This annex summarises the main project meetings and activities conducted during the development of the HSPA framework for Luxembourg, including meetings of the PWG, HLAB, specific Technical Focus Groups and project activities aimed at capacity building. It documents how stakeholders’ proactive input, feedback, technical discussions and international exchanges informed the design and development of the HSPA framework, the selection of its indicators and proposed HSPA governance arrangements, complementing the analytical content presented in the main chapters of this report.
Health System Performance Assessment Framework for Luxembourg
The Principal Working Group (PWG) of the Developing the HSPA Framework for Luxembourg project was composed of representatives of organisations involved in health system and health data governance and of other health sector stakeholders in Luxembourg, including technical experts (see the list of participating organisations in section 1.2.2).
1st Principal Working Group meeting (in-person, September 2024)
This Principal Working Group (PWG) workshop launched the HSPA development project in Luxembourg, bringing together representatives from 27 organisations and governmental bodies across the Luxembourgish health system. It introduced the concept of HSPA to a national audience and provided a first opportunity for in-person engagement and discussion on the potential purpose and scope of Luxembourg’s HSPA.
2nd Principal Working Group meeting (online, November 2024)
The second PWG workshop was held as a joint activity together with stakeholders from the Slovak Republic, benefitting from the multi-country structure of the project split into individual country workstreams (Section 1.2.1). The aim of the workshop was to share the experience of other countries who have developed and implemented, or were at present implementing, their national HSPA frameworks with health system stakeholders in the Slovak Republic and in Luxembourg. It focussed on the other countries’ early stages of HSPA development, and their lessons learnt. The meeting was attended by 36 participants from Luxembourg, with a broad representation of stakeholder organisations.
Participants from Luxembourg highlighted the need to align the Luxembourg’s HSPA framework and its indicators with stakeholder needs. They emphasised that the HSPA must remain relevant by using meaningful indicators that align with policy goals. A well-implemented HSPA can break down inter-organisational barriers. Participants emphasised that due to characteristics of the Luxembourgish health system, the engagement of a wide group of stakeholders remains essential for reaching these objectives. During the discussion, participants appreciated the possibility to learn from other countries’ experience to build on existing work. It was also suggested to consider cross-border healthcare in developing the HSPA in Luxembourg. Participants also referenced potential data management challenges, which may include identification, availability, interoperability, and collection; concerns about data access on the private healthcare sector was specifically mentioned. Participants suggested using placeholder indicators where data is not yet available.
3rd Principal Working Group meeting (online, November 2024)
This workshop aimed to discuss the preliminary findings of the situational analysis on health data landscape in Luxembourg with health system stakeholders. The analysis fed into the Baseline report (OECD, 2025[1]) that provides an overview of health data readiness for HSPA indicators in Luxembourg and then served as a basis for the following HSPA project phase. The meeting was attended by 47 participants and 25 organisations and governmental bodies, representing broad stakeholder engagement.
The discussion revealed stakeholders’ agreement with the analysis that Luxembourg benefits from a rich but fragmented health data landscape, with important progress made in recent years in data availability and quality. Representatives of main health data custodian organisations highlighted datasets and detail of data infrastructure they custody, highlighting opportunities to build on the existing infrastructure for measurement. The discussion highlighted both strengths and persistent challenges, notably around data timeliness, maturity of newer datasets, and limitations to secondary use. While administrative and programme data cover key areas, gaps remain particularly for primary care activity, outpatient care and clinical registries – often compounded by missing legal frameworks or incomplete data flows across institutions. Participants emphasised that improving data linkage, automation and secondary use of existing data sources should be prioritised over launching new data collections, in order to reduce reporting burden and enable regular, timely HSPA indicator production.
4th and 5th Principal Working Group meeting (in-person, January 2025)
The workshops aimed to generate and narrow down potential performance and indicator themes for Luxembourg’s national HSPA framework, building on the draft purpose and scope discussed with the PWG and the HLAB during autumn 2024. Over two days, representatives from 26 organisations and 41 participants worked together in a highly interactive setting, generating ideas that laid the foundation for the structure of Luxembourg’s HSPA. The meetings facilitated open discussion, collective reflection on the national health system priorities, and fostered a foundation for strong stakeholder ownership of the Luxembourg’s HSPA. The in-person format was vital for dynamic interaction and for building national consensus. The stakeholder input from these the workshops formed the foundation of the first draft of Luxembourg’s HSPA framework, and contributed preliminary ideas for potential indicators and indicator themes.
