The Integrated Healthcare Agreement – where do we go from here?

After almost 6 months of negotiations, which ultimately came down to the last few days, an agreement on the Integrated Healthcare Agreement (IZA) was reached on 16 September 2022. It is the first time that the cabinet has concluded a (general) agreement with (almost) all parties involved with curative care. No fewer than thirteen of the fourteen parties ultimately signed, except for the general practitioners (LHV). Although their support is decisive for the success of the agreement, this decision does not mean that the impact of the agreement is limited.

Appropriate care

The Integrated Healthcare Agreement is set to run for four years. During this period it will gradually work toward appropriate use of care, with the goal of organizing care closer to (where possible) and with more time for the patient. Healthcare parties are committed to more regional cooperation, strengthening primary care, focusing on prevention and better working conditions for healthcare professionals. All this is driven by the idea of better managing and absorbing the increasing demand for care.

Bittersweet ending

Although these concerns about the future of healthcare are being voiced sector-wide, parties also want to be able to trust each other on the perspective offered. For the time being, concrete (financial) guarantees seem to be lacking in many areas. The outcome was thus bittersweet: the agreement was reached, but without the general practitioners. A “pity,” according to Health Ministers Helder and Kuipers, given their crucial role in the implementation of the agreement.

The agreement threatens to become part of a previously observed trend, which is that the healthcare debate tends to focus on general themes rather than pay close attention to the details. This threatens to overlook the “how” question. Only with concrete commitments can the agreement actually be enforced. However, partly in view of the consensus reached on the content, it would be a shame not to take the agreement seriously. There is undoubtedly still much to be done in terms of implementation, and with the momentum generated in the final phase of the negotiations there are plenty of opportunities to continue working on this in the coming period. Stakeholders, in that regard, have actually benefited from the resulting friction for three reasons:

1. Opportunities for signatories?

Thirteen out of fourteen parties who have managed to unite their individual interests and express confidence in an integrated approach. That in itself is quite an achievement, since previous agreements were concluded by individual sectors. Broad support for the content is ultimately the first step towards continuing the conversation about implementation. And this is happening: The parties have agreed to continue speaking every three months. The importance of these follow-up talks is emphasized by the lack of the LHV’s signature. It holds up a mirror to health insurers and the cabinet: now it’s time to come up with concrete guarantees. And with expected effect, after all: it is clearly in everyone’s interest not to let the agreement turn into a failure. Because what does that say about the future of healthcare?

2. Opportunities in the House of Representatives?

Meanwhile, the House of Representatives can also make its voice heard, and it has several opportunities to do so in the coming period. For example, next Thursday, September 29, the Commission will discuss the long-awaited cabinet response to the Scientific Council for Government Policy (WRR) report “Choosing Sustainable Care. People Resources and Social Support”, followed by another separate Commission debate on the Integrated Healthcare Agreement on October 12. A week later, the House will debate on the recently presented healthcare budget for 2023. MPs will have the opportunity to sharpen the financial picture and discuss how for example the 300 million euros for stimulating cooperation within curative care, as was announced on Budget Day, will be spent.

3. Opportunities for advocates?

At the same time, the attention to the Integrated Healthcare Agreement, be it positive or negative, offers parties who were not directly involved in the negotiations a relevant cause to make their objections known and to clarify how certain developments may be at odds with the agreements made. Take for example the recent closures of emergency rooms or groups of patients who may be left out in the cold due to changes in the basic package. This way, they keep the signatories on their toes where promises to patients and care providers and the needs of practice may clash. And only then the transformation to appropriate care will truly be characterized by an integrated approach.

Conclusion

Time will have to tell whether the cooperation on paper will be able to take shape in practice. This not only requires a discussion about financially securing the agreements made, but ultimately also about how an integrated approach fits within the current healthcare system. The past has shown that cooperation across healthcare domains is not always easy. The agreement is a step in the right direction to enable parties to realize this cooperation. All the more important to get serious about its further implementation.