Update 26 February 2025

We have actually had winter these last few weeks, with very cold nights and beautiful days with sunshine. A great change from the previous weeks, but the forecast is that it will change. As always, there is a lot of news to report regarding the Dutch healthcare sector:

• McKinsey report highlights the opportunities for productivity gains through digital transformation in the Dutch healthcare sector. What are the next steps?
• Intensified supervision for major healthcare insurance company. What are the key reasons?
• In a snapshot we give an overview of Flexdokters, a provider of modern primary care

McKinsey report highlights opportunities for productivity gains through digital transformation of the Dutch healthcare sector

The Netherlands faces the same challenges as most countries with a strong increase in healthcare related expenditure (increasing to 15% of GDP in 2040) and a growing shortage of healthcare staff (currently missing 50.000 FTEs in the sector). Digital care and AI are seen by many as a key part of the solution for these challenges. A recent report from McKinsey highlights both the potential benefits and suggests what needs to be done to realize the benefits.

Based on a detailed analysis of individual care activities, McKinsey believes that efficiency gains totaling €22 billion can be achieved (approximately 20% of current spend). The expected benefits from digital healthcare are primarily expected to come from the following areas:

• Electronic Health Records (EPD) and Information Exchange:This will enable improved communication between care providers and reduce duplication of activities and other inefficiencies.
• Teleconsultations:Remote consultations offer time savings for both patients and healthcare providers.
• Prevention and Lifestyle Promotion:Digital tools can play a key role in promoting healthier lifestyles and preventing diseases.
• Generative AI:Clinical productivity enhancements, automation of administrative tasks, and personalized patient experiences.
• Purchasing and Operational Efficiency:Optimizing the procurement processes and improving operational efficiency.
• Capacity management:Better planning and utilization of resources.

McKinsey believes that there are five crucial actions for driving the transformation:

1. Patient-first, Digital-first Mindset: A fundamental system change prioritizing user-friendliness and citizen awareness, with patients owning their health data.
2. Large-Scale Use Case Implementation: Focus on productivity-enhancing digital solutions instead of isolated initiatives.
3. Federated Data Sharing: Establish a common architecture for data sharing to enable scaling, with public governance ensuring trust.
4. Aligned Financial Incentives: Implement appropriate funding mechanisms with central coordination to promote digital healthcare adoption.
5. Centralized Decision-Making and Collaboration: To effectively execute these actions.

The Dutch healthcare sector is at least as complex as the sector in other countries with its unique mix of public management of what is essentially a privatized market (although most providers are non-profit organizations). As a consequence, successfully conducting the five crucial actions suggested by McKinsey will require a high degree of central coordination by a combination of government decisions and actions, and a coordinating and motivating role for the healthcare insurance companies. There are examples of steps being taken that will help the suggested transformation. Cumuluz is an example of a program that is making timely progress in improving data connectivity between healthcare providers. However, the never-ending process related to developing a successful patient-portal solution highlights how difficult it is to make progress. In addition, the IZA and WOZO programs highlight the complexities of aligning interests across the different sub-sectors and individual organizations in the Dutch healthcare market.

Intensified supervision for major healthcare insurance company

The Dutch Healthcare Authority (NZA) has a wide range of responsibilities. One of these is to ensure that healthcare insurance companies comply with relevant regulations. One of the key responsibilities of the insurance companies is that they contract sufficient care from providers to ensure that their clients have timely access to high-quality assistance. Agreements have been made between the NZA and the insurance companies regarding maximum wait-times before hospital; and mental healthcare patients can access a relevant care provider (in Dutch Treeknormen). In March last year two of the major healthcare insurance companies (CZ and Menzis with a combined 33% market share) were warned for not meeting the agreed targets.

The two companies were given six months to decrease the average time that their clients had to wait before receiving appropriate care. Menzis has succeeded in reducing the waiting time. According to the NZA, CZ has defined the areas to be improved too narrowly and not achieved the required improvements. The NZA has therefore, for the first time in its history, placed an insurance company under intensified supervision. This entails closer contact between NZA and CZ, detailed progress reports, unannounced visits, etc. If CZ does not implement sufficient improvements within the agreed time limit the NZA can impose more severe measures, including fines.

We have seen healthcare insurance companies scramble to ensure sufficient primary care for patients after the bankruptcy of Co-Med. With the growth in demand for healthcare services and growing staff shortages it is likely that insurance companies will have similar problems in the future. The NZA has in the last few years become more proactive and the intensified supervision of CZ is probably meant as a warning shot to all the insurance companies that they need to take their responsibilities regarding accessibility of care seriously.

Snapshot of a Dutch commercial healthcare company: Flexdokters

In the previous update we were able to (finally) give some positive news about the Dutch primary care sector. It is nice to be able to follow up on this with a snapshot of an innovative company developing new primary care locations. Flexdokters is a non-profit cooperative where participating GPs are members. It currently has approximately 35 members spread across the country and is actively looking for new members (either GPs wanting to start a new primary-care location or existing locations). The core concept of Flexdokters is a way of working where the doctor patient relationship is central and where many activities are outsourced to the patient. An example is that a Flexdokters location does not have a reception and that the patient makes direct contact with the GP. The GP is supported by various digital tools for planning and appointments. The central costs of Flexdokters are financed by healthcare insurance companies that see the approach as helpful in increasing the number of doctors willing to start new primary care practices.