Transforming Health Systems: Mapping the Landscape with 172 Regional Cross-sector Partnerships in the Netherlands

Background: Across health systems worldwide, there is growing attention for regionalization in the organization of care. This is a response to shared challenges, including population ageing, workforce shortages, widening health inequalities, and rising healthcare expenditures. Like many other western countries, the Netherlands is pursuing regionalization in the organization of care. The shift is shaped by national agreements between the government and national representatives of healthcare and wellbeing organizations, professionals, and patients.

 

However, its implementation is carried out by regional cross-sector partnerships (CSPs) that determine their own organizational arrangements. These CSPs bring together actors such as (health)care providers, insurers, citizen and patient representatives, and municipalities, who jointly develop subsidized transformation plans tailored to their local contexts.

However, despite growing reliance on these networks, overall understanding of how CSPs are configured remains limited, hindering the development of targeted, context-sensitive support measures and cross-regional learning. An empirically grounded overview of the CSP landscape can help address these gaps by informing policy design, supporting practice, and contributing to comparative analyses across international contexts.

 

Methods: For this study, a descriptive cross-sectional design was applied. Previously collected data from two rounds (2023–2024) of a national, annually recurring survey targeting a broad sample of CSPs in the Netherlands was used. Data analysis was performed in two consecutive steps. First, a Latent Class Analysis (LCA) identified subgroups of CSPs based on structural and strategic features (partnership size, population served, public health involvement, prevention orientation, and breadth of targeted outcome domains).

 A subsequent comparative analysis examined how the identified classes were positioned across key determinants associated with collaborative capacity and system development for health and wellbeing, including governance, trust, learning, resource sufficiency, and target population engagement.

 

Results: In total, 172 CSPs across all Dutch regions participated in the surveys. The LCA identified two classes: (1) Broadly oriented networks, spanning multiple sectors and outcome domains; and (2) Targeted partnerships, focused on relatively smaller populations and care pathways. Preliminary results of the comparative analysis show that broadly oriented CSPs more often reported stronger connections with their target populations, greater involvement of patient and client representatives, and were more likely to function as “networks of networks”, coordinating or connecting multiple underlying partnerships.

 

They also showed higher attention to key national priority populations, such as people with limited health literacy, mental health problems, and older adults in frail health. These partnerships were more often established during recent transformation programs and reflect closer alignment with current national policy agendas.

 

Discussion: These findings underline that system transformation does not follow a single pathway: partnerships develop along varied trajectories shaped by their scope and strategic orientation. The two identified classes illustrate different profiles of regional collaboration within the Dutch national policy context. This variation reflects the adaptive nature of current transformation policies, which allow regional actors substantial freedom to design partnerships that align with local priorities, existing collaborations, and contextual circumstances. By clarifying the landscape, this study provides a foundation for future evaluation, targeted policy support, and international learning on integrated, community-based system transformation.