Home care organization Buurtzorg has been working for a year and a half without freelancers. “Even before this whole event,” says director Jos de Blok. “This whole event,” those are the stricter rules for self -employed people, who have to prevent false independence, and the enforcement that started at the beginning of this year. In practice, those rules mean that many organizations must largely stop using self -employed people.
Almost ten years ago the rules surrounding the self-employed board were tightened. The rules will be maintained from this year; The tax authorities have announced that it would impose fines from next year. How healthcare institutions adapt to this can be seen in figures from the Central Bureau of Statistics (CBS): The number of self -employed people in healthcare was 7 percent lower in the second quarter of 2025 than in the same quarter last year.
From 2013, the number of care workers who worked as a self -employed person grew every year (with the exception of the Corona Years 2020/2021). So that trend is over. Can the care organization without self -employed people?
Night shifts
So according to the block. As a home care organization you also provide terminal patients, he says, and work with night shifts. “That is difficult to arrange with regular people, you can’t use them for other things. That’s why we arranged that with self -employed people. But those rates went up in such a way that we have stopped.”
The solution? Coach of a home care team in the Achterhoek Margo Berends came up with the idea for a separate pool, says De Blok, for employees who wanted to spend more hours and had no storage against night shifts. There are many ‘small contracts’ (with few hours) in healthcare, so there were quite a few people open for that. “In this way the night shifts could be distributed among all people who wanted to run a few extra hours. It went remarkably smoothly.” In addition to the Pool and the extra hours for permanent employees, Buurtzorg has also adopted around a thousand employees in recent years through a side entrance process.
An employment contract has many advantages, such as continued payment in the event of illness and pension structure. But we can’t match the rates that self -employed people set
Having self -employed people in service seems to be an obvious solution. “We discussed this with our self -employed people,” says Anne Kroezen, director of human resources at the Leiden University Medical Center (LUMC). So far, only a few wanted this. “An employment contract has many advantages, such as continued payment in the event of illness and pension structure. But we cannot match the rates that freelancers set. If you only look at what you get in your account every month, they will indeed deteriorate.”
Another solution found the hospital, which no longer works with self -employed people, in ‘creative scheduling’ and looking closely at the interpretation of the work. “Which part of the tasks can a care assistant take over, so that the trained nurse has more time for nursing actions?” Artificial intelligence can also play a role in this. For example, the project ‘You cares, AI is currently registering’ in the LUMC to reduce the administrative burden for nurses.
Operating room
That does not mean that the new policy did not cause any difficulties. “We have felt it, yes,” says Kroezen, “especially in the OR [operatiekamer]. That has traditionally been the place with the most freelancers, partly because the staff shortages are the greatest there. That is the engine of the hospital, which has to keep running. Sometimes it is exciting, but so far that also works. “
Marieke Roelink, capacity manager at Gelre hospitals, recognizes that. In principle, that institution no longer works with freelancers, but still has exceptions, if the continuity of care otherwise cannot be guaranteed. “Especially in specialist departments such as the OR, the Intensive Care or Emergency Department. It can suddenly be very busy there, and the staff is highly specialized, so it is not easy to scale up otherwise.”
Gelre hospitals also offered self -employed people with employment. Some wanted that, but not all. The hospital has therefore recruited new employees and uses an internal ‘Flexpool’ and posting agencies. In this way virtually no gaps have arisen in the gratings, says Roelink. “It was sometimes tight of summer, but not tighter than in other summers.”
Flexible skin
If stopping valuable self -employed people apparently can be organized, why did that seem to be not possible for so long? For a long time, healthcare organizations benefited from a large ‘flexible skin’, says Kroezen, so that you could quickly scale if it became calmer and were not tied to high structural costs. Due to the lack of regulations – and later enforcement – but also because of the scarcity on the labor market, the share of self -employed people grew very fast, with all its consequences: high rates, pickiness regarding the services to be worked.
“As a result, the popular services went to the self -employed and the less popular services to the permanent employee,” says Kroezen. Now that the rules are being maintained, the popular services are also available to the permanent employee and the burden she can be distributed fairly. Moreover, healthcare organizations now benefit from a smaller flexible shell: in times of large worker scarcity, with vacancies that are permanently open, you want to bind people to you for the longer term.
Lex Tabak, himself a former self-employed person in healthcare and now director of Service Organization for self-employed persons ZZP-erindezorg.nl, finds the image of the self-employed person as someone who intenses high rates and the easy services does not choose fair. “There are excesses, but why could they arise? Because it was not attractive enough to be employed. Look at the quality of your employment. Why is a self-employed self-employed person for a good income, control over his own schedule and a healthy work/private balance. Those things must be guaranteed to do the employment before you do the self-employed person. high absenteeism: Everyone knows how high the workload is in healthcare. ”
According to him, the fact that self-employed people do not opt for the employment en masse shows that this is not a ‘viable alternative’ for the self-employed. According to Jos de Blok from Buurtzorg, that alternative is there, although it requires some creativity. “Margo from Team-Achterhoek has found that alternative for us.”
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