Health System Performance Assessment Framework for Luxembourg

4. HSPA governance and implementation in Luxembourg

Abstract

This chapter presents HSPA governance arrangement proposal to support implementation and long-term sustainability of Luxembourg’s HSPA. The proposed governance structure involves four governance bodies operationalising the HSPA in a sustainable way. It builds on existing institutional responsibilities and formally anchors HSPA implementation within ObSanté, in line with its legal mandate. 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 chapter also outlines the consultative process used to design the HSPA governance structure, identifies the key institutions involved, and describes HSPA governance, including roles, responsibilities and implementation considerations. In addition, the chapter explores how HSPA outputs can be embedded in policymaking processes and outlines the next steps to operationalise Luxembourg’s HSPA.

4.1. Laying the ground for Luxembourg’s HSPA governance structure

Establishing a clear governance structure is essential to translate HSPA from a conceptual framework into a tool that can be implemented and sustained over time. Successful HSPA implementation relies on regular data flows, co‑ordinated analytical work and sustained engagement across institutions, all of which require clearly defined roles and responsibilities throughout the reporting cycle.

In Luxembourg, Article 8 of the ObSanté Law establishes a triennial reporting obligation, requiring the institution to produce, every three years, a national report on population health, health determinants and health system performance, including assessments and policy proposals. This reporting obligation corresponds to the core objectives of HSPA and therefore makes ObSanté legally responsible for Luxembourg’s HSPA implementation. Delivering on this mandate depends on close, well-defined collaboration with a wide range of key institutions, ranging from statistical bodies to health system organisations.

4.1.1. Process and steps undertaken in designing Luxembourg’s HSPA governance structure

The completion of Luxembourg’s HSPA framework development and indicator population marked the beginning of discussions on establishing an appropriate and sustainable governance structure for HSPA in Luxembourg. These discussions were initiated through a joint meeting of the Luxembourgish and Slovak Project Management Teams (PMTs), the OECD and the EC representatives in November 2025. The meeting aimed to establish a shared understanding of governance in the HSPA context and to identify the conditions necessary for effective implementation of the first HSPA cycle and smooth operation of subsequent cycles.

The timing of these discussions was critical to ensure a governance plan would be ready for the first HSPA cycle (Figure 4.1). Defining the governance structure early on and consulting with data custodians helps ensure that arrangements are practical, clearly understood, and sustainable. This is especially important to avoid ambiguity around roles and responsibilities during the first HSPA reporting cycle, when implementation pressures are highest. The initial project team discussion therefore focussed on providing a conceptual foundation for governance by addressing four core questions: who should be involved, what tasks and functions need to be performed, how to allocate responsibilities efficiently, and when and how often the HSPA cycle could run to deliver results when needed.

Figure 4.1. Foreseen plan to define the governance structure and publish HSPA reports in Luxembourg

To find answers to these questions, the Luxembourg PMT held internal meetings in November and December 2025 while the OECD provided support through bilateral meetings with both country PMTs. For instance, as part of this process, tasks within the HSPA governance mechanism were organised into five core functions, which served as a guidance to support internal discussions. These functions, together with illustrative tasks under each category, were intended for illustrative purposes and not as a prescriptive model (Figure 4.2).

Figure 4.2. Common main tasks and functions in a regular HSPA cycle

The resulting proposal for HSPA governance structure and responsibilities, including reflections on reporting timeline and HSPA cycle, was presented by the Luxembourg PMT at the HLAB meeting held in December 2025 (see Annex A for meeting details). The proposal was noted by the HLAB members and endorsed with refinements introduced in response to comments and suggestions from HLAB members. Building on this, the allocation of roles and tasks will be further clarified during the implementation phase, as detailed operational arrangements will be defined once the HSPA moves to implementation.

Following the publication of this HSPA framework and methodological report, the HSPA process in Luxembourg will enter the “Implementing the HSPA” phase as depicted in Figure 4.1. During this phase, the HSPA governance structure will be operationalised for the first time: temporary arrangements of the project “Developing the HSPA framework for Luxembourg” (described in section 1.2.2) will be converted into permanent HSPA governance bodies, co‑ordination mechanisms will be tested, and the first HSPA cycle will proceed through to the drafting and publication of the inaugural HSPA report.

