I hope that you are enjoying nice summer weather (not too hot as in southern Europe and not too wet as in parts of northern Europe). Typically, updates cover between two and four different news items. However, this update will focus only on current developments and announcements from the government that will have a very large impact on the overall Dutch elderly care sector and will raise new strategic challenges for all types of organizations that are involved (directly or indirectly) with the sector. In earlier updates I have covered the plans of the government (see update of 12 April for an initial view on the plans to not build any additional nursing homes and the update of 1 June giving an overview of the government’s plans for reducing healthcare expenditure.

In recent statements the government has clarified some of the issues resulting from the earlier statements and has clearer plans for implementing many of the suggested changes. Based on this, it makes sense to present a broad overview of the plans presented by the government and give a first-cut view of what the suggested changes entail for the different types of organizations active in the sector.

It was great seeing many of you last week at the HBI conference in London. The presentations and discussions were (as always) good, but played a secondary role to meeting and talking face-to-face with old and new friends. A special welcome to the people I met in London and who are now receiving my updates on the Dutch

In this update on the Dutch healthcare sector, we cover:

• Actief Zorg continues growing through acquisitions. Is the strategy to become a national homecare provider?
• Hospitals had reasonable results in 2021. Do they have the financial strength to meet coming challenges?
• Government takes a more active role in developing interoperability between systems and data flows between healthcare operators. Will it help the sector solve key problems?

Dear <First name>,

I hope that you are all enjoying wonderful spring weather. In this update on the Dutch healthcare sector, we cover:

• Government is planning structural savings on healthcare expenditure. What will be the consequences?
• Minister wants to tighten rules regarding the use of personal budgets (PGBs). What will this mean for innovation?
• Increasing number of healthcare professionals choosing to leave jobs for an independent career. What are the reasons and what can be done?

Sorry for the long wait since my last update. The delay was due to a combination of a wonderful two-week vacation in Sicily and lots of work with ongoing projects. However, I have now been able to find the time to write a new update on the Dutch healthcare market with news about:

• Acquisition of Dutch laboratory by Eurofins. Will more consolidation follow?
• Major changes announced to financing of youth care. What will be the consequences for commercial operators?
• M&A activities in healthcare sector grow again. Will the growth continue?

At the beginning of 2017 I saw an increasing interest in the Netherlands from international healthcare operators and investors. In May 2017 I decided to provide my international contacts with a bi-weekly update on the Dutch (commercial) healthcare sector. The first update gave news about Acibadem entering the Dutch market with a new hospital, staffing issues in the elderly care sector, and a snapshot of Domus Magnus.

We are now five years further and the commercial nursing home sector is dominated by French providers, international private equity has made major investments  in mental healthcare (Mentaal Beter) and private clinics (Bergman and Equipe) and numerous smaller investments. In addition, international property funds are very active and there is ongoing interest in other types of healthcare related companies.

This is the 100^th update that I have published. Along the way the number of subscribers has steadily increased and now includes a mixture of senior executives from international healthcare operators, partners at private equity company, real estate investors, and a surprising number of Dutch readers (who clearly enjoy getting an external and more commercial view of the healthcare sector). Onwards to the next 100 updates.

In this update we cover:

• Problems in the Dutch mental healthcare sector lead to closures of locations. Good news or bad news?
• Minister claims that no additional nursing homes will be built. What are consequences for the sector?
• Technology update. What will be next?

The war in Ukraine continues and the news is filled with a strange combination of terrible pictures of homes bombed and people being forced to flee, and Ukrainians showing incredible bravery and resilience. I am a music fan, and a huge fan of The Clash. See here for an updated version of their most classic song by the Ukrainian band Beton.

Even in these strange times there is news from the Dutch healthcare sector. In this update we cover:

• Valuations and volume of acquisitions in the sector are rising. Will this continue?
• Actief Zorg continues to grow. When will profits catch up?
• Mental healthcare and psychedelics – what is the situation in the Netherlands?

Most news here in the Netherlands is focused on the terrible situation happening in Ukraine, so there is not a lot of news from the Dutch healthcare sector.

In this update we cover:

• Contracting between operators and healthcare insurance companies for 2022 still not signed. What are the key reasons?
• In our snapshot we give an overview of Zorggroep De Laren, one of the few remaining independent Dutch commercial nursing home providers.

Terrible news from Ukraine. I wish the brave fighters against Russian Tyranny all the best and hope that Europe manages to stay united and strong in its actions against Putin.

Even with the horrible things happening internationally there is also news from the Dutch healthcare sector. In this update we cover:

• Long waiting lists for mental care. More opportunities for commercial providers?
• Yet another hospital merger called off. Is the ACM (Dutch Authority for Consumers and Markets) showing its teeth again?
• Dutch healthcare sector does not earn enough to fund required investments. Can the trend be reversed?

One year ago, we had freezing weather and 50cm snow. Now it feels like spring. Not sure if this is bad, indifferent, or good news. Good news is certainly that further reductions of Corona-related restrictions will be officially announced in a press conference this evening. Expectations are that almost all restrictions will be lifted as of Friday next week.  In this update we cover the following news from the Dutch healthcare sector:

• Court case related to innovative corona-test. What will be the consequences for the company?
• Good and bad news for Bergman Clinics. Do the insurance companies and the competition board have a different view of the market?
• Costs of treating dementia patients have increased. How can these costs be controlled?
• Bankruptcy for provider of long-term mental care. What are the consequences for the rest of the group?

After a number of weeks in lockdown, it was last week announced that restaurants and cafes can open again (until 2200), theaters and museums can open again, and that the public is again welcome at sports events. Number of infections is high and rising, but this is not expected to have major negative consequences for the healthcare system. Let us hope that the positive developments continue.

January has been a busy month in the Dutch healthcare sector. In this update we cover:

• Another Dutch healthcare company sold to private equity. Who will be next?
• Mentaal Beter acquisition gets green light from anti-competition authorities. What will be the impact on the commercial mental healthcare sector?
• Ontzorgd Wonen saga finishes. Will we hear more from the previous owners?
• Commercial mental healthcare provider takes over psychiatric department of regional hospital. Is this a new trend?
• In our snapshot we give an overview of MoleMann Mental Health, a provider of ambulant mental healthcare services

I hope that you have enjoyed the first two weeks of 2022 and that the year will only get better as it progresses. Recent news from the Dutch healthcare sector includes:

• Investment in healthcare related real estate again above €1 billion. Will trend continue?
• New entrant in healthcare real estate investing buys large portfolio. Will other new investors follow?
• Medux acquires company in the UK. Will further European expansion follow?
• Traditional Dutch mental healthcare providers issues bonds. Will the role of traditional banks in financing healthcare