Specifically, during Workshop 4, two interactive sessions (Figure A A.1. ) engaged participants in identifying potential HSPA domains, which were subsequently clustered by the OECD and the PMT into emerging domain topics (see Box 2.2). In total, 331 ideas were generated and grouped into 38 domain themes, of which 20 were prioritised by stakeholders through assignment of votes. The participants assigned the votes as groups, which were formed based on their roles within the health system. Stakeholders highlighted in particular the importance of integrated care, access and equity, health system governance, mental health, prevention, and health workforce education and training (Section 2.3). Building on these results, the first proposal for the draft HSPA framework was developed and discussed during Workshop 5 the next day. An interactive session was held to generate ideas and share initial reflections on indicators that could be used to assess performance across domains.
Source: Developing the HSPA framework for Luxembourg project, PWG meetings in January 2025.
6th Principal Working Group meeting (online, July 2025)
The meeting was held to update Luxembourg’s stakeholders on the project progress made since the previous PWG meeting, provided an update on the at-that-time version of the Luxembourg’s HSPA framework, and shared next steps and details on the PWG involvement in the upcoming indicator scoring process. It was attended by 27 participants representing 21 organisations.
The PMT presented refinements to the draft HSPA framework developed following the January workshops and inputs from Technical Focus Groups. These refinements aimed to strengthen the framework’s internal coherence, clarify domain definitions, and improve usability and strategic alignment. The July 2025 draft framework was presented in detail, highlighting its structure around four main building blocks, placing a strong emphasis on the outcomes block in line with the HSPA’s purpose (Section 2.3). Participants welcomed the refined framework and acknowledged that expert and stakeholder feedback had been appropriately integrated.
The OECD and the PMT presented the indicator repository developed for the Luxembourg project, drawing on national and international sources, existing HSPAs and expert discussions. These indicators had been mapped to the draft framework subdomains. The next phase in the project was outlined, focussing on selecting indicators to populate the framework with an aim to select a feasible number of policy-relevant indicators. The methodology for the indicator selection process was presented, highlighting the central role of PWG members in scoring short-listed indicators based on indicator importance and relevance.
7th and 8th Principal Working Group meetings (online, October 2025)
These meetings aimed to review the results of stakeholders’ prioritisation of HSPA indicators for Luxembourg and to agree on a final set of indicators, taking into account both the scoring results and this meeting’s discussions to ensure that the selected indicators are fit for the purpose of the HSPA and sufficiently cover framework domains. Ahead of the meeting, PWG members received an Excel file with a summary of the indicator scoring results, structured in the same way as the voting file that stakeholders filled with their indicator prioritisation (see Section 3.1.2 for more detail on the prioritisation exercise).
A total of 40 participants from 25 organisations attended the two meetings, which took place over two consecutive days. During the sessions, scoring results were presented domain by subdomain by the PMT and the OECD teams. Each subdomain presentation was followed by a short group discussion, during which PWG members provided comments, expressed agreement, or suggested refinements. Considerations related to data availability and the possibility of international benchmarking were also taken into account in the group decision making on inclusion or exclusion of an indicator. Overall, the discussions resulted in a mutually agreed set of indicators populating ten domains of the Luxembourg HSPA framework. The remaining two domains, comprising five subdomains that could not be discussed due to time constraints, were circulated to PWG members for written consultation following the meetings.
The High Level Advisory Board (HLAB) of the Developing the HSPA Framework for Luxembourg project was composed of representatives of the core organisations that would be involved in national HSPA governance once the HSPA is set up. The HLAB regularly followed the progress of the project, provided organisational perspectives and inputs on the developed materials and outputs, and served as liaisons with respective organisations (for list of participating organisations, see section 1.2.2).
1st High Level Advisory Board Meeting (in-person, September 2024)
The first meeting of the HLAB provided information on the project rationale, objectives, governance structure and timeline and clarified the role of the HLAB in guiding the process and providing strategic oversight for Luxembourg’s HSPA development.
Seven Luxembourg HLAB member organisations and governmental bodies attended the meeting, represented by 14 participants. The HLAB members welcomed the initiative and stressed the importance of high-level political ownership, consensus building and stakeholder engagement to ensure the HSPA supports evidence‑based policymaking. Discussions highlighted the need to balance a broad scope, covering prevention, physical and mental health, long-term care, efficiency and cross-border care, with an actionable set of indicators. Members also emphasised the value of public reporting and international benchmarking to strengthen accountability and public trust. The HLAB also mentioned monitoring of health system as a possible HSPA purpose for Luxembourg.
