Who, what, where? The influence of the Integral Care Agreement (IZA) on established regional networks in Dutch healthcare

Abstract Health and welfare organizations are encouraged to collaborate in regional, cross-domain networks. Although the literature has shown that policy changes can influence the effectiveness of existing
networks, the impact of the Dutch Integral Care Agreement (Integraal ZorgAkkoord, IZA) is not yet known.
We investigated this in a longitudinal qualitative case
study of a network that has been in existence for a long
time. The results show that after implementation of
the IZA, a new overarching network at the healthcare
administrative regional level was established. This led
to uncertainty regarding the objective, composition,
and sustainability of the existing network. A division
emerged in the existing network between members
who participated in the new network and those who
did not. Organizations that participated in the new
network questioned their participation in the existing network, to reduce administrative pressure. Organizations that only participated in the existing network doubted their participation because they lost
sight of the network’s purpose and experienced a lack
of transparency regarding decisions made in the new
network. The Dutch national government and policymakers would do well to seek close alignment with
practice when further developing the IZA.