•Treatment of knee and hip osteoarthritis shifted from hospitals to primary care.•Policy measures and renewed medical guidelines aimed to stimulate this shift.•Deductibles might form a barrier for substitution from hospitals towards primary care.•Future policy should consider unintended effects due to interference with deductible usage. Medical guidelines aim to stimulate stepped care for knee and hip osteoarthritis, redirecting treatments from hospitals to primary care. In the Netherlands, this development was supported by changing health insurance coverage for physio/exercise therapy. The aim of this study was to evaluate healthcare utilization patterns before and after health changes in health insurance coverage. We analyzed electronic health records and claims data from patients with osteoarthritis in the knee (N = 32,091) and hip (N = 16,313). Changes between 2013 and 2019 in the proportion of patients treated by the general practitioner, physio/exercise therapist or orthopedic surgeon within 6 months after onset were assessed. Joint replacement surgeries decreased for knee (OR 0.47 0.41–0.54) and hip (OR 0.81 0.71–0.93) osteoarthritis between 2013–2019. The use of physio/exercise therapy increased (knee: OR 1.38 1.24–1.53, hip: OR 1.26 1.08–1.47). However, the proportion treated by a physio/exercise therapist decreased for patients that had not depleted their annual deductibles (knee: OR 0.86 0.79 – 0.94, hip: OR 0.90 0.79 – 1.02). This might be affected by the inclusion of physio/exercise therapy in basic health insurance in 2018. We have found a shift from hospitals to primary care in knee and hip osteoarthritis care. However, the use of physio/exercise therapy declined after changes in insurance coverage for patients that had not depleted their deductibles.