2nd High Level Advisory Board Meeting (in-person, January 2025)
The second HLAB meeting reviewed progress in the project, with a particular focus on the January 2025 PWG workshops 4‑5 on draft framework development, and the preparation of the Baseline Report. The PMT presented the draft purpose and scope of Luxembourg’s HSPA, which emphasises monitoring population health and inequalities, strengthening accountability and transparency in health system performance, raising public awareness, and supporting evidence‑based policymaking. The scope was confirmed as broad and holistic, covering wider determinants of health and extending beyond resident nationals.
Eight HLAB member organisations and governmental bodies were present at the meeting, represented by 13 individuals. Several participants stressed the importance of clearly defining the HSPA’s purpose, balancing breadth with actionability, and avoiding organisational bias in framework design. Suggestions for further refinement included stronger emphasis on climate and environmental factors, care quality and patient safety, system resilience, cross-border care, and forward-looking indicators. Members also underlined the value of learning from other countries’ HSPA experiences and discussed the need to embed the HSPA more firmly in public reporting and policy cycles, with further discussions planned later in the project.
3rd High Level Advisory Board Meeting (online, July 2025)
The third HLAB meeting reviewed project progress, presented the July 2025 draft of Luxembourg’s HSPA framework, and gathered strategic feedback from HLAB members. The PMT outlined key refinements made since the January draft, incorporating inputs from Technical Focus Groups to improve structural coherence, clarify domain definitions, and strengthen usability and strategic alignment. Members welcomed the progress and confirmed that the framework remains a draft, to be further refined based on indicator prioritisation and stakeholder feedback.
The meeting convened six HLAB member organisations and governmental bodies, represented by 10 participants. The OECD and the PMT also outlined next steps, focussing on populating the framework with a feasible and policy-relevant set of indicators (explained above in the “6th Principal Working Group meeting” section). HLAB members broadly supported the approach, stressing the importance of data availability, automation, and international benchmarking in indicator selection, while avoiding excessive reporting burdens. Members agreed to reconvene in a dedicated autumn meeting to review the final indicator set. The meeting concluded with appreciation for the strong stakeholder engagement and a discussion on the possible publication of the Baseline Report, which was widely shared within the public administration and health sector.
4th High Level Advisory Board Meeting (online, November 2025)
The fourth HLAB meeting focussed on reviewing the list of indicators selected by the PWG to populate Luxembourg’s HSPA framework. The PMT summarised the indicator selection process, which took place between September and October 2025 and resulted in the selection of first set of indicators. This set was considered to strike an appropriate balance between technical feasibility and comprehensive coverage of health system performance.
14 participants attended the meeting, representing seven HLAB member organisations and governmental bodies. The PMT and the OECD presented the selected indicators structured along the HSPA framework blocks, highlighting coverage by subdomain, data sources, data availability and the scope for international benchmarking. These discussions led to further refinements to the indicator list, such as the addition of two indicators in the Fiscal Sustainability subdomain following IGSS recommendations, aimed at strengthening monitoring of the insurance system’s financial position. HLAB members welcomed the final indicator set, noting that the overall number (including placeholder indicators) was reasonable, and underlined the importance of maintaining flexibility as data availability and infrastructure continue to evolve to support HSPA implementation.
5th High Level Advisory Board Meeting (online, December 2025)
The fifth HLAB meeting focussed on presenting and discussing the proposed HSPA governance model, which is intended to support sustained implementation of the HSPA in Luxembourg. The OECD outlined project progress and explained how the governance design links to other project components, including the reporting cycle. Discussions centred on defining who should be involved in HSPA governance, the allocation of roles and tasks across co‑ordination, strategic oversight, and the timing of the first report and following HSPA cycles.
Eight HLAB member organisations attended the meeting, represented by 13 participants. The members broadly welcomed the proposed governance model, considering it aligned with international experience, while raising several points for refinement. Key issues discussed included resource constraints, particularly for DiSa, alongside the need to rely as much as possible on automation to limit additional workload, especially after the first cycle. Members also highlighted the importance of clarifying ObSanté’s strategic role vis-à-vis advisory bodies, ensuring well-defined stakeholder consultation through a focussed Stakeholder Forum, with broad support for publishing the first HSPA report in around 2028 and aligning future cycles with political and budgetary processes.
