Healthcare services everywhere are becoming more complex by the
hour—and so are the population's demand patterns. Massive
amounts of data must be collected and analysed to gain insight on
what healthcare professionals are doing and whom they are working
with. To meet these needs, healthcare
providers are cooperating with each other to coordinate the
provision of care and to centralise information. Such partnerships,
networks, and alliances (PNAs) largely determine the efficiency of
a community's or country's health system, which leads to a
number of questions: where is there room for improvement? Which
links need to be strengthened? And also, importantly: how can
research facilities, educational institutions, and commercial
players be brought into the fold of the system?
The local outlook
In Luxembourg, we have seen a great deal of progress in the last
decade. Ten years ago, from a research point of view, Luxembourg
was fragmented—no convergence of activities was outwardly
foreseen. But thanks to widespread efforts, including several
mergers and infrastructural investments, this system has become
much more coordinated and organised.
Through the Fédération des Hôpitaux
Luxembourgeois (FHL), Luxembourg's hospitals have implemented
an exchange platform that has been in use for more than 50 years
now, with efforts being made through the years to mutualise their
activities. More and more purchases, ranging from medicine to
equipment, are made together by the hospitals via the FHL. This
enables them to have greater power during negotiations (thus
reducing costs), but it also enables them to harmonise the quality
of care throughout the country. It can be said that the hospitals
are finally in a position to better master their purchases and the
To further push the initiative of collaboration, Luxith was
created in 2012 to mutualise the exploitation of software and
infrastructure for hospitals: it has become a common datacentre
hosting mutualised applications and providing a high-speed network
for hospitals. Luxith also works in close collaboration with the
Agency eSanté, which put in place the Dossier de Soins
Partagés (DSP). This electronic file-sharing system
cataloguing patients' medical histories is currently being
developed—when finished, it will majorly cut down the time
spent sharing patient information while also helping create more
continuity in care provision. It will enable the centralisation of
information related to the health of patients and will give all the
healthcare providers of the country (physicians, hospitals,
laboratories, pharmacy, and care homes) access to this information
(with the patient's consent).
While these achievements certainly denote progress, there are
still goals to be reached.
If Luxembourg is to succeed in its initiative to put in place
centres of competences through its hospitals that allow them to
focus time and effort on their critical mass, then the purpose of
this initiative and a clear vision regarding its strategic
deployment within the hospitals needs to be defined.
In the 2010 reform of the healthcare sector, the idea was
introduced to foster hospitals to form alliances to focus on the
interdisciplinary provision of care for certain pathologies. The
intention was, and still is, to avoid having everything done
everywhere, to enable hospitals to achieve a critical mass and an
expertise, to reduce costs, and to avoid unnecessary multiplication
of equipment. Six years later, however, the sector still encounters
difficulties when it comes to putting this concept in place. Even
though it is foreseen in the new bill, it is subject to several
criticisms which range from the definition of the term
"competence centre", to worries that the sanitary card
lacks reliability, to the question of governance of these
competence centres, to the control of the results and the quality
thereof, and to the guidance for putting these competence centres
in place. Ideally, the competence centres should be proposed by
hospitals (in a context of relative competition), and viewed in a
A prescription for change
The lesson from our analysis of world health systems is that
partnerships are what help the medicine go down. From the initial
strategy-forming to the final implementation there will be a host
of challenges, but the fact remains: digital interconnection has
facilitated (indeed, revolutionised) many fields, and just because
health and medical research networks are vast, complex, and
expensive should not exclude them from our attention. In fact, just
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