After publication of the first HSPA report, the HSPA governance transitions from initial implementation to a “running the HSPA” phase. Subsequent cycles rely on the established governance structure to ensure continuity and regular operation, while systematically collecting stakeholder feedback after each cycle. This feedback will be useful to refine processes, clarify roles where needed, and improve outputs over time.

4.2. HSPA governance structure and roles of key stakeholders

The governance structure for Luxembourg’s future HSPA cycles builds on existing institutional responsibilities and anchors the process within ObSanté’s legal obligation to evaluate the health system. This mandate provides a stable foundation for sustaining future HSPA cycles and ensures that HSPA cycles are carried out in a transparent, methodologically robust, and policy-relevant manner.

4.2.1. Key organisations in Luxembourg’s HSPA governance

ObSanté, legally mandated to evaluate the health system, forms the operational core of the HSPA, providing both the strategic oversight (through its Council of Observers) and the day-to-day execution needed to successfully run Luxembourg’s HSPA cycles. Although it does not collect primary data, ObSanté acts as a major indicator custodian and consolidates data from bodies such as IGSS, DiSa, CNS and STATEC. This is supported by legislation that grants ObSanté the right to request, centralise and analyse pseudonymised data from public administrations and institutions, and other national organisations.

Other key organisations include Ministry of Health and Social Security (M3S; leading health system governance and digital-health strategy, and co‑ordinating the implementation of the EHDS regulation); CNS (managing statutory health insurance and holding patient, provider reimbursement and hospital activity datasets); IGSS (overseeing social security institutions, acting as a custodian to data on healthcare use, long-term care, employment and socio-demographic variables, and operating an environment for linking datasets); DiSa (data custodian managing clinical and public health data, such as hospital and surveillance datasets and surveys); and STATEC (collecting health-related survey data and analysing demographic and socio-economic information essential for understanding population health determinants and health inequalities). Further, MiFa, which is responsible for LTC provision for older people and people with disabilities, and the Inspectorate of Finance (IGF), responsible for the State budget and public finances, will also take part in the HSPA governance to provide cross-sectoral perspectives on topics beyond the strict boundaries of the health system, such as indicators related to spending and long-term care. More information about health data custodians and other relevant organisations in Luxembourg’s health data ecosystem is provided in Annex B and in the Situational analysis of Luxembourg’s health data infrastructure for HSPA purposes (OECD, 2025[1]).

4.2.2. HSPA governance bodies

Luxembourg’s HSPA governance model, depicted in Figure 4.3, brings together the core institutions responsible for steering, regulating, and analysing the health system, together with other partners and stakeholders.

Figure 4.3. The proposed governance structure for Luxembourg’s HSPA brings together core health system institutions as well as stakeholders under different HSPA governance bodies

Note: Conseil des observateurs = Council of Observers of the ObSanté

Source: Developing the HSPA framework for Luxembourg project, HLAB meeting in December 2025.

The governance model comprises several components, with responsibilities spanning from strategic guidance to day-to-day operation:

The Advisory Committee (Comité consultatif) will be the platform that provides guidance and advice in Luxembourg’s HSPA governance model. Bringing together senior representatives from M3S, IGSS, DiSa, STATEC, CNS, MiFa, IGF and ObSanté, it represents the evolution of the former HLAB into a permanent advisory body that will support future HSPA cycles. The Committee’s role is to contribute to keeping the HSPA cycles on track from development through dissemination, supporting its alignment with national health priorities and long-term sustainability by drawing on perspectives from across the health system.

In practical terms, the Committee will offer guidance on how each HSPA cycle should unfold. Members will advise on process decisions, review whether the work aligns with national health strategies, and help identify opportunities for political and cross-sector engagement. They will provide feedback on outputs and communication plans, while also flagging where additional resources or capacity might be needed within their organisations. Planned to meet twice a year, the Committee will maintain senior-level awareness and co‑ordination, ensuring continued commitment of the key HSPA organisations and helping the various parts of the system stay connected even as priorities evolve.

