Monitoring changes in cross-sector healthcare utilisation after policy reforms in the Netherlands

Background

Healthcare accessibility in the Netherlands is under pressure due to ageing of the population, increasing care complexity, and workforce shortages. In response, the government and healthcare sector established the Integral Care Agreement to strengthen cross-sector accessibility and efficiency. To monitor progress, we studied changes in healthcare utilisation across primary and secondary care, as well as patients’ perceived accessibility of primary care.

Methods

Routinely collected electronic health record (EHR) data from general practitioners (GPs) were linked to out-of-hours primary care EHRs and health insurer claims to analyse healthcare utilisation across sectors. Patient perspectives were captured through a survey among 9,752 citizens (42% response). Descriptive analyses compared changes between 2019 (pre-agreement) and 2024 for patient groups targeted by the agreement (e.g. people with diabetes).

Results

The prevalence of all targeted conditions increased between 2019 and 2024 (0.2-1.5%). The proportion of patients with ≥ 1 annual primary care contact declined between 2019 and 2023 and stabilised or decreased further in 2024, particularly in GP care, out-of-hours care, physiotherapy, and district nursing. In contrast, the proportion referred by GPs to hospital care increased for all conditions. Most patients reported timely access (>60%), good accessibility (e.g. to schedule an appointment) (68%), and sufficient opportunity to ask questions (95%).

Conclusions

Cross-sector healthcare utilisation patterns shifted after the implementation of the Integral Care Agreement, although changes may also reflect evolving disease severity, patient and provider preferences, and long-term COVID-19 effects on care-seeking. Citizens generally report positive experiences with primary care. These findings offer early insight into the potential impact of national policy reforms. Further research is needed to assess the appropriateness of these utilisation changes.

Key messages

• Cross‑sector healthcare utilisation shifted after the Integral Care Agreement, while patients consistently reported positive accessibility of primary care services.

• Changes in healthcare utilisation may reflect policy reforms as well as change in disease severity or patient preferences. Further research must clarify whether these shifts indicate appropriate care.