Context
Faced with growing challenges from demographic changes, financial sustainability, workforce shortages and the sector’s environmental footprint, Luxembourg has developed a national Health System Performance Assessment (HSPA) framework. The initiative was led by the National Health Observatory (ObSanté), with support from national authorities. It received technical and financial support from the European Commission’s Technical Support Instrument (TSI) and the OECD through a joint project with Slovakia.
Main purpose
The purpose of Luxembourg’s HSPA encompasses:
- monitor of population health to target its improvements and address inequalities;
- enhance accountability and transparency;
- increase public awareness, health literacy and promoting patient-centredness; and
- support evidence based policy planning and decision making.
Framework content
The HSPA framework is comprehensive in scope, covering population health, healthcare services, broader determinants of health and the country’s unique cross-border populations. It follows international good practice while remaining adapted to Luxembourg’s specific context and data availability. It is organized into 12 domains and 30 subdomains, categorized into four core blocks:
- outcomes: health status, person-centredness;
- processes: access to care, value-based care, integrated care;
- inputs: governance, infrastructure, workforce, finances; and
- cross-cutting: sustainability, determinants of health, equity.
To operationalize the framework, 105 indicators were selected through a multi-stage prioritization process involving extensive stakeholder consultation (workshops, focus groups and advisory meetings) and distributed across all domains and subdomains. This collaborative approach ensured national relevance and shared ownership. The final indicator set was formally approved in November 2025, providing a balanced yet flexible foundation for assessing health system performance while allowing for future refinement as data systems evolve.
Governance and implementation
To ensure long-term sustainability, the HSPA governance structure involves four dedicated governance bodies. It builds on existing institutional responsibilities and places ObSanté at the centre of implementation, consistent with its legal mandate to evaluate health system performance. However, successful implementation will require continued stakeholder collaboration, clear accountability mechanisms, aligned reporting cycles, and effective use of HSPA findings in policy development and monitoring.
Expected outcomes and next steps
Detailed in a methodological report, the framework provides a transparent and robust foundation for a sustainable and accountable HSPA process in Luxembourg. By clearly defining the framework, indicators and methodological choices, it aims to promote stakeholder engagement, enhance understanding of health system performance, and support the systematic use of evidence in health policy planning and evaluation. Ultimately, the HSPA is intended to become a key instrument for monitoring progress, identifying areas for improvement, and informing strategic decision-making across the health system. A first HSPA report is expected by mid-2028.