Luxembourg: consultations with a view to developing a National Health Plan and strengthening the resilience of the healthcare system

Report (2022)

With the aim of developing a National Health Plan, Luxembourg is currently undertaking collective consultations to define a vision of the healthcare system of tomorrow, taking into account existing ... [more ▼]

With the aim of developing a National Health Plan, Luxembourg is currently undertaking collective consultations to define a vision of the healthcare system of tomorrow, taking into account existing challenges whilst remaining attractive to patients and service providers. The first results of these consultations are now being implemented, but some developments will need more time. [less ▲]

Social protection and inclusion policy responses to the COVID-19 crisis. Luxembourg.

Report (2021)

Between Monday 3 February 2020 and Sunday 18 April 2021, the total number of confirmed COVID-19 cases per 100,000 people was 6,740 for the EU-27 as a whole; in Luxembourg, it was 10,545. The total number ... [more ▼]

Between Monday 3 February 2020 and Sunday 18 April 2021, the total number of confirmed COVID-19 cases per 100,000 people was 6,740 for the EU-27 as a whole; in Luxembourg, it was 10,545. The total number of deaths per 100,000 people was 126 for the EU-27, and also for Luxembourg. Section 1 presents more data on the impact of the pandemic on the demographic, economic and social situation. A total of 14 different social protection and inclusion measures deployed by the Luxembourg government to counter and mitigate the effects of the pandemic are described in Section 2 in terms of the targeted population, the timing and their novelty. These measures relate to: unemployment benefits; job protection; sickness benefits and sick pay; health insurance; minimum-income schemes and other forms of social assistance; housing support; leave for parents whose children are unable to attend school or a pre-school service by reason of COVID-19; and leave for family support. This section also analyses the social impact and the relevance of these measures, including, where appropriate, the concrete description of the benefits and (estimated) numbers of targeted populations and/or effective recipients. Some of these measures are only of a regulatory nature and do not require any expenditure of money by the government or others (e.g. the National Health fund, employers or landlords), others are associated with more or less extensive expenditure, depending on whether they are aimed at many potential recipients or only a few. In Section 3, a preliminary and tentative estimate of the induced costs of these measures is provided. According to this, the global cost would amount to roughly €996 million in 2020, which represents around 1.5% of 2019 GDP. Some of the measures have been new ones, whereas others have only been adjustments or extensions of existing measures; in either case, not all of them will continue to be in force once the pandemic is over (some have already stopped). Whether, or the degree to which, any of these temporary measures will become permanent is not predictable at this time. In general, the social protection system in Luxembourg has proved quite resilient to the COVID-19 crisis. However, a number of shortcomings have also been highlighted, several of which will most probably persist. This is the case for the growing number of people at risk of poverty, which has not been offset by the minimum income reform. The increase in the percentage of NEETs (young people not in employment, education or training), as well as in the number of unemployed people aged 16-29, is to be mentioned, together with the fact that there are still groups that are not covered by the national health insurance system. Specific groups such as non-EU migrants and homeless people have been particularly exposed to the crisis and they are also in general more heavily exposed to the risk of poverty. The shortcomings of the housing market, with ever growing prices and the spill-over effects on rent levels, have certainly been somewhat cushioned by the measures, but there have been no structural changes to a situation that keeps getting worse. In addition, the crisis has exacerbated the crucial importance of the medical workforce, which is in danger of shrinking in the next years because of upcoming retirements. Finally, the crisis has revealed the problem of self-employed people not being sufficiently covered by social security cushions. There is also a need to rethink social policy beyond the Luxembourg borders, and to improve the European co-ordination of national healthcare systems. [less ▲]

Socioeconomic and behavioural factors associated with access to and use of Personal Health Records

in BMC Medical Informatics and Decision Making (2021), 21

Background: Access to and use of digital technology are more common among people of higher socioeconomic status. These differences might be due to lack of interest, not having physical access or having ... [more ▼]

