Dutch Healthcare Sector Tackles Self-Employed Shortage By Boosting Output

(MENAFN- ING) Self-employed working hours drop

In 2024, almost one in 10 Dutch healthcare professionals was self-employed without staff. That's double the number from 10 years ago. But that trend has been reversing. In the first quarter of this year, the number of self-employed healthcare workers without staff was 8% lower than in the first quarter of 2024. And this development seems to be continuing. Stricter enforcement of false self-employment rules is prompting many healthcare providers to rapidly scale back their use of self-employed workers. This shift is one of the key factors behind the healthcare sector's vacancy rate climbing to a new record in the second quarter of this year, reigniting concerns about staff shortages.

In total, one in five indicate that they will stop working as a self-employed healthcare professional and about a quarter of them, roughly 10,000 healthcare professionals, expect to leave the sector. As a result of this outflow, the total number of hours worked in the healthcare sector has decreased every quarter since the start of 2024. While employees in traditional employment have increased their working hours by 3%, self-employed professionals have actually worked 14% fewer hours. Some have transitioned into employed roles. Based on sample data, between 40% and 55% of self-employed individuals considered making this switch around the turn of the year.

Self-employed working hours drop while employee hours rise

Number of hours worked per quarter, *1 million

Source: Statistics Netherlands Productivity accelerates after declining prior to the pandemic

On the bright side, since the third quarter of 2024, labour productivity in the healthcare sector has increased by more than 2% for three quarters in a row. Productivity has been increasing almost continuously since 2021 and has picked up further in recent quarters. This stands in stark contrast to the long-term trend: over the past 30 years, measured productivity has grown by just 0.1% per year on average. Notably, the average quarterly productivity growth of 1.6% over the past two years marks a striking improvement compared to the average 1.7% contraction in the two years leading up to the Covid pandemic.*

*There is a caveat here: productivity development is difficult to measure precisely for healthcare. For example, lower-quality care can lead to more aftercare for the same patient, which is then registered as extra care delivery. Also, prices do not always reflect the actual qualitative value (as is often the case in commercial sectors), because they are partly based on centrally determined (maximum) rates.

Productivity growth in healthcare sector has increased

Labour productivity growth in healthcare, per quarter

Source: Statistics Netherlands, ING Research Digital applications and informal care bear fruit

The need to organise care processes more intelligently amid ongoing staff shortages underpins efforts to improve productivity. Broader adoption of digital tools is a key enabler. Since the Covid pandemic, these tools have become an integral part of healthcare delivery. Although uptake is no longer increasing rapidly, healthcare providers are increasingly proficient in using digital technologies. For example, hospitals are increasing the occupancy of operating rooms more often with data-driven capacity management. Like providers of elderly care, hospitals also treat and monitor more patients at home, so that they need to visit a doctor or nurse less frequently. In elderly care, there is also a growing focus on involving informal caregivers to ease the burden on professional staff. The rise of AI applications also helps by gradually reducing the registration burden and reducing the number of no-shows due to better forecasting of probabilities.

Less volume growth in 2025

For the whole of 2025, positive productivity will still ensure continued growth in total healthcare volume, but due to the retirement of self-employed workers, we expect lower growth in total healthcare production (+1.5%) than in 2024 (+3.0%). Structurally, the ageing population, medical-technological progress and higher use of healthcare due to growth in prosperity continue to boost demand. Moreover, the government continues to create the financial space to accommodate growth. In addition to the budgeted growth in collective healthcare expenditure, a number of planned cuts for 2026 have been scrapped due to the fall of the cabinet and the conclusion of the Supplementary Care and Welfare Agreement (AZWA) and the Outline Agreement on Elderly Care (HLO).

Staff shortages and absenteeism remain major challenges

Higher productivity growth doesn't change the fact that staffing remains a major challenge for healthcare providers. According to the latest estimate, the staff shortage will increase to 266,000 by 2034. Moreover, reducing absenteeism due to illness is also a persistent challenge. In healthcare, the decline of absenteeism has stagnated and is still significantly higher than the figure for all sectors (7.4% vs. 5.3%). The departure of freelancers is compounding staff shortages this year, which in turn is increasing the workload for remaining employees and likely contributing to further absenteeism.

Foreign-trained healthcare professionals could help

Two other ways to tackle the staff shortage are to extend the working week or attract foreign healthcare professionals. The first option is often complex in practice. Only a limited proportion of part-time workers are able and willing to work longer hours. In addition, employers cannot always honour a longer working week because of bottlenecks in the organisation of work, such as adjusting work schedules. Attracting foreign healthcare professionals has more potential. Compared to neighbouring countries, the Netherlands has few doctors and nurses trained abroad. The use of migrant workers brings challenges in terms of language barriers, diplomas and housing, but in other countries, a targeted approach appears to work.

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