Background <p>People with intellectual disabilities often have complex healthcare needs and may therefore experience different patterns of healthcare utilization. This study examined the overlap between the use of public and private healthcare providers as an indicator of access to choice-enabled healthcare providers within a patient-choice-based health system.</p> Methods <p>We assessed overlap in two complementary ways: among people with at least one private healthcare contact and among those with at least one public healthcare contact in a cohort of people with intellectual disability (ID cohort) and a referent cohort from the general population (gPop cohort). The ID cohort comprised 2 813 children and 9 079 adults, whereas the gPop cohort comprised 146 048 children and 982 186 adults. Data regarding healthcare contacts in public and privately organized healthcare were collected from the Skåne Healthcare Register.</p> Results <p>Among those with at least one contact in privately organized healthcare, both children and adults with intellectual disabilities were as likely as those in the general population to also have contacts in public primary healthcare and public somatic specialist care. However, they were more likely to have contacts in public psychiatric specialist care. Among those with at least one contact in public healthcare, children with intellectual disabilities were as likely as their age peers in the general population to also have contacts in privately organized healthcare. However, adults with intellectual disabilities were less likely than their age peers to have contacts in privately organized healthcare.</p> Conclusions <p>These findings have important implications for patient‑choice‑based health systems. They indicate that formally available provider choice does not result in similar patterns of utilisation across populations. Also, that adults with intellectual disabilities may face challenges in navigating and using privately organised providers within such systems. The prominent role of public psychiatric specialist services further highlights the continued importance of publicly provided specialist care for this group. Together, the results underscore the need for patient‑choice‑based healthcare systems to be designed and implemented in ways that support accessibility, coordination, and navigation for people with intellectual disabilities, particularly adults with complex healthcare needs and during periods of healthcare disruption.</p>