Background: Access to and use of digital technology are more common among people of higher socioeconomic status. These differences might be due to lack of interest, not having physical access or having lower intentions to use this technology. By integrating the digital divide approach and the User Acceptance of Information Technology (UTAUT) model, this study aims to further our understanding of socioeconomic factors and the mechanisms linked to different stages in the use of Personal Health Records (PHR): desire, intentions and physical access to PHR. Methods: A cross-sectional online and in-person survey was undertaken in the areas of Lorraine (France), Luxembourg, Rhineland-Palatinate and Saarland (Germany), and Wallonia (Belgium). Exploratory factor analysis was performed to group items derived from the UTAUT model. We applied linear and logistic regressions controlling for country-level heterogeneity, health and demographic factors. Results: A total of 829 individuals aged over 18 completed the questionnaire. Socioeconomic inequalities were present in the access to and use of PHR. Education and income played a significant role in individuals' desire to access their PHR. Being older than 65 years, and migrant, were negatively associated with desire to access PHR. An income gradient was found in having a physical access to PHR, while for the subgroup of respondents who expressed desire to have access, higher educational level was positively associated with intentions to regularly use PHR. In fully adjusted model testing the contribution of UTAUT-derived factors, individuals who perceived PHRs to be useful and had the necessary digital skills were more inclined to use their PHR regularly. Social influence, support and lack of anxiety in using technology were strong predictors of regular PHR use. Conclusion: The findings highlight the importance of considering all stages in PHR use: desire to access, physical access and intention to regularly use PHRs, while paying special attention to migrants and people with lower socioeconomic backgrounds who may feel financial constraints and are not able to exploit the potential of PHRs. As PHR use is expected to come with health benefits, facilitating access and regular use for those less inclined could reduce health inequalities and advance health equity. [less ▲]

Adolescent Body Dissatisfaction in ContrastingSocioeconomic Milieus, Coming from a French andLuxembourgish Context

in International Journal of Environmental Research and Public Health (2020), 17(61),

: To analyze the relationships between body mass index (BMI), ideal body,current declared body shape, and gap between ideal and declared body shape, and the associationsthat these have with social and ... [more ▼]

: To analyze the relationships between body mass index (BMI), ideal body,current declared body shape, and gap between ideal and declared body shape, and the associationsthat these have with social and cultural factors among 329 adolescents (11 to 15 years i.e., at two stagesof adolescence, the early and late adolescence), attending an international school in Luxembourg,and 281 from Paris.Methods:A cross-sectional survey was conducted using an online questionnaire.Missing data were addressed using the data augmentation method in a Bayesian framework.Results: For both sets, higher the BMI and bigger their current body shape (CBS), the slimmertheir ideal body shape, especially for those who perceive a link between body shape and beauty.For girls, slimness is a shared ideal; for boys, older they are, more they want a muscular body shape.Most students want slimmer bodies, but in affluent or intermediate social milieu students in relationsto identification to personalities such as celebrities, while students from modest milieus, this isexpressed in relation to success in love. In addition, they declared that their “talk diet with friends”were associated with large gap between ideal and declared body shape.Conclusions:A social controlnorm was revealed involving a displacement of values affecting body weight and health in the latestage of adolescence to early adolescence, especially for boys. [less ▲]

Mieux situer la place de l’Approche Patient Partenaire de Soins en Grande Région

in Muller, L.; Laguette, V.; Dany, L. (Eds.) Pratiques et interventions en psychologie de la santé. (2020)

Nos résultats appellent également à un développement de la culture de l’approche patient-partenaire de soins. Même si ce genre de démarche, favorisant l’implication du patient, est recommandé depuis de ... [more ▼]

Nos résultats appellent également à un développement de la culture de l’approche patient-partenaire de soins. Même si ce genre de démarche, favorisant l’implication du patient, est recommandé depuis de nombreuses années, c’est tout le paradigme de l’organisation des systèmes de santé qui doit évoluer en parallèle à l’évolution des besoins sanitaires. Ce paradigme touche aux valeurs, aux représentations de ce que constitue l’acte même de soigner. L’exploration menée auprès des professionnels de santé et des patients révèle des envies d’évolution des pratiques de soins et de la relation soignant-soigné. Cependant, ces volontés sont freinées par des ambiguïtés sur le concept même du patient-partenaire de soins, une connaissance et des compétences limitées en matière d’approche patient-partenaire de soins et des éléments de contexte de travail qui rendent cette évolution impossible. Le point positif est la mise en évidence d’une volonté commune d’évoluer vers un patient plus acteur dans les soins, plus autonome, avec une série d’avantages perçus. On peut dire qu’il existe un décalage important entre la vision souhaitée et ce qui est actuellement possible. Notre projet a permis d’observer une volonté affichée d’évoluer vers davantage d’engagement du patient dans la relation de soin et dans les structures de soins de santé. Le développement attendu passera par une approche systémique de l’engagement tant sur des aspects micro (de la relation de soin) méso (dans la coordination des structures de soins) et macro (avec l’engagement des politiques de santé). Le développement doit s’appuyer sur les initiatives existantes : en ce sens le projet Interreg est une belle façon de promouvoir les échanges de bonnes pratiques au service de cet engagement du patient. [less ▲]

