Crisis, competition and care: Market disruption in elective gynecology in the Netherlands due to COVID-19

Background: Regulated healthcare markets rely on provider competition to improve efficiency and access. During the COVID-19 pandemic, Dutch hospitals were urged to prioritise emergency COVID care, while independent treatment centres (ITCs) were largely exempt. This reallocation of capacity substantially reduced hospitals’ ability to deliver elective gynecological care and may have affected medium-run market dynamics between provider types. Objectives: This study examines how the COVID-19 pandemic affected revenues, treatment volumes, and surgical care proportions in benign gynecological care across different provider types in the Netherlands over time. Methods: We used nationwide monthly claims data from 2016 to 2022 covering all Dutch hospitals. Focusing on six common gynecological care pathways, we assessed changes before, during, and after the initial COVID-19 shock. Regression models with hospital and care-path fixed-effects were used to estimate the impact of the immediate COVID-19 shock and the subsequent COVID-adjustment period, distinguishing between academic, top-clinical, general hospitals, and ITCs. Results: All provider types experienced an initial revenue decline during the COVID-shock, with general hospitals most affected. ITCs saw smaller losses and rebounded strongly, increasing their revenue by 23.62% and surgical care share by 21.34% relatively. In contrast, general, top-clinical and academic hospitals, responsible for emergency COVID care, suffered deeper, more persistent losses. Conclusion: Providers exempt from emergency COVID-19 care showed different adjustment trajectories than hospitals delivering emergency services, with prolonged implications for their relative market positions up to 2022. This indicates that crisis conditions can affect market dynamics and should be explicitly considered when shaping emergency response policies.