2023 Global Health Care Outlook

“A stitch in time saves nine”

The outlook for Luxembourg’s healthcare sector is looking promising for 2023. Though the scars of COVID-19 remain widespread, the time to make use of lessons learned and silver linings is now.

The magnitude of the pandemic helped accelerate medical innovation across the world. Overnight, tech-skeptic physicians embraced tools that helped care for their patients, “laggards" became swift “adopters,” and the wellbeing of the medical workforce gained visibility in political agendas. This holds partially true for Luxembourg. While gaps within the healthcare system became apparent, they have the potential as a catalyst for change. While Luxembourg never suffered from a complete surgical paralysis during lockdown that still ails the rest of Europe, a backlog of elective patient care continues to mount. Applying the transformative changes witnessed in the healthcare sector during the pandemic could certainly help in tackling the local issues that continue.
 

Hanging from a thread

We are running out of skilled medical professionals. Historically, Luxembourg managed its surplus demand by virtue of its residents seeking care abroad. But since the pandemic, Luxembourgers are becoming less inclined to follow this route as reimbursement for care abroad becomes restricted. In parallel, the number of patients is escalating with the population surge. So it follows that waiting lists for specialist care are bordering on critical levels (e.g., nine months for an uncomplicated cataract operation).

Thus, the healthcare sector will be hard hit when the upcoming wave of physicians retire, leaving many patient cohorts struggling to find new practitioners. This has already been felt in the south of the country, where elective ophthalmic care is spilling into specialist hospitals in the center. With limited replacement staff, rising elective lists, and lack of operating space, it is proving increasingly difficult to take on more specialized cases.
 

Threading the needle

While there are certainly obstacles, Luxembourg has the opportunity to improve their healthcare system with strategic moves in sustainable staffing, optimized processes, and strengthened partnerships between patients and their providers.

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Sustainability

One of the first components to address is the volume of healthcare workers: staffing levels need to be sustainable. With the second lowest number of physicians in Europe, the OECD report shows—when compared to the EU average—Luxembourg houses more general practitioners than specialists. The local medical employment websites are also a bit problematic, as they are difficult and time-consuming to navigate. But there is hope. With the advent of local apps, like MediNation the process is becoming more centralized and simplified; a user-friendly, digital solution knocking down yet another barrier to entry.

But to achieve a sustainable workforce, one must hone in on retention. Unfortunately, younger doctors and nurses alike don’t find working in Luxembourg to be an attractive offer. This is not for a lack of pay, but for a lack of formalized specialist training; junior doctors are enticed by practical opportunities, medical research, and the prospect of self-growth within their specialty of interest. Thus, to retain staff, we need to recognize—and address—their needs.

We are uniquely situated in the heart of Europe with three strategic borders. Expanding our ties with the greater region and linking with leading medical universities to provide such opportunities would offer a remedy to both medical staff shortages and retention. Establishing academic nursing training programs with flexible completion dates would enable staff’s upskilling while also keeping them vested in the Luxembourgish healthcare system. Another opportunity, not yet explored, is the diversification of medical staff. For example, the creation of physician assistants to deal with shortages in the United States has been successfully transposed in Belgium, the Netherlands and Switzerland. By implementing similar learnings, we could redirect our dependence on foreign healthcare professionals while also encouraging interdisciplinary team coordination within the hospital setting.

Optimization

When you have a country this size, you can more easily take advantage of bringing key stakeholders together for discussions to align on a national vision. For instance, how might we best manage process improvement in our four largest hospitals? Outpatient surgery, otherwise known as ambulatory care, is on par with our neighbors; inpatient care in Luxembourg, however, has not only been higher historically, it has risen further since the pandemic, stretching thin the available physical resources.

But this problem is not permanent. The creation of satellite hubs dedicated to outpatient care is an example of process improvement in specialist care that’s already proven very effective across Europe. Within the proximity of a larger hospital, these hubs provide operating rooms devoted for high-volume, short-duration, and low-risk surgical procedures in ophthalmic, vascular, or orthopedic care. They would not only increase capacity for specialized, in-patient care that is more complex; it would strengthen the outpatient setting. This would help tackle the mounting pressures of patient lists and give the practical experience that the younger surgeons are looking for in their training, helping to center Luxembourg as a more promising home for their medical careers.

Partnership

Lastly, the patient-physician partnership also needs to be bolstered, and electronic patient health records (EHRs) can help. With EHRs come the advantages of shared expertise and seamless patient care; the transparency acting as a catalyst to reinforce patient partnerships. Another benefit of a nationwide, electronic healthcare system is the analytics, which become data mines for preventative medicine and detection. Adolescent obesity, for example, is one of the many health epidemics in Luxembourg that could be tackled via preventative and public health campaigns. Digitalization, via apps, can also can also help by gamifying healthy eating—something that’s been done successfully abroad. In fact, several funding initiatives currently promote HealthTech startups within the country; it’s something Luxembourg could definitely leverage to stay competitive.

The benefits of digitalization go beyond day-to-day operations and data collection; they can also help the collection of patient reported outcomes (PROs), which not only help measure patient satisfaction, but are pivotal to monitoring—and improving— the quality of patient care provided. Facilitating links between these advances in the digital space and the Luxembourgish healthcare sector is the way forward to a health system that reflects and adequately addresses the population’s needs and values.

Unfortunately, when it comes to electronic patient health records (EHRs), we are not yet equipped with a national system. But there is hope. The healthcare professionals entering the medical field in the next half- decade are digitally savvy; they’re a generation that’s comfortable working with digital medical tools to practice more effectively. To ensure we don’t miss out on key opportunities, it will be important that they help Luxembourg get on a level playing field with its neighbors.

If we are to follow in the footsteps of the future of healthcare—that is to build a partnership with patients—then this year will require a strategic initiative that positions organizational change and workforce retention at its heart.