A decade of lessons learned from integration strategies in the Netherlands

Henk Nies*, Diny Stekelenburg, Mirella Minkman, Robbert Huijsman

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review


Introduction: In the Netherlands multiple single, cross sector and cross governance level policy reforms were introduced to improve health and social care and decrease fragmentation. In addition to legislative and funding measures, the governmental strategy was to set up long-lasting improvement programs and supported by applied research. Description: Five national improvement programs on chronic disease management, maternity care, youth care, care for older people and dementia care were analysed. The Laws of integration of Leutz were used as an analytical framework. The programs demonstrated a mixture of employing policy, quality and financial measures to stimulate coherence and integration. Discussion: The Laws that Leutz formulated are to a large extent applicable in the Dutch context. However, the characteristics of the system of governance being corporatist in its structure and its culture imply that it is hard to distinguish single actors being in the lead. Integration is a more complex process and requires more dynamics, than the law ‘keep it simple, stupid’ suggests. Conclusions: In the Dutch context integration implies a permanent pursuit of aligning mechanisms for integration. Sustainable integration requires long-standing efforts of all relevant stakeholders and cannot be achieved quickly. It may take a decade of consistently applying a mix of policy instruments.

Original languageEnglish
Article number15
JournalInternational Journal of Integrated Care
Issue numberS2
Publication statusPublished - 2021

Bibliographical note

Funding Information:
Investors The establishment of IMCos is accompanied by additional costing and reimbursement mechanisms. According to the contracts between IMCos and healthcare insurers, these costs are (partially) reimbursed. Furthermore, IMCos can obtain financial support by the CMC, the Ministry, or the Taskforce Maternity Care.

Publisher Copyright:
© 2021 The Author(s).


  • Governance
  • Integration strategies
  • Netherlands
  • Policy measures
  • System integration


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