Health System Performance Assessment (HSPA) is a systematic approach to comprehensively evaluating a health system, acting as a critical tool for health policymakers in achieving high-performing health systems. An HSPA framework provides a structure for countries to systematically assess whether their health systems meet population needs, deliver high‑quality care, and progress toward strategic health objectives.
Luxembourg’s decision to develop a national HSPA reflects a shared recognition of the necessity for strategic planning to cope with health system sustainability issues, including demographic pressure, financial constraints, health workforce availability, and health system’s environmental footprint. Against this backdrop and aligned with its organisational objectives set forth in the legislation, the National Health Observatory (ObSanté) initiated, with the support of national authorities, the process of developing a national HSPA framework that would be tailored to Luxembourg’s needs and co-developed with health sector stakeholders. The project “Developing HSPA Frameworks for Luxembourg and Slovakia” benefited from funding and technical support from the European Commission and the OECD and allowed the two countries to develop their HPSA frameworks in parallel, enhancing cross-country learning and mutually sharing experience on HSPA development.
The development process of Luxembourg’s HSPA was stakeholder-inclusive: the broad stakeholder participation in formulating the framework and selecting HSPA indicators ensured that the resulting HSPA framework is nationally relevant and enjoys shared ownership.
The purpose of Luxembourg’s HSPA encompasses monitoring of population health to target its improvements and address inequalities; monitoring of healthcare system performance to enhance accountability and transparency; increasing public awareness, health literacy and promoting patient-centredness; and supporting evidence‑based policy planning and decision making. Its scope is comprehensive and includes broader determinants of health and cross-border populations.
Luxembourg’s HSPA framework consists of 12 domains and 30 subdomains, comprehensively covering all aspects of health, healthcare, and the health system. It is structured around outcomes, processes, inputs, and cross‑cutting domain blocks, reflecting international common practice while being adapted to local needs and data realities. Designed through an inclusive and participatory process, the HSPA framework is a product of broad stakeholder engagement achieved through workshops, focus groups, high‑level advisory meetings, and iterative consultations.
The framework is populated by 105 indicators which are distributed across all domains and subdomains. The balanced selection allows for a technically feasible yet comprehensive assessment of Luxembourg’s health system performance, acknowledging that further refinement might occur over time as data infrastructure evolves. Indicators were selected through a stepwise selection process, engaging health system stakeholders in several discussions and an indicator prioritisation activity, and gaining their approval for the final set of indicators in November 2025. A use case example illustrates how the HSPA framework allows moving beyond isolated indicators towards a structured assessment and coherent understanding of mental health and care performance, which can be applied to other areas of health and care for guiding policy recommendations.
The proposed HSPA governance structure involves four governance bodies to operationalise the HSPA in Luxembourg in a sustainable way. It builds on existing institutional responsibilities and anchors the HSPA implementation within ObSanté, in line with its legal mandate to evaluate health system performance. While this mandate provides a strong foundation for Luxembourg’s HSPA, effective implementation and impact will depend on strong collaboration among stakeholders, clearly defined responsibilities for HSPA implementation, well-aligned reporting cycles, systematic use of HSPA outputs for health policy planning and monitoring, and effective dissemination of HSPA results.
The purpose of the methodological report is to provide a groundwork for a transparent and accountable process of HSPA implementation in Luxembourg, based on a commonly shared HSPA purpose, scope and framework. By describing in detail the HSPA framework for Luxembourg and its indicators, including processes, methodology and considerations that accompanied its development and indicator selection, the report aims to foster greater awareness of and engagement in HSPA across health system stakeholders and the public.