Core Values that Influence the Patient—Healthcare Professional Power Dynamic: Steering Interaction towards Partnership

in International Journal of Environmental Research and Public Health (2020), 7(8458),

Healthcare has long been marked by the authoritative-physician–passive-patient interaction, with patients seeking help and physicians seeking to restore patients back to health. However, lobalisation ... [more ▼]

Healthcare has long been marked by the authoritative-physician–passive-patient interaction, with patients seeking help and physicians seeking to restore patients back to health. However, lobalisation, social movements, and technological advancements are transforming the nature of this relationship. We aim to identify core values that influence the power dynamic betweenpatients and healthcare professionals, and determine how to steer these interactions towards partnership, a more suitable approach to current healthcare needs. Patients with physical chronic diseases (10 men, 18 women) and healthcare professionals (11 men, 12 women) were interviewed, sessions transcribed, and the framework method used to thematically analyse the data. Validation was done through analyst triangulation and member check recheck. Core values identified as influencing the patient-healthcare professional power dynamic include: (A) values that empower patients (acceptance of diagnosis and autonomy); (B) values unique to healthcare professionals (HCPs) (acknowledging patients experiential knowledge and including patients in the therapeutic process); and (C) shared capitals related to their interactions (communication, information sharing and exchange, collaboration, and mutual commitment). These interdependent core values can be considered prerequisites to the implementation of the patient-as-partner approach in healthcare. Partnership would imply a paradigm shift such that stakeholders systematically examine each other’s perspective, motivations, capabilities, and goals, and then adapt their interactions in this accord, for optimal outcome. [less ▲]

Life Satisfaction and mobility: Their associations with career attitudes, and health-related factors among postgraduates having studied in universities intra EU and outside EU

in BMC Public Health (2020), 20(3),

Background. University postgraduates’ mobility towards, and outside the EU is continuously increasing, creating a competitive context in which maintaining a high life satisfaction (LS) is a public health ... [more ▼]

Background. University postgraduates’ mobility towards, and outside the EU is continuously increasing, creating a competitive context in which maintaining a high life satisfaction (LS) is a public health challenge. However, the relationship between LS and its determinants among this population are under-documented. Our aims were to measure LS indicators of mobile postgraduates (Intra EU: Who pursue part of their studies in Europe; Outside EU: Who study outside of Europe) versus non-mobile (pursue their studies in Luxembourg), and to analyze the associations between LS and career attitudes, socioeconomic characteristics, and health-related factors for each group. Method. Six hundred and sixty-four (644) students obtained financial aid from the Luxembourgish government independent of their family’s socioeconomic situation. Contacted by post, they completed an online questionnaire. Analyses included a multiple linear regression model in which only significant relationships (p < 0.05) were used. Results.Three groups were created: Mobile intra EU (n = 381), mobile outside EU (n = 43) and non-mobile (n = 66) postgraduates. Health satisfaction was positively linked to LS, in all groups. Among the mobile outside EU group, majority (63.2%) were men and 57.9% did not live alone - health was the only determinant which contributed to their LS. Among the mobile intra EU, majority (57.8%) were women, and 64.3% not living alone. Autonomy and career adaptability attitudes were positively associated with their LS (b: 0.210 and 0.119, respectively), whereas the worry factor was negatively (b: − 0.153 and -0.159) associated. The non-mobile, were the oldest of the three groups. Majority (51.6%) were women, and 93.7% did not live alone. Career optimism and planning attitudes were positively correlated to their LS (regression parameter estimates (b: 0.400 and 0.212, respectively). Conclusions.Attention should be devoted to the LS of local and cosmopolitan students, as it seems to be a relevant health indicator. Overall, the farther the mobility was, the higher the postgraduates’ general LS (8.5/10) was; this indicator was higher than the LS indicator for the age group 25–34 years 7.53/10 (EU-28, in 2013). University’ services could promote the development of career projects and the promotion of health to enhance postgraduates’ LS. University policy makers need to ensure this for all students. [less ▲]

Emotional and social repercussions of stroke on patient-family caregiver dyads: Analysis of diverging attitudes and profiles of the differing dyads

in PLoS ONE (2019), 14(4), 0215425

For patients, the social and emotional repercussions of stroke include shame, personality changes, and upheavals experienced by the couple (i.e. patient and main family caregiver). These impacts on the ... [more ▼]