The Co‑ordination Team (Comité de co‑ordination) will be responsible for organising and steering the implementation process. Bringing together ObSanté, IGSS, and DiSa, it will translate the Advisory Committee’s strategic direction into a practical workplan.

Rather than producing indicators or analyses itself, the Co‑ordination Team will orchestrate “who does what” and “when and how”, which cover strategic planning, stakeholder engagement, dissemination and production processes. Its responsibilities include managing resource allocation, tracking timelines and milestones, preparing the communication and implementation plan, and compiling suggestions for improvements in future cycles. The team will present and discuss HSPA results with the Advisory Committee, the Stakeholder Forum, and the Council of Observers (ObSanté), while ensuring meaningful engagement across all actors. It will also contribute to oversight of data collection, processing, analysis, and the production of indicator sheets.

The HSPA Custodian will be the governance body responsible for the operational implementation and long-term functioning of Luxembourg’s HSPA. It will work in close co‑operation with the Co‑ordination Team and be responsible for the core day-to-day management of the HSPA, including indicator production, updates and maintenance, dissemination of HSPA results and maintaining the HSPA webpage. The HSPA Custodian will operate through two complementary arms:

• The Strategic arm (Mandataire stratégique HSPA) will oversee the implementation and long-term maintenance under the responsibility of the Council of Observers in ObSanté. It will ensure that ObSanté fulfils its legal obligation to evaluate the health system and supports the institutional stability and continuity of Luxembourg’s HSPA framework.

  Its tasks include allocating human and infrastructure resources within ObSanté, holding final accountability for HSPA outputs, guiding the use of HSPA findings in policy dialogue, and overseeing the publication and dissemination of analytical results. The Strategic arm is foreseen to have quarterly meetings to ensure that strategic decisions, resource allocations and implementation efforts remain coherent and sustainable.

• The Operative Custodian arm (Mandataire opérationnel HSPA), carried out by ObSanté staff, will manage the day-to-day execution of the HSPA. It will be responsible for producing HSPA outputs and ensuring that all analytical, technical and co‑ordination activities proceed smoothly in accordance with the plan and the legal mandate (see Chapter 4.3).

  This includes liaising with partner organisations and data custodians to secure the necessary data and indicators, calculating indicators, ensuring quality and consistency of HSPA outputs, and producing the analytical and policy-relevant components of the report. Operative staff will also use HSPA findings to contribute to ongoing policy dialogue and support the integration of results within the planned policy cycle.

The Stakeholder Forum (Forum des parties prenantes) will ensure broad professional engagement and provides a platform for expert and stakeholder feedback on HSPA results, methodologies, and potential adjustments for future cycles. Composed of representatives from the former principal working group and other relevant stakeholders, it will also serve as a key dissemination channel.

Its advisory function includes providing technical and methodological feedback, discussing potential modifications to Luxembourg’s HSPA framework, and following progress throughout the cycle. As a strategic partnership function, the Forum will support acceptance, understanding, and use of HSPA outputs within stakeholder organisations. Members will also participate in focus groups when needed and promote wider communication and dissemination of findings. It is foreseen to meet at once per year.

4.2.3. Indicator custodianship, data governance and stakeholder accountability in Luxembourg’s HSPA governance structure

A timely assessment of health system performance relies on high-quality data that are delivered, processed and analysed according to clear and predictable timelines. In Luxembourg, the health data landscape provides a strong foundation for performance assessment, but also presents structural constraints that require co‑ordinated governance arrangements. In line with OECD experience, clearly defined roles, responsibilities and co‑ordination mechanisms with data custodians are essential to ensure predictable data provision, avoid bottlenecks, and safeguard the credibility of HSPA outputs (OECD, 2026[2]). Establishing such arrangements supports consistent indicator production throughout the cycle and reduces reliance on ad hoc solutions.

