Health in Luxembourg

The Ministère de la Santé et de la Sécurité sociale and the Direction de la santé oversee health policy, prevention, screening, provider authorization, quality and safety supervision, surveillance and public-health programmes. The Caisse nationale de santé (CNS) sets coverage and reimbursement limits. The Portail Santé provides public health information and current guidance. A médecin généraliste provides general medical care and can coordinate continuing treatment. A patient may directly choose a general practitioner, specialist, dentist, hospital, pharmacy or home-care provider; Luxembourg has no general referral requirement or gatekeeping pathway. A médecin référent is voluntary and can coordinate referrals, medical reports, medication checks and follow-up, especially for chronic or complex conditions. Authorized providers operate under compulsory conventionnement, meaning they participate in the national contractual framework for healthcare services. Prevention is available through general practitioners, the Direction de la santé and Centres médico-sociaux run by the Ligue médico-sociale. Services include smoking cessation, advice for infants and young children from birth to age four, school medicine, nutrition, physical activity, sexual health, addiction prevention, chronic-disease prevention and geriatric prevention. Mental-health care is supported by general practitioners, psychiatric and psychotherapeutic services, outpatient and inpatient facilities, and rehabilitation services. The National Mental Health Plan, known as PNSM, provides the strategic framework for 2024–2028. The CSMI issues vaccination recommendations and the Direction de la santé implements the national programme. The programme includes infant vaccinations from two months of age, MMRV vaccination at 15–23 months, two HPV doses for ages 9–14 with catch-up vaccination from 15–26, and DTaP/IPV boosters every ten years. From age 65, recommendations include pneumococcal, influenza, herpes zoster and seasonal COVID-19 vaccination. During pregnancy, influenza and pertussis vaccination are recommended in the second or third trimester, and RSV vaccination is recommended at weeks 32–36 from September to February. Programme vaccinations are publicly covered under the applicable arrangements. The Programme Mammographie invites women aged 45–74 for screening every two years. It covers residents and non-resident women affiliated with the CNS, and participation in the programme is free. The colorectal cancer screening programme, PDOCCR, is available to women and men aged 45–74 who are registered with the CNS or social security. It uses a home FIT/iFOBT stool test. The invitation or voucher can be handled through MyGuichet, by telephone or at a pharmacy or BIONEXT. The voucher remains valid for two years, the kit should generally be ordered no earlier than about seven days after the previous one, and participation is voluntary. A positive test requires follow-up colonoscopy. Primary care includes general practitioners, medical practices and Centres médico-sociaux. Secondary care includes specialists and hospitals. Tertiary care includes aid-and-care establishments and home-care networks, often after a hospital stay. Available services include medical, dental, psychotherapeutic, nursing, physiotherapy, speech-therapy, psychomotor, dietetic and midwifery care. Luxembourg's four hospital groups are CHL, HRS, CHEM and CHdN. Specialized institutions include INCCI, CFB, CHNP, REHAZENTER, HIS and CRCC. Haus Omega provides palliative care, while the LNS provides laboratory and diagnostic services. Some complex services are concentrated nationally. The three geographic areas used for out-of-hours access are Luxembourg City, Belval and Ettelbruck; practical provider distribution otherwise varies between central, southern and northern Luxembourg. Call 112 for a life-threatening or immediately dangerous condition. The service is free and available 24 hours a day, seven days a week through the CGDIS emergency rescue service. Examples include unconsciousness, severe chest pain, sudden paralysis or loss of vision, breathing difficulty, uncontrollable bleeding, childbirth complications and a suicide attempt. Hospital emergency departments treat acute cases. Routine questions should use an ordinary provider or an out-of-hours service rather than 112. The three Maisons Médicales de garde provide medical care outside normal practice hours: Luxembourg City at 23 Val Fleuri, Belval at 3–5 avenue du Swing and Ettelbruck at 110 avenue Lucien Salentiny. They open Monday to Friday from 20:00 to 24:00 and on Saturdays, Sundays and public holidays from 08:00 to 24:00. No appointment is required. They do not replace a hospital emergency department. During opening hours, the hotline is +352 20 333 111; current on-call information is also published through the Portail Santé and 112.lu. After midnight, 112 is the required contact and the médecin de garde decides whether a consultation, telephone advice or home visit is appropriate. Pharmacies have a separate on-call service from 08:00 until 08:00 the following day. Public pharmacies, called officines, are state-concessioned services. They dispense prescription medicines and can also provide medicines after pharmacist advice or a patient's request. Pharmacists check dosage, interactions and possible adverse effects, and a generic or brand substitute may be available. A standard prescription is generally valid for about three months, while the last partial dispensing may take place no later than six months after the first dispensing. Reimbursement and the positive list depend on insurance and cost rules rather than on the healthcare pathway itself. The Dossier de Soins Partagé, or DSP, is a free personal electronic health record managed by the eSanté Agency. It can contain laboratory results, imaging reports, discharge reports and treatment information. The patient or legal representative controls access, and a médecin référent or other healthcare professional can view it with the required consent. The access history is visible, permissions can be changed or blocked, and the record can be closed at any time. It closes automatically after ten years of inactivity and does not replace the local patient file kept by a provider. Rehabilitation may be outpatient or inpatient and can be geriatric, psychiatric, functional or post-oncological. Aid-and-care networks can support washing, dressing, eating and drinking, mobility at home and other daily care. Luxembourg also has day and night centres and residential care facilities. Maternity services are available in the four hospital groups. Home birth is legally possible, and a midwife can provide postnatal follow-up for an outpatient birth for up to ten days. Newborn examinations and screening take place during the early postnatal period. Patients have equal access based on health status and are entitled to dignity, privacy, confidentiality, understandable information, free informed consent and withdrawal of consent. They may choose or change a provider, request a second opinion and access their medical records and health information, although hospital and provider choice can be limited by organization and availability. A companion may be present, and a personne de confiance can be appointed through a dated and signed document. An interpreter may be used when needed. Patients should provide relevant information, give consent or a reasoned refusal and cooperate with care. Providers may refuse non-urgent treatment for legitimate reasons, but they must not discriminate and must provide initial emergency care and continuity of care. The Service national d'information et de médiation dans le domaine de la santé, known as the Médiateur Santé, offers information, advice and voluntary confidential mediation. It does not decide purely financial or CNS reimbursement disputes and does not handle disputes limited exclusively to everyday care services. In liberal medicine, patients often pay the provider first and request reimbursement separately; the exact reimbursement and patient share depend on the applicable insurance and cost rules.