Patients in the Netherlands wait longer and longer for a first appointment with a specialist: 42 days on average in 2025, an increase of 24% compared with 2022. Patients wait longest in specialties with a lot of chronic care, such as gastroenterology, rheumatology, gynaecology and neurology. The cause lies mostly in how outpatient care in the Netherlands is organised and paid for, and much less in differences between hospitals and their specialists. Over the past months we analysed waiting times by specialty and by condition, and spoke with many specialists. Below is what we see and why I think this can be done better.
How long do patients wait for an outpatient appointment?
The agreed standard in Dutch healthcare is that a patient has a first outpatient appointment within four weeks. That is the Treeknorm. According to an ANP analysis of data from the Dutch Healthcare Authority (NZa), just over half of waiting times exceeded those four weeks in 2025. In 2022 that was still about 45%. Over the same period the average wait rose to 42 days.
That average hides large differences between specialties. This year we collected the access times that hospitals report per specialty, via the NZa waiting times on ZorgkaartNederland and the hospitals’ own waiting-time pages:
Source: Seeve survey via NZa waiting times on ZorgkaartNederland and hospitals' waiting-time pages (2026). For rheumatology, neurology, dermatology and pulmonology a sample of 18 to 20 hospitals.
Four of these six specialties are well above the Treeknorm. At the end of 2024 the comparison site Independer, using NZa data, found the same picture: at 86% of gastroenterology clinics and 80% of neurology clinics the wait was above the standard.
The first appointment is often only the start. A migraine patient who has seen the neurologist then waits for the headache clinic, and then for a treatment that works. For menopause care we found several menopause clinics that had temporarily stopped accepting new referrals. For a patient with a chronic condition, the time that really counts is the time to a treatment that works.
Why the chronic patient in particular?
There are three causes that reinforce each other.
Hospitals are built for different work than chronic care. A hospital is a large system, with many different specialties, an emergency department, operating theatres, inpatient beds and expensive equipment. That is highly relevant for acute and complex care: emergency care, surgery, admissions and complicated diagnostics. That is precisely the care only a hospital can provide, and the organisation is designed around it. A patient with rheumatism, IBD or migraine mostly needs a stable team, good monitoring and quick contact when things get worse. In a hospital that care carries the same overhead, while using little of it.
Payment rewards procedures. An operation or an endoscopy earns a hospital more than a series of follow-up visits. Hospitals also agree a maximum revenue with insurers. When the budget is fixed, follow-up for chronic patients competes with all other work for the same hours. Groups of independent treatment centres (ZBCs), too, are often built around procedures such as cataracts, knees and varicose veins. For the chronic outpatient there are currently limited alternatives.
You can see this in the numbers. For more than 1,500 diagnoses, covering 9.5 million patients, we put the revenue per patient next to the waiting time.
Source: Seeve analysis of NZa Open DIS 2024 and NZa waiting times per hospital site (January 2025 to October 2026): 1,513 diagnoses and 9.5 million patients, excluding oncology, acute care and trauma. Revenue per patient, not margin. Waiting time is measured per subspecialty, not per diagnosis; the rise covers January 2025 to October 2026. Chronic = fewer than 5 operations per 100 patients; surgical = 20 or more. This shows a correlation, not a proven cause.
Look at what each kind of care needs and who provides it today, and it becomes clear why the chronic patient has no place of their own.
Source: Seeve analysis of NZa Open DIS 2024 and waiting times 2025–26; analysis of ZBC chains (2026).
There is a persistent idea that hospitals want to hold on to this care. The numbers tell a different story. Within the hospital, the chronic patient does not get the attention they need, and that is exactly where waiting times are rising fastest. Specialists do want to help these patients well, but within a hospital’s budget and hours, acute care and procedures come first.