Luxembourg’s current HSPA framework comprises 105 indicators, with ObSanté acting as the main indicator custodian (organisation responsible for analysing indicators for HSPA purposes). ObSanté custodies approximately three‑quarters of all HSPA indicators and therefore plays a central role in secondary data use and indicator calculation (Table 4.1). Its legal mandate grants it the right to request, centralise and analyse pseudonymised personal data from public administrations and institutions, and other national organisations, thereby strengthening accountability by centralising data management. Table 4.1 provides a summary of HSPA indicator custodianship by organisations and governmental bodies, while a detailed overview of individual indicators (including their HSPA custodianship) is available in Section 3.2.

Table 4.1. HSPA indicator custodianship among different stakeholders in Luxembourg’s HSPA

HSPA Indicator custodian: Organisation who will be providing the indicator for the purposes of Luxembourg’s HSPA

Organisation	Number of indicators	Share of total indicators
ObSanté	76	72%
IGSS	6	6%
DiSa	5	5%
FHL/CNS	2	2%
INC	1	1%
INC/RNC	1	1%
RNC	1	1%
CNS	1	1%
CSL	1	1%
Agence e‑Santé	1	1%
OECD	1	1%
Collège Médical	1	1%
FHL	1	1%
MEGA	1	1%
Ministry of Family Affairs, Solidarity, Living Together and Reception of Refugees	1	1%
TBD	5	5%
Total	105	100%

Source Developing the HSPA framework for Luxembourg project, January 2026.

The ObSanté aims to automate HSPA data collection and analytical processes as much as possible to streamline the process of HSPA production, and plans to dedicate targeted resources to achieve this objective. Nevertheless, the first HSPA cycle will necessarily require a very close and intensive collaboration across institutions and is likely to generate additional workload as organisations engage with the HSPA framework for the first time. Like experienced in other OECD countries with HSPA in place, initial HSPA cycles often involve higher co‑ordination costs before processes become routine. To ensure feasibility and sustainability, participating organisations may explicitly reflect HSPA-related tasks within their programmes of work, embedding performance assessment activities into routine institutional processes rather than treating them as ad hoc project tasks. The gradual transition of HSPA framework development project bodies into formal HSPA governance mechanisms will further support this institutional continuity and reinforce accountability beyond individual actors.

HSPA indicator custodians need not to be necessarily the same organisations or governmental bodies who are data owners, i.e. managing the primary datasets. Organisations which are responsible for managing the underlying datasets, which are used to generate HSPA indicators, act as data owners within the HSPA governance structure and are referred to as “data custodian” herein (see Box 3.2 in Section 3.2, and Annex C for more details). The main data custodians in Luxembourg’s HSPA are DiSa (approximately 35% of indicators), IGSS (20%), and STATEC (10%), while other organisations such as CNS and FHL also contribute (Table 4.2).

Table 4.2. Data custodianship among different stakeholders in Luxembourg’s HSPA

Data custodians: organisations managing the dataset used to obtain the HSPA indicator (data owners)

Organisation	Number of indicators	Share of total indicators
DiSa	37	35%
IGSS	21	20%
STATEC	10	10%
CNS	4	4%
University of Luxembourg	3	3%
ObSanté	2	2%
OECD	2	2%
FHL/CNS	2	2%
FHL	2	2%
Ministry of Family Affairs, Solidarity, Living Together and Reception of Refugees	2	2%
Agence e‑Santé	2	2%
TBD1	8	8%
Other2	10	10%
Total	105	100%

1. Most data custodians listed under To Be Discussed (TBD) are classified as placeholders as of January 2025.

2. Organisations under the category of “other” are CSL (Chambre des salariés); INC; Ecole nationale de santé du Luxembourg (ENSA); Ministry of Education and Research; AGE (Administration de la gestion de l’eau); RNC; Collège Médical; MEGA (Le Ministère de l’Égalité des genres et de la Diversité) ; Luxembourg’s Ministry of Health and Social Security.

Source: Developing the HSPA framework for Luxembourg project, HLAB meeting in December 2025.

