Context
Healthcare reform in the Netherlands is nowadays not regulated directly via acts but starts with (cross-sectoral) agreements among stakeholders who draft a joint plan of necessary changes in healthcare. Whenever necessary, existing acts are adjusted to accommodate these changes. Historically, separate agreements were concluded for separate parts of the healthcare sector, but in September 2022, the first cross-sectoral care agreement (Integraal Zorgakkoord, IZA) was realized, involving healthcare providers, health insurers, patients, the Ministry of Health, and municipalities. In 2025, its successor, the Supplementary Care and Wellbeing Agreement (Aanvullend Zorg en Welzijn Akkoord, AZWA) was concluded.
All stakeholders have consented to and signed the agreement, demonstrating broad support for the measures proposed in the agreement.
Impetus
The impetus for the formulation of the new AZWA was for the cross-sectoral approach started in the IZA to be expanded, made more concrete and sped up via supplementary successor agreements. The main objectives of IZA were to provide the right care at the right place and to promote cooperation between different stakeholders by shifting the focus from disease to health, emphasizing more prevention and support for vulnerable people and an intersectoral response to care requests, for example, evaluating when a medical response or other care (e.g., in the social domain) is more appropriate. The new AZWA aims to strengthen these aims by formulating additional plans.
Main purpose of the reform
AZWA focuses on access to care by tackling the increasing shortages in health workforce and by managing waiting lists. Furthermore, improving access to care and reinforcing primary care are central aims of the new agreement.
Content
According to the agreement, workforce shortages in healthcare should be tackled by improving the efficiency of administrative work, promoting cross-sectoral assessments of patient needs, promoting medical technologies that save time, and supporting prevention to diminish health care demand. Better access to care should be promoted by ensuring that people with urgent problems receive care more quickly, by promoting transparency in waiting lists and introducing more active waiting list counselling in both mental and medical specialist care. The website where people can look up reliable medical information (thuisarts.nl) – and thus better assess whether they need to seek medical care – will be structurally secured. The shift towards more preventive and primary care will be supported by strengthening GP care and the cooperation between care providers in the medical and social domain to ensure good access to and high quality of care in local communities. To ensure appropriate care, among other things, quality information will be made transparent, access to existing medicines will be improved and attention will be paid to prevent fraud in healthcare. There is a different agreement that applies specifically to care for older people: the Headlines Agreement on Care for Older People (Hoofdlijnen Akkoord Ouderenzorg) addresses specific agreements related to cooperation across domains, including palliative care, dementia care and diminishing administrative pressure in this specific group.
Implementation steps taken/Outcomes to date
The Ministry of Health has committed to providing the financial preconditions necessary for the execution of the agreement. Now the agreement is concluded, the stakeholders will start consulting their members to decide how to shape healthcare in the future. While some goals set in the agreements are very explicit and tied to deadlines/timelines, others only indicate broad plans for the implementation of actions/initiatives.
The concluding of the AZWA was temporarily hampered by the decision of the Dutch Association of Municipalities to withdraw from both IZA and its successor (AZWA) in 2024. The Association of Municipalities felt that they did not have enough say in the process and, compounded by impending municipal budget cuts in 2026 and increasing workloads, it would be impossible to cooperate. In June 2025, sufficient guarantees for the financing of IZA and AZWA were provided, prompting municipalities to resume their participation.