The pressure on our healthcare system is mounting like rising floodwaters. Complex care needs and staff shortages often trigger a single reflex: building more reservoirs – more beds. But what if the problem isn’t the size of our reservoirs, but the way we channel the streams of care between them?

In a recent report and accompanying publication, Dennis Moeke and Richard Westerman (HAN University of Applied Sciences, Netherlands) reveal a powerful current of thought: Intermediate care is not a physical location or a type of bed, but a system function – the very engine that keeps the healthcare river flowing.

Three core functions, one goal

Internationally and substantively, intermediate care revolves around three interconnected core functions that keep the care chain flowing:

• Time-limited, recovery-oriented flow: A deliberately channelled trajectory with a clear destination, regular checkpoints, and a fixed outflow direction – like a tributary designed to return patients to their main course.
• Orchestrating care confluences: Explicitly managing the merging and diverging of care streams (from hospital to home or follow-up care) with clear triage gates and multidisciplinary navigation – ensuring no patient gets lost in the rapids between care settings.
• Diverting the hospital flood: Providing appropriate care at a different intensity level, which prevents unnecessary admissions or enables responsible early discharge – acting as overflow channels that prevent the acute care dam from bursting.

The Dutch Challenge: uniting scattered waterways into a single river

In the Netherlands, these currents already exist – think of Primary Care Stay (ELV), Geriatric Rehabilitation Care (GRZ), neighbourhood clinics, and intensive home care (Hospital at Home). But here’s the problem: these streams flow through separate channels, divided by different financing basins, access gates, and responsibility banks. The water is there, but it’s fragmented into isolated puddles rather than a powerful, unified river.

As long as we approach intermediate care as an isolated pond, we will keep talking about beds and silos. The solution lies in a shift in perspective: stop asking ‘where are the reservoirs?’ and start asking ‘how does the current flow?’. By treating admission, throughput, and discharge as one integrated watershed design, intermediate care becomes the turbine that reduces backlogs and accelerates the current.

The conclusion runs clear

To deploy scarce capacity more effectively and guide patients to the right channel faster, we must stop thinking in isolated pools and start designing integrated waterways.

“Those who put the patient journey at the centre look at capacity differently. Not more beds. But better flow.”