Demand grows faster than capacity. Statistics Netherlands (CBS) expects the number of people aged 65 and over to rise from 3.8 million in 2025 to 4.8 million in 2040. The Dutch national public health institute RIVM expects the number of people with three or more chronic conditions to grow from 3.3 million in 2022 to 4.3 million in 2050. Meanwhile the shortage of care staff is set to reach almost 266,000 people by 2034, around four times what it is now. New treatments make the picture sharper still. A drug that only a specialist may prescribe, with mandatory follow-up, brings patients to the clinic who used to stay with their GP. That seems like good news for those patients, but capacity does not grow with it.
Source: Statistics Netherlands (CBS), population forecast 2025–2070; RIVM, Public Health Foresight Study 2024; Arbeidsmarkt Zorg en Welzijn staffing forecast (December 2024).
What the waiting costs
For the patient it is clear. Someone who waits months for a rheumatologist or gastroenterologist often has symptoms in that time, works less or stays at home. That hits employers too: a single day of sick leave costs them €350 to €400 on average. With a chronic condition, delay can also cause damage that is hard to repair later.
The waiting times cause problems for the specialist too. In many conversations we heard the same thing: the schedule is full of follow-up visits, there is little room for new patients, and a large part of the day goes to documentation and administration. Anyone who would like to organise care for their condition differently often has no time or room for it within the existing structure.
And the GP sees patients for longer, while they really belong with the specialist. So the waiting also shifts to the rest of the chain.
What would help
We think the answer starts with a focused clinic organised around one chronic condition. One team that knows a group of patients well, one protocol, and outcomes that are measured and improved. That is not a new idea. Hospitals already do it themselves on a small scale, with results. Medisch Spectrum Twente in the east of the Netherlands, for example, runs a focus clinic for reflux and for irritable bowel syndrome with a three-week wait, against twelve weeks for its general gastroenterology clinic.
Independent clinics already show the same difference. Across all specialties, a patient at an independent clinic waits about a third as long as at a hospital.
Source: NZa waiting times via ZorgkaartNederland (2026), median across all specialties. Clinics treat simpler cases on average, so the comparison is not like for like.
What makes this model strong:
- Focus. A fixed care pathway for one condition makes every step predictable, from intake to follow-up.
- A team with the right division of roles. Junior doctors handle much of the follow-up under the specialist’s supervision. The specialist keeps time for the patients who really need her.
- Software for the routine work. Intake, documentation, scheduling and billing can largely be automated. The doctor decides and signs off.
- Remote care where possible. Many follow-up contacts can happen by video or with measurements at home.
Much of this care needs no operating theatre or hospital bed. It actually fits better outside the hospital, in a small clinic with low overhead. That leaves the hospital room for the complex and acute work that only it can do. We see that as collaboration rather than competition: the same specialists and the same referrers, each with their own role. A clinic that takes on this care does not take away anything the hospital wants to keep. It frees up room for the work the hospital was built for.
As a specialist you may be asking yourself: which patients in my schedule would be better off with their own care pathway, and what would I need to build it? That is what we work on at Seeve. If you recognise this in your own field, I would like to hear from you at joost@seeve.ai.
Sources
- ANP via Hart van Nederland, more than half of outpatient clinics have too long a waiting time (2 March 2026, in Dutch)
- Kassa (BNNVARA), Independer analysis of NZa waiting times (30 December 2024, in Dutch)
- Seeve, survey of waiting times by specialty via NZa waiting times on ZorgkaartNederland and hospitals’ waiting-time pages (2026). Access times as reported by hospitals; for rheumatology, neurology, dermatology and pulmonology a sample of 18 to 20 hospitals.
- NZa, Open DIS 2024 and waiting times per hospital site 2025–2026 (Seeve analysis of revenue per patient and waiting time for 1,513 diagnoses, in Dutch)
- Medisch Spectrum Twente, waiting times gastroenterology and FocusPoli (in Dutch)
- Statistics Netherlands (CBS), population forecast 2025–2070 (in Dutch)
- RIVM, Public Health Foresight Study 2024 (November 2024, in Dutch)
- Arbeidsmarkt Zorg en Welzijn, forecast of staff shortages in care and welfare (December 2024, in Dutch)
- KVK, Ondernemen met Personeel: the cost of sick leave (2026, in Dutch)