A detailed review of the Luxembourgish health data ecosystem and stakeholders for the purposes of HSPA, composed as the baseline report for the Development the HSPA framework in Luxembourg project, highlights several strengths and opportunities for HSPA data and indicator management (OECD, 2025[1]) (findings summary is available in Aennx B). These include comprehensive administrative data on hospital inpatient stays, strong infectious disease surveillance systems, well-established mortality and causes-of-death registries, and a solid foundation of population health surveys. There is also clear potential to expand secondary data use, as technical capacity exists to link datasets using personal identifiers. Despite its breadth, the system continues to face fragmentation and standardisation issues across organisations. Strengthening data linkage can further improve international reporting and analytical depth. At the same time, challenges remain in streamlining data flows, improving interoperability, and expanding disease‑specific information beyond cancer to cover other major conditions such as cardiovascular diseases and diabetes (Annex B).

Due to these shortcomings, the organisation of data collection, data flows and indicator production for HSPA requires a clearly defined and predictable operational timeline. As the initial HSPA indicator set largely draws on existing data sources and established statistical products, the periodicity of data collection and the availability of time series are already known for most indicators, providing a strong basis for HSPA operational planning. This information is suggested to be explicitly documented for each indicator as part of the HSPA framework, in individual indicator sheets. To ensure timely and consistent delivery of HSPA outputs, establishing clear deadlines is useful for key steps of the indicator production process, including data transfer between institutions, indicator calculation by ObSanté where relevant, preparation of indicator technical sheets with updated values and contextual information, review by technical bodies, and final validation and approval. Automatisation of the data collection and analytics will also help meeting these deadlines (see above).

Beyond the technical production of indicators, an effective HSPA draws also on stakeholder accountability. Clear mechanisms through which stakeholders are held accountable for their contributions, engagement and use of results have been found instrumental for the regularity of HSPA cycles and its use (OECD, 2026[2]). Without such mechanisms, HSPA risks becoming an analytical exercise, disconnected from institutional ownership and policy follow-up.

In this context, the Co‑ordination Team and the Stakeholder Forum will play complementary and central roles in ensuring stakeholder accountability in Luxembourg. The Co‑ordination Team will be responsible for operationalising accountability throughout the HSPA cycle by co‑ordinating timelines, managing the indicator production process, and overseeing interactions between ObSanté and contributing institutions. Through these functions, the team will ensure that stakeholders meet agreed commitments related to data provision, analytical inputs, review of outputs and dissemination. Its interactions with the Advisory Committee, the HSPA Custodian team and contributing stakeholders will further help align expectations and responsibilities across HSPA governance levels.

The Stakeholder Forum will complement this operational accountability with a structured mechanism for collective review, feedback and ownership. By bringing together representatives of the former PWG and other relevant stakeholders, the Forum will provide a formal space for stakeholders to engage with HSPA results, scrutinise analytical outputs, and discuss proposed changes to the framework and indicators. This process aims to strengthen accountability by making stakeholder engagement visible, continuous and traceable over time. The Forum’s role as a dissemination channel will further strengthen accountability by encouraging stakeholders to take responsibility for communicating and using HSPA findings within their own organisations and professional networks.

4.3. Embedding the HSPA intelligence in Luxembourg’s policymaking

Consistent with the experiences of other OECD countries, the design of HSPA reporting cycles is more than a technical afterthought. It is also a core HSPA governance choice that shapes policy relevance, credibility and sustainability. An effective HSPA governance requires alignment between institutional mandates, reporting timelines, policy cycles and stakeholder engagement mechanisms for optimum impact. It is therefore instrumental to have reporting cycles designed in light of national political, legal and organisational contexts, balancing independence, usability and long-term continuity (OECD, 2026[2]).

While the Article 8 of the ObSanté Law (The Government of the Grand-Duché of Luxembourg, 2021[3]) secures a binding framework that ensures the regular production of system-wide health system assessments, there are several other strategies that Luxembourg can follow to ensure a sustainable HSPA and maximise its use.

4.3.1. Designing reporting cycles for maximum impact and sustainability

Establishing a clear reporting timeline and cycle for HSPA is a strategic decision that directly affects both the usability of results and the long-term sustainability of the cycles. OECD country experience shows that timing can be instrumental for HSPA findings to inform policy debates: countries that align HSPA cycles with policy planning tend to achieve a greater impact on decision making (OECD, 2026[2]). Strategic approaches include releasing reports when national health plans are developed, timing assessments to inform budget cycles, and co‑ordinating with electoral timeliness (OECD, 2026[2]).

