Dutch Health Disruption: Reimagining Care with Social Entrepreneurship

The Dutch Health Disruption is a pressing issue that Michel van Schaik, Director of Healthcare at Rabobank, addresses in the June 2025 issue of Zorginstituut Magazine. He argues that the Dutch health system is fundamentally unsustainable due to escalating healthcare costs, chronic workforce shortages, and increasing demand. Van Schaik posits that these challenges cannot be rectified by existing sector players or through mere optimization of current systems. Instead, he advocates for breakthrough innovations emerging from outside traditional sectors. Drawing on Rabobank’s Sectorvisie Zorg and economist Joseph Schumpeter’s concept of “creative destruction,” he envisions a society by 2040 centered around citizen self-reliance and neighborhood solidarity, supported by new organizations.

The Case for Disruption: Systemic Challenges and External Innovation

Van Schaik’s core argument suggests that radical change cannot originate from current institutions, whose self-preserving tendencies limit transformation. Established providers and advocacy groups may seek only incremental improvements. Yet today’s challenges—such as chronic illness, widening health disparities, unsustainable costs, and insufficient staff—necessitate a new paradigm. He proposes a shift in focus from treatment toward well-being and prevention, positioning professional healthcare as a last resort. This model reinvigorates citizens’ collaboration within neighborhoods, echoing the historical concept of “noaberschap” (neighborliness). Notable examples include Rabobank’s support for local initiatives like fall prevention Health Impact Bonds, projects reducing pesticide use, and efforts encouraging healthier lifestyles.

Van Schaik claims that the “hindermacht” (obstructive power) of the current system often stifles new initiatives. He calls for regulatory and financial incentives to favor prevention and societal well-being over “paying for repair.” This would allow creative, socially motivated newcomers—irrespective of profit status—to flourish if they provide real value.

Societal Trends and International Comparisons: Workforce, Costs, and Community Solutions

Van Schaik’s critique and vision resonate with recent global health sector trends and challenges. A 2025 Deloitte outlook notes that health systems worldwide face persistent staff shortages, budget constraints, and a need for efficiency and patient engagement. Over 70% of surveyed C-suite executives emphasize productivity, with many anticipating further workforce shortages, particularly among generalists.

In the U.S., 2025 data shows health care costs rising faster than inflation, compounded by workforce and spending complexities. Yet it’s widely acknowledged that medical care contributes little to health outcomes compared to social determinants like housing, income, and education. This reinforces Van Schaik’s assertion that only 10% of health and well-being derives from healthcare.

Moreover, community-based health approaches, including neighborhood support systems and “healthy urban living” projects, have been promoted by the WHO since 2023. Strengthening primary care, prevention, and community engagement is vital for bending the cost curve amid rising chronic disease and demographic changes.

Implications for Health Economics, Market Access, and Reimbursement: Toward Systemic Realignment

The implications of Van Schaik’s arguments are profound for health economics and policy. If most health outcomes are shaped by non-medical factors, reorienting investment toward prevention and social determinants could yield greater societal value. For payers and policymakers, this means supporting payment models prioritizing prevention and community-based solutions over care volume.

In terms of market access, new forms of value assessment and innovative contracting—like Health Impact Bonds—must be embraced to sustain social entrepreneurship. Regulatory frameworks should also evolve to create room for unconventional entrants and reduce procedural obstacles.

In conclusion, Van Schaik’s insights align with a growing consensus: sustainable health systems require adaptive, community-driven innovation backed by supportive incentives. Transitioning to this model demands financial creativity and a cultural shift in perceptions of health and societal responsibility. For more insights, explore the detailed magazine article.