Luxembourg is a unitary parliamentary constitutional monarchy. There are 3 official languages: Luxembourgish, French and German.
The healthcare system of Luxembourg is seen as the best in the world. Healthcare expenditure per capita is among the highest in Europe. Medicines are reimbursed up to 80%, but medicines for the treatment of long-term illnesses or for treatment in a hospital are fully reimbursed. Of some non-essential pharmaceutical products (such as vitamin preparations), only 40% is reimbursed.
GDP per capita
Health spending in Luxembourg is the highest among EU countries. In 2015, Luxembourg spent EUR 5 090 per head on health care, compared to the EU average of EUR 2 797. This equals 6,0% of GDP. Some 82% of health spending is publicly funded and out-of-pocket spending is one of the lowest in the EU.
Luxembourg’s health system is characterized by a compulsory social insurance system relying on substantial inputs from the central budget. The single-payer fund (Caisse National de Santé – National Health Insurance, CNS) is responsible for two schemes: health care insurance and sickness leave insurance. On top of this, CNS is also responsible for the financing of long-term care insurance.
The country has by far the lowest penetration of generic drugs in the EU (11% of the total volume of reimbursed pharmaceuticals versus 49% in Member States with available data in 2015). 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 between 2013 and 2016.
Despite stable funding, there are concerns over growing costs, with efforts to improve efficiency. Governance arrangements seem to respond to health challenges appropriately yet they fail to carry out systematic performance assessment.
Gert van Alewijk and Bauke Buwalda
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