The OECD organised four technical focus group (TFC) meetings to explore themes that had been highly prioritised by stakeholders during the 4th and 5th PWG meetings in January 2025. These meetings aimed to identify potential indicators to cover the priority themes and areas of improvement for indicator measurement by bringing together relevant stakeholders from across Luxembourg’s health system, with representatives spanning from patient organisations to research bodies.
Technical Focus Group 1: Patient centredness and empowerment (online, May 2025)
Eleven participants from ObSanté, DiSa, IGSS, patient organisations (La Ligue Luxembourgeoise d’Hygiène Mentale, CAPAT), and LIH attended Luxembourg’s first TFC meeting. The session began with OECD presentations on PREMs and PROMs, PaRIS indicators, and international examples of health literacy metrics, including indicators used in HSPAs of other countries.
The discussion confirmed patient centredness and empowerment as priority area within Luxembourg’s HSPA framework. There was broad consensus on prioritising existing PaRIS survey indicators, which focus on primary care users in community settings. Participants also discussed the possibility to develop indicators from hospital satisfaction surveys to capture hospital settings. Patient organisations stressed the importance of incorporating equity dimensions and developing systematic approaches of patient-centredness across all chronic diseases, including those related to mental health, across settings.
Participants identified measurement gaps including the lack of national health literacy surveys, limited data on vulnerable populations (cross-border patients, lower socio-economic groups), and the lack of care pathway navigation indicators (especially for mental health).
Technical Focus Group 2: Integrated care (online, June 2025)
The focus group brought together a broad range of Luxembourg health system stakeholders to discuss integrated care measurement within the HSPA framework. Discussions drew on perspectives from 13 participants representing ObSanté, DiSa, M3S, LIH, National Cancer Institute, the nursing association, patient organisations (CAPAT), and other health system stakeholders (Cellule Scientifique, Cellule d’expertise médicale, Croix-Rouge Luxembourgeoise).
The focus group began with OECD presentations on integrated care frameworks and data used for international benchmarking, and integrated care metrics used in HSPAs of other countries. There was a broad consensus on the need to include indicators around care co‑ordination and continuity. The most advanced existing indicators were identified through the ParkinsonNet réseau de compétences, PaRIS survey data, and the “Médecin référent” programme for diabetes patients. The National Cancer Institute presented opportunities through lung cancer network certification indicators and comprehensive cancer centre development. Healthcare providers highlighted the potential of the DSP (Digital Health Record) system for measuring interdisciplinary access and advanced care planning documentation, while noting current underutilisation. Furthermore, participants discussed a comprehensive range of potential indicators spanning chronic disease management (diabetes, Parkinson’s, dementia), long-term care co‑ordination, medication management and polypharmacy guideline adherence, and health literacy assessment.
Representatives also flagged the limited availability of data on socio‑economic disparities in care co‑ordination experiences as a potential measurement gap.
Technical Focus Group 3: Value‑based healthcare (online, June 2025)
The session brought together 16 participants representing key Luxembourg health system organisations to discuss how value‑based healthcare could be reflected in the HSPA framework. Participants included ObSanté), CNS, IGSS, M3S, MiFA, LIH, Croix-Rouge Luxembourgeoise, patient organisations (CAPAT), providers organisations (La ligue luxembourgeoise de prévention et d’action médico-sociales, Fédération Luxembourgeoise des Laboratoires d’Analyses Médicales), and research institutes (LISER, Conseil Scientifique – Domain de la Santé). The OECD presented value‑based healthcare frameworks, international benchmarking indicators, and examples of value‑based metrics used in HSPAs in countries such as Belgium, Estonia, Czech Republic and Ireland.
The discussion emphasised the importance of prioritising outcome indicators over process indicators to meaningfully assess value in healthcare, with strong consensus on incorporating PREMs and PROMs. This also led to a number of suggestions for the indicator selection process, such as vaccination and cancer screening uptake as measures of appropriate preventive care, variations in average length of stay to assess efficiency, and indicators of long-term care quality.
The discussion highlighted measurement gaps, notably the limited linkage between utilisation and clinical outcome data and the need to systematically disaggregate indicators by socio‑economic status to better assess equity in health system performance.