For patients, the social and emotional repercussions of stroke include shame, personality changes, and upheavals experienced by the couple (i.e. patient and main family caregiver). These impacts on the couple ‘patient/family caregiver’ are scarcely documented. Focusing on the perceptions of the patients and the family caregivers living at home, two years after a stroke occurrence, the aims of the study were to analyse the concordance of attitudes towards the emotional and social repercussions of stroke and to determine the profiles of the differing dyads. Two researchers conducted separate face-to-face structured interviews with stroke survivors and their family caregivers. Eleven items, identified through a content analysis of interviews and after a qualitative process of generating questionnaire items, assessed the commonly experienced impact of stroke on the family, the social repercussions of stroke, and its emotional effects on the stroke survivors. The kappa concordance coefficient was used to determine the response convergence between patients and family caregivers. Four items, selected by a panel of experts, were included in logistic regressions (i.e., demographic characteristics and patients’ impaired functions) to identify the differing dyadic profiles. Family caregivers’ and patients’ attitudes towards the social repercussions of stroke were similar. Patients with motor deficiencies tended to underestimate the upheaval brought to their couple by stroke, whereas caregivers of language-impaired patients tended to underestimate their feelings of shame and demeaning. Communication disturbances, but also residual physical disabilities in stroke survivors, may affect the understanding of each other’s attitudes within dyads. In order to avoid dysfunctional relationships between family caregivers and patients, healthcare professionals need to pay special attention to this issue, especially in cases of aphasia and motor deficiencies. [less ▲]

“Patient participation” and related concepts: A scoping review on their dimensional

in Patient Education and Counseling (2019), 39

Several concepts on collaboration between patients and healthcare systems have emerged in the literature but there is little consensus on their meanings and differences. In this study, “patient ... [more ▼]

Several concepts on collaboration between patients and healthcare systems have emerged in the literature but there is little consensus on their meanings and differences. In this study, “patient participation” and related concepts were studied by focusing on the dimensions that compose them. This review follows two objectives: (1) to produce a detailed and comprehensive overview of the “patient participation” dimensions; (2) to identify differences and similarities between the related concepts. Methods; A scoping review was performed to synthesize knowledge into a conceptual framework. An electronic protocol driven search was conducted in two bibliographic databases and a thematic analysis was used to analyse the data. Results. The search process returned 39 articles after exclusion for full data extraction and analysis. Through the thematic analysis, the dimensions, influencing factors and expected outcomes of “patient participation” were determined. Finally, differences between the included concepts were identified. Conclusion. This global vision of “patient participation” allows us to go beyond the distinctions between the existing concepts and reveals their common goal to include the patient in the healthcare system. Practice implications. This scoping review provides useful information to propose a conceptual model of “patient participation”, which could impact clinical practice and medical training programs. [less ▲]

Resources and Competences required at the Institutional Level for a Patient – Healthcare Professional Partnership

in Conference Handbook EHPS : Individuals and Professionals Cooperation to health (2019)

Societal changes have catalyzed the perception of health as a personal responsibility, with social studies showing a behavioral trend where patients are increasingly seeking health information. This has ... [more ▼]

Societal changes have catalyzed the perception of health as a personal responsibility, with social studies showing a behavioral trend where patients are increasingly seeking health information. This has given rise to patients who are active players in their care, and participate in decision-making. Central to these changes, are patients and healthcare professionals’, whose backgrounds and experiences reflect both cultural factors that influence health decisions, and a power shift from professional dominance to a more equitable partnership style. Our study aims to determine resources and competences required at the institutional level to implementing a partnership Semi-structured focus groups with 20 chronic disease patients and interviews with 15 healthcare professionals were conducted. Thematic content analysis was performed with NVivo 12 to categorize verbatim. Items were grouped into dimensions, and themes common to both parties were grouped together. Three major areas emerged: 1) Training to develop a partnership culture - Training healthcare professionals in patient psychology, developing therapeutic education programs for patients and enriching available information with patients’ experiential knowledge. 2) Creation of information / support centers for: Interdisciplinary meetings, facilitating the provision of structured, verified and pertinent information and providing administrative aid to patients. 3) Development of e-health solutions to: Provide information 24/7; facilitate collaborative content creation by healthcare professionals, patients and researchers, and for sharing and updating patient files among professionals. Our findings will help design, implement, monitor and evaluate suitable actions, and help promote sustainable forms of expertise – inclusion of experiential knowledge and resource patients within the healthcare team [less ▲]