The Dutch government has 109 billion euros available for healthcare next year. This was announced during the presentation of the Budget Memorandum on Budget Day ((known in the Netherlands as 'Prinsjesdag' when the 'Miljoenennota' is presented, marking the start of the new government year). From 2025 onward, the Dutch government aims to make healthcare more accessible and equitable for all citizens. People should be able to live as long as possible in good health, with opportunities to stay (mentally) healthy and fit. In the digital field, the government primarily seeks to address personnel shortages by prioritizing the preconditions for data exchange and the use of generative AI. Sector organizations NVZ, NFU, and Actiz have responded with mixed feelings.
The NVZ (Dutch Hospital Association) has called, calls on the government and the Eerste Kamer (Lower House) to take firm action in the coming year to harness the potential of innovation and digitization in healthcare. According to this association, which represents general hospitals, rehabilitation centers, and specialized care institutions, current means to address labor shortages in the healthcare market are insufficient.
Regulating preconditions
To prevent the staff shortages in healthcare, as highlighted by the NVZ, from becoming unmanageable, the government intends to regulate the preconditions for deploying generative AI, digitization, standardization, automation, and data exchange, with a focus on privacy, as a priority next year. A budget of 162 million euros will be available for this in 2025. Additionally, the government will launch a campaign against aggression towards aid workers, including healthcare professionals, with the slogan: 'Aggression against aid workers, you don't do that!'
The budget for the Ministry of Health, Welfare, and Sport (VWS) in 2025 emphasizes equal equal access to care for all patients, as previously stated by the government. This includes efforts to make the labor market shortage in healthcare more manageable and to cut administrative tasks by half. The government also aims to supplement the Integral Care Agreement (IZA), which further emphasizes quality care provision in local regions.
NVZ: extra steps needed
NVZ chairman Ad Melkert emphasized that everyone must be able to rely on the best care and support. This requires ongoing efforts in the coming years to meet the growing demand for healthcare. Hospitals, general practitioners, and elderly care organizations are working together in regional collaborations to address these challenges.
“The NVZ is pleased with the government's support for the Integral Care Agreement,” Melkert said. “However, we are asking the government to take extra steps in the fields of healthcare innovation, labor market policy, and improving the financial strength of hospitals to cope with the increasing demand for care.”
Preventing huge staff shortages
VWS recently wrote that despite steps already taken to help more patients per employee, a huge staff shortage in care and welfare of nearly 200,000 employees is expected by 2033. The government wants to prevent this “unthinkable scenario along three lines.
- Halving administration time to 20 percent within five years
- Proper deployment of employees.
- Increasing professionalism.
The government expects that generative artificial intelligence (gen AI), such as ChatGPT, can significantly reduce administration time in healthcare. Digitalization, standardization, automation, and improved data exchange (while respecting privacy) are also being actively pursued.
Room for more innovation
The NVZ is pleased that the government is committed to using digitization opportunities and strengthening the IZA to encourage more cooperation in the region. According to NVZ chairman Melkert, this forms the foundation for permanently accessible and high-quality care. He also stressed that institutions need the freedom to invest in these changes and innovations.
“In recent years, there has not been enough room for such investments. So if we really want these initiatives to take off, the government must provide financial resources to support them. And this applies to the various tasks hospitals face, such as AI, digitization, sustainability, the provision of appropriate care, and addressing labor market issues.”
Important task
“In recent years, there has not been enough room for such investments. So if we really want these initiatives to take off, the government must provide financial resources to support them. And this applies to the various tasks hospitals face, such as AI, digitization, sustainability, the provision of appropriate care, and addressing labor market issues.”
“We still don't see any funds in the budget to raise the salaries of middle-level employees, and the resources for labor market policy have disappeared from the budget. This must change. We urge the House of Representatives (Tweede Kamer) to address this during the budget debate. Good patient care depends on retaining good employees.”
NFU: mixed feelings
The NFU (de Dutch Federation of University Medical Centers) has mixed feelings about the proposed Government policy. While the organization welcomes certain measures, it is deeply concerned about the continued cut of 1 billion euros from research and education, which it considers disastrous for the Netherlands. NFU president Helen Mertens, chair of the Maastricht UMC+ board, referred to the preservation of sector plans as a "band-aid" solution. The preserved funding allows over 1,200 researchers to continue their work, but the cuts severely affect research on critical healthcare issues, such as cancer treatments and rare diseases.
“The gigantic cut in start-up and incentive grants and the grab from the Research and Science Fund and the National Growth Fund hit our society unprecedentedly hard,” Mertens stated. This translates into less research on new cancer drugs or innovative treatments for rare diseases. Also, the UMCs can investigate fewer solutions to reduce administrative burdens, keep care affordable and reduce health disparities in the neighbourhood.
More attention to IZA positive
The coalition program does rightly pay attention to keeping good quality healthcare affordable and accessible, partly in view of the ageing population and tight labor market. According to the NFU, it is important that all healthcare parties work together to make healthcare future-proof, together with the social domain in the regions. The UMCs view this as a positive development, as the government is broadening and concretising the Integral Care Agreement (IZA) into a supplementary care and welfare agreement, aiming to address important challenges in healthcare in collaboration with care providers.