Technical Focus Group 4: Mental health system and population well-being (online, July 2025)
This meeting engaged 18 participants representing 10 organisations and governmental bodies to discuss mental health and care related indicators in the HSPA framework, including ObSanté, M3S, IGSS, DiSa, LIH, mental health organisations (La Ligue Luxembourgeoise d’Hygiène Mentale), medical and providers associations (Collège medical, Fédération Luxembourgeoise des Laboratoires d’Analyses Médicales, La Ligue luxembourgeoise de prévention et d’action médico-sociales), and research institutes (LISER).
The discussion confirmed mental health as a priority area within Luxembourg’s HSPA agenda and emphasised the need for a cross-cutting approach, with a strong focus on outcomes and the integration of mental health indicators across multiple HSPA domains, particularly access and quality of care.
Participants endorsed the use of existing survey-based indicators (EHIS, HBSC, EU-SILC, PaRIS, SHARE, or the Quality of Work Index), which already capture a wide range of aspects, including depression screening, well-being, service use patterns and patient-reported outcomes. At the same time, several potential indicators were identified for future development, notably related to waiting times, self-harm and suicide, hospitalisation patterns. The discussion also touched upon measurement gaps specific to certain populations, particularly in relation to children’s and older people’s mental health, coverage of cross-border populations, and challenges related to data integration.
As part of the project’s capacity-building activities, a joint visit to the OECD with the Slovak Republic headquarters in France and a study visit to Estonia were organised to support participating institutions in preparing for HSPA implementation and reporting. Both activities were also designed to promote shared learning, knowledge exchange between two countries, and expose national teams to practical experiences from OECD work and peer countries that have already progressed further in their HSPA journey.
Joint capacity building visit to the OECD (March 2025)
The joint visit to the OECD, held in March 2025, served as a capacity building and knowledge‑exchange activity for the Luxembourgish and Slovak teams. Reflecting the multi-country nature of the project, teams from both countries participated together in a structured programme of sessions with OECD experts. This joint format was intended to foster mutual learning, encourage exchange of perspectives and approaches to HSPA. The programme aimed to strengthen the countries’ understanding of OECD data, methodologies and indicators relevant to HSPA, the capacity of the participating countries in data analysis, visualisation, and indicator interpretation for policy use. The Luxembourg delegation included representatives from ObSanté, IGSS and the DiSa.
The programme covered a broad range of policy-relevant areas underpinning HSPA, including health data collections and metadata standards, public health modelling, mental health performance assessment, data visualisation, health workforce statistics, patient-reported outcomes and experiences, long-term and integrated care, patient safety, climate change and health, digital health, and data governance. Through thematic sessions and practical examples, participants explored how OECD indicators, benchmarking tools and analytical models can support evidence‑based policymaking, improve measurement of outcomes and equity, and address emerging challenges such as workforce shortages, digital transformation and climate‑related health risks.
Throughout the visit, structured discussions and daily debriefs helped participants reflect on how OECD tools and approaches could be applied to their national HSPA frameworks. The final wrap-up highlighted key takeaways, areas for further work and the value of continued co‑operation between Luxembourg, the Slovak Republic and the OECD.
HSPA study visit to Estonia (May 2025)
The study visit to Estonia served as a practical learning and peer-exchange activity, allowing Luxembourgish stakeholders to draw lessons from a country that has already developed its HSPA framework and is moving into the implementation phase. The visit aimed to provide first-hand insight into how HSPA development translates into routine practice, including how governance arrangements are operationalised, how indicators are produced and maintained over time, and how HSPA results are communicated to policymakers and the public.
The Luxembourg delegation included representatives from ObSanté, IGSS and the DiSa. During the visit, the Luxembourgish delegation engaged in focussed discussions with Estonian counterparts on the development and implementation of Estonia’s HSPA. These discussions covered stakeholder engagement, governance arrangements and the integration of HSPA into policy and decision making cycles, as well as Estonia’s advanced eHealth infrastructure and the practical use of data to support health system planning and policy action. The exchanges allowed Luxembourg participants to reflect on concrete implementation challenges at a stage when Estonia is preparing its first HSPA report.
The exchanges provided Luxembourgish participants with practical advice for the upcoming implementation phase, with key lessons including the importance of early planning for resource‑intensive HSPA governance and implementation, and adopting a gradual approach by starting with a set of indicators before fully scaling up.
References
[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.