From an operational perspective, an HSPA cycle is expected to take at least a year from the confirmation of the final indicator list to the publication of HSPA report. During this assessment phase, it is useful to keep the HSPA framework stable, with no methodological changes introduced. Following the HSPA report publication, a dedicated interval between cycles is needed to disseminate findings, implement agreed improvements to the indicators, and allow governance structures and contributing institutions to adapt. This inter-cycle period also provides space to discuss potential refinements to the framework to align with evolving national policy priorities, including the addition of new indicators or methodological adjustments, supported by regular meetings foreseen in the HSPA governance model to ensure continuous learning and improvement.

Figure 4.4 illustrates a theoretical HSPA timing cycle, displayed in a context of national elections. In line with the triennial reporting obligation set out in Article 8 of the ObSanté Law, the first HSPA report could be produced in 2028. This timing would place publication shortly before the next national elections, creating an opportunity to inform the priorities, plans and reform agenda of the incoming government. For subsequent HSPA reporting cycles, the HLAB meeting held in December 2025 (see Annex A) held a preliminary discussion on the potential advantages and drawbacks of aligning the HSPA report production cycle with key political and policy timelines.

Figure 4.4. Possible HSPA timeline and reporting cycles

Source: Developing the HSPA framework for Luxembourg project, HLAB meeting in December 2025.

4.3.2. Leveraging HSPA for health policy planning and monitoring

To maximise usability and long-term sustainability of HSPA, it is important to understand how HSPA can effectively support national health strategies and plans. In the context of policymaking, HSPA can contribute to the implementation and monitoring of current national priorities, and to the design and refinement of future health strategies.

To support an alignment, a mapping exercise was conducted for Luxembourg’s specific health action plans and the HSPA domains/subdomains, assessing HSPA indicators topical alignment to national health policy priorities (national action plans relevant for considerations when developing the HSPA framework were identified earlier in the project and are summarised in the Situational Analysis (OECD, 2025[1])).

Results of the mapping show that most Luxembourg’s health action plans align mainly through the Processes and Outcomes blocks of Luxembourg’s HSPA framework. In particular, topical alignment has been identified with HSPA domains of Integrated care, Value‑based care, Population health outcomes, and Person centredness. Several action plans, especially those related to prevention, chronic diseases, mental health and infectious diseases, span across multiple HSPA domains, linking Inputs (such as Infrastructure and Workforce domains), Processes (including subdomains of Prevention and Co‑ordination of care in Integrated Care domain, and Access to care domain) and Outcomes (such as Population outcomes and Patient experience subdomains). This reflects on how chronic conditions, mental health, and infectious diseases and their care delivery extend across all factors of the health system and thus their assessment needs to provide the same level of complexity – an example of which is provided for mental health and care in Section 3.3. In addition, Luxembourg’s climate‑, resilience‑ and equity-focussed action plans are best captured through the Cross-cutting HSPA domains such as Sustainability and Equity.

By reviewing HSPA indicators in relation to national health policy priorities, performance assessment can be more effectively embedded in a systematic monitoring of development across strategic areas. This, in turn, strengthens the long-term sustainability of HSPA and supports greater uptake and impact across the health system and policymaking.

4.3.3. Strengthening the use and impact of HSPA through effective dissemination

Effective dissemination helps position HSPA as a shared reference point for health policy dialogue, monitoring and continuous improvement across the health system and its stakeholders. By establishing appropriate communication and dissemination arrangements within the HSPA governance structure, HSPA results are more likely to be understood, trusted and actively used. Investing in communication capacity can therefore strengthen outreach and credibility, while increasing the likelihood that HSPA findings inform policy discussions and practice.

An important element is the development of a dedicated dissemination infrastructure that combines regular analytical reporting with more dynamic and accessible formats. In addition to the periodic publication of comprehensive HSPA reports, an online HSPA platform can add value to dissemination efforts. First, in a static format it provides a useful point of reference for anyone interested to explore assessment of Luxembourg health system performance. Additionally, the static format may also serve as a dissemination tool for information on where further analyses or more detailed data information can be found, directing to appropriate other national websites. Second, in its possibly interactive format, the HSPA platform can offer updates for selected indicators and results when new data become available.

An HSPA platform, potentially including interactive dashboards, enables users to explore trends over time, benchmark performance and access technical documentation on indicators, while complementing longer HSPA reporting cycles. In line with Luxembourg’s HSPA governance structure, responsibility for the development and maintenance of a dedicated HSPA platform in Luxembourg is with the ObSanté in its capacity as the HSPA Custodian (see section 4.2.2). Therefore, as part of the HSPA implementation phase, the ObSanté foresees a piloting of an HSPA-dedicated platform to support timely updates, consolidated publication of validated results and consistent communication of HSPA findings.

Dissemination efforts can be strengthened by embedding them within a continuous stakeholder engagement process. Stakeholder forums or dedicated HSPA discussion events can raise awareness of the HSPA process, create structured opportunities for feedback, and foster shared ownership of results. These forums can further provide space to discuss policy implications, identify priority areas for follow-up, and reflect on potential refinements in future HSPA cycles.

The dissemination and use of HSPA results can be further supported through knowledge translation activities. Targeted initiatives (such as seminars, training sessions or collaboration with higher education institutions) can help strengthen analytical literacy and promote the practical use of HSPA findings in decision making. From a longer perspective, embedding HSPA concepts and results into professional training, policy discussions and organisational processes reinforces institutional memory, continuity and sustained demand for health system performance assessment and evidence‑based policy.

4.4. The HSPA methodological report as a blueprint to transition from development to HSPA implementation

The present Luxembourg’s HSPA framework, described in this report and populated by carefully selected indicators, marks a milestone in the country’s journey towards national HSPA implementation. During the development work, the Luxembourg’s PMT, technically supported by the OECD, worked hand in hand with Luxembourgish stakeholders to jointly shape the national HSPA purpose, scope, framework and indicator set. This work was grounded in an open and inclusive process, bringing the key stakeholders and PMT through a series of thematic workshops, focus groups, bilateral technical discussions and targeted capacity-building activities, including international study visits. Beyond the technical outputs, this process aimed to strengthen collaboration across institutions and build a shared understanding of assessing the national health system and its performance. Based on OECD country experience, such benefits are commonly observed as positive spillovers from an inclusive and participatory HSPA development (OECD, 2026[2]).

Moving forward, Luxembourg authorities and stakeholders will focus on delivering the first national HSPA report. The ultimate aim of having a national HSPA in place is to use the HSPA framework as a sustainable tool to embed the intelligence from the performance assessment into policymaking. Effective HSPA governance arrangements, technical work and continued stakeholder engagement are all instrumental for the ability to translate HSPA results into policy-relevant insights. As the HSPA implementation moves forward, the OECD will continue to support Luxembourg in 2026, providing guidance on HSPA implementation, including indicator production and data interpretation.

This methodological report on HSPA framework in Luxembourg is setting the grounds, and aims to support continued collaboration across Luxembourg’s stakeholders and governmental bodies to ensure that Luxembourg’s HSPA becomes an instrument that is used, understood and continuously improved to inform policymaking over time.

References

[2] OECD (2026), “Learning through national Health System Performance Assessment (HSPA): Emerging findings from OECD countries”, OECD Publishing, Paris, https://doi.org/10.1787/2fa1314a-en.

[1] OECD (2025), Situational analysis of Luxembourg’s health data infrastructure for HSPA purposes, OECD, Paris, https://www.oecd.org/content/dam/oecd/en/about/projects/the-oecd-technical-support-to-national-hspa-development/Luxembourg-HSPA-Baseline-report.pdf.

[3] The Government of the Grand-Duché of Luxembourg (2021), Law of 2 March 2021 on the creation of a National Health Observatory [Loi du 2 mars 2021 portant création d’un Observatoire national de la santé], https://legilux.public.lu/eli/etat/leg/loi/2021/03/02/a168/jo.