However, increasing pressure on care and growing health gaps also call for a firm commitment to prevention and health, something for which the NFU, on the other hand, sees substantial cuts planned. “This is astonishing and shows short-term thinking,” Mertens believes. “From the MUMCs we do a lot of research on prevention, and we know that the commitment to prevention has proven effective: it saves lives, keeps care affordable and retains people for the labor market. It's a no-brainer to invest in prevention.”
Accelerating data availability together
Then again, this administration's ambitions on data availability and AI are promising. The NFU states that it shares this ambition and is happy to work with the government to accelerate data availability and data sharing - indispensable for good, personalized and future-proof care. Data availability and knowledge development are also important conditions to accelerate the deployment of AI in healthcare.
The UMCs are working hard on innovative AI applications in healthcare, according to the NFU. For example, deployment of AI tools makes it possible to reduce the time surgeons spend in the OR; doctors can diagnose diseases more accurately or better predict the course of disease. ‘In this way, we are making patient care better and safer and reducing the administrative burden for healthcare workers.’
Actiz: remove barriers
Anneke Westerlaken, president of ActiZ sector association of healthcare organizations, sees a lot of ambition for elderly care in the government's policy, with concrete measures that the sector is already working on. However, Schoofs (the new Dutch Prime Minister) first government's supposedly greatest commitment to instruments such as gen AI to drastically reduce the administrative burden in care raises the question for Actiz whether this is perhaps wishful thinking, and whether the promises can be realized.
Westerlaken agrees that a transition is needed in how we work in elder care and that technological innovation plays a crucial role in this. “But as the coalition agreement rightly states, care remains human work.” It is therefore a missed opportunity that the coalition agreement does not pay attention to closing the wage gap in elder care in order to retain and attract sufficient care workers in the coming period.
More decisiveness
Westerlaken further calls on the government to be decisive in removing barriers, such as the current complexity of the (elderly) care system. The coalition agreement speaks of elderly care that is hopelessly fragmented over various care laws. The government therefore wants to better align and possibly merge the care laws, provided it is more efficient and cheaper.
For a serious AI revolution, barriers must also be addressed in concrete terms, Westerlaken emphasizes. After all, healthcare organizations run into the limited availability of people and resources. “Attracting skilled people is currently the biggest challenge, also for large-scale technological innovation in healthcare.” Westerlaken clearly states that the revolution can only be successful if it is accompanied by the sustainable funding of the digitization and innovation task.
Crucial role of primary care
Westerlaken also welcomes the recognition of the crucial role of primary care: “More and more elderly people are living independently at home for longer, and given the demographic trends, this is necessary. Essential care, such as district nursing, makes it possible to organize care close to and in the client's network. The government wants to strengthen cooperation between primary care providers and harmonize purchasing requirements.”
Westerlaken does argue that the sector already knows where the bottlenecks are, “So let's not spend another two years researching the complexity of the system, when there are already numerous reports and the sector now wants to act pragmatically." One example is re-ablement, an approach that helps older people become more independent. 'The pilots show great results, but it is proving difficult in practice to organize this across different care domains.
Other points from the Dutch Budget Bill:
- The health care premium rises to an average of 156 euros per month. Three-quarters of this is due to the adjustment of wages and prices in health care. The care allowance goes up by 6,50 euros per month. The deductible will be frozen at 385 euros in 2025. Leading up to lowering the deductible to 165 euros in 2027, 2.5 billion euros has already been made available in 2025 to reduce the burden on all households.
- Next year, VWS will concretize the Integral Care Agreement (IZA) with parties from the care sector. The so-called movement to the front and thus keeping the regional hospitals open will be the starting point. Agreements must be made to remove emergency care, acute obstetrics and intensive care from market forces and to finance them on the basis of an availability contribution as is customary in ambulance care. Multi-year contracts and no longer centralizing operations of a simple nature should give security to continue working in the regional hospital or smaller hospital in the city.
- A line has been drawn through three elder care measures from the previous administration, effectively cancelling the €615 million cut for 2025. An additional €168 million will be allocated to disability care next year. Furthermore, from 2027, the budget for long-term care will increase by €600 million. Long-term care will also play a role in the concretising of the Integral Care Agreement (IZA).
- To better protect the health of vulnerable groups, the government aims to start vaccinating babies against the RS virus in 2025. A new pneumococcal vaccine for the elderly is also available. Increasing mental resilience and reducing mental health (mental health) waiting lists will be further developed in a mental health and mental health work agenda in 2025. An additional 30 million euros per year will be available to address waiting lists in 2025 and 2026.
- VWS has the ambition that everyone in the Netherlands has the opportunities to play sports and exercise. VWS spending on sports planned for 2025 will remain the same. There will therefore not be cut next year.
- By 2025, 74 million euros will be available for the sustainability of sports clubs via the BOSA scheme. This will support the sports infrastructure and sustainable society that encourages exercise.