory and primary care services.

Figure 15. There has been a fall in numbers of beds but average length of stay remains high

Beds per 1 000 population Hospital beds Average length of stay in hospital ALOS (days) 10 10

9 9

8 8

7 7

6 6

5 5

4 4 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Source: Eurostat Database.

9. After several hospital mergers in 2014, Luxembourg has four general and six specialised hospitals providing acute, rehabilitative and palliative care.

STATE OF HEALTH IN THE EU: COUNTRY HEALTH PROFILE 2017 – LUXEMBOURG 16 . Health in Luxembourg

6 Key findings Luxembourg

l The Luxembourg health system provides good quality to some uncertainty. This is also true for the provision of care and has made a major contribution to improving specialised care services, where Luxembourg relies on . Life expectancy in Luxembourg is neighbouring countries for treatment. among the highest in the EU and amenable mortality rates are among the lowest. Yet there is room for making l The efficient allocation and use of health care resources prevention and treatment of diseases such as diabetes could receive higher policy priority. Several efficiency more effective. indicators and structural challenges signal room for improvement, as the system is very costly and payment l Behavioural risk factors – smoking, drinking and obesity methods do not promote efficiency in service provision. – are important challenges for the health system and Pharmaceutical spending could also provide more reveal substantial inequalities according to education value for money by increasing generic penetration and and income status. Preventable mortality indicators substitution. Similarly, the definition and setting of tariffs reveal a mixed picture of the effectiveness of prevention for medical services and Health Technology Assessment policies and suggest that these can be improved further. could be prioritised. A comprehensive set of health strategies, targeted health promotion and prevention activities aims to address l To improve efficiency in hospital care, further development these risks through raising awareness and public health of day care surgery is needed and, in the absence of campaigns. However, careful monitoring will be needed to case-based payments, increased transparency and demonstrate the effectiveness of these programmes and accountability have to be implemented. Efficiency could to detect health inequalities within the population. also be improved by using compatible information technology solutions for hospital administration and l Per capita health care spending in Luxembourg is the management, as well as centralised public procurement highest among EU countries. This allows for a very systems. Stronger collaboration between the four generous benefits package with low cost-sharing and high general hospitals would be a possible way forward, with quality of health care services. The population benefits competence networks involving voluntary hospitals as from good financial and geographic access to services, well as other providers. which is reflected in the low level of unmet needs and out-of-pocket expenditure. However, the level of unmet l Finally, there is considerable room to do more with regular needs for financial reasons is slowly creeping up in the health system performance assessments, particularly lowest income groups. when it comes to the monitoring of inputs, processes, outputs and outcomes. Setting up appropriate information l Questions have been raised about the long-term systems will be key in this effort. stability of resources. Financial resources for the health care system are currently stable and have enabled expansions of the benefits basket. However, health expenditure growth, especially in long-term care, might pose a challenge to the future fiscal sustainability of the system. In terms of human resources, although Luxembourg does not face worrying shortages today, it does depend on graduates from other countries, leading

STATE OF HEALTH IN THE EU: COUNTRY HEALTH PROFILE 2017 – LUXEMBOURG Health in Luxembourg . c

Key sources Luxembourg

Berthet, F. et al. (2015), “Luxembourg: HiT in Brief”, European OECD/EU (2016), Health at a Glance: Europe 2016 – State of Observatory on Health Systems and Policies, . Health in the EU Cycle, OECD Publishing, , http://dx.doi. org/10.1787/9789264265592-en.

References

ADEM (2017), “Panorama du marché de l’emploi”, Agence pour IHME (2016), “Global Health Data Exchange”, Institute for Health le développement de l’emploi, http://www.adem.public.lu/fr/ Metrics and Evaluation, available at http://ghdx.healthdata. marche-emploi-luxembourg/panorama-marche-emploi/index. org/gbd-results-tool. html, accessed on 22/02/2017. Kringos, D. et al. (2015), “Luxembourg”, in D. Kringos et al. (eds.), CNS (2016), Rapport Annuel 2015, Caisse National de Santé, Building Primary Care in a Changing Europe. Case Studies, Luxembourg. Observatory Studies Series 40, WHO Regional Office for Europe, Copenhagen, pp. 163–170. European Commission (2015), “Patients’ Rights in Cross-border Healthcare in the European Union”, Special Kringos, D. et al. (2013), “Building Primary Care in a Changing 425, Directorate General for Health and Consumers (SANCO). Europe”, Observatory Studies Series 38, Vol. 1, WHO Regional Office for Europe, Copenhagen. European Commission (DG ECFIN) and Economic Policy Committee (AWG), “The 2015 Ageing Report – Economic and Maier, C.B. et al. (2014), “Monitoring Health Professional Mobility budgetary projections for the 28 EU Member States (2013– in Europe”, in J. Buchan et al. (eds.), Health Professional 2060)”, European Economy 3, , May. Mobility in a Changing Europe – New Dynamics, Mobile Individuals and Diverse Responses, World Health Organization IGSS (2016), Rapport Général sur la Sécurité Sociale au Grand- (on behalf of the European Observatory on Health Systems Duché de Luxembourg 2016, Inspection Générale de la and Policies), Copenhagen, pp. 95-127. Sécurité Sociale, Luxembourg.

Country abbreviations Austria AT Denmark DK Hungary HU Malta MT Slovenia SI Belgium BE Estonia EE Ireland IE Netherlands NL Spain ES Bulgaria BG Finland FI Italy IT Poland PL Sweden SE Croatia HR France FR Latvia LV Portugal PT United Kingdom UK Cyprus CY Germany DE Lithuania LT Romania RO Czech Republic CZ Greece EL Luxembourg LU Slovak Republic SK

STATE OF HEALTH IN THE EU: COUNTRY HEALTH PROFILE 2017 – LUXEMBOURG State of Health in the EU Country Health Profile 2017

The Country Health Profiles are an important step in the Each Country Health Profile provides a short synthesis of: European Commission’s two-year State of Health in the EU l  health status cycle and are the result of joint work between the Organisation l  the determinants of health, focussing on behavioural risk for Economic Co-operation and Development (OECD) and the factors European Observatory on Health Systems and Policies. This l  the organisation of the health system series was co-ordinated by the Commission and produced with l  the effectiveness, accessibility and resilience of the health the financial assistance of the European Union. system

The concise, policy relevant profiles are based on a transparent, This is the first series of biennial country profiles, published in consistent methodology, using both quantitative and qualitative 2017. The Commission is complementing the key data, yet flexibly adapted to the context of each EU Member findings of these country profiles with a Companion Report. State. The aim is to create a means for mutual learning and voluntary exchange that supports the efforts of Member States For more information see: ec.europa.eu/health/state in their evidence-based policy making.

Please cite this publication as:

OECD/European Observatory on Health Systems and Policies (2017), Luxembourg: Country Health Profile 2017, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels. http://dx.doi.org/10.1787/9789264283480-en

ISBN 9789264283480 (PDF)

Series: State of Health in the EU ISSN 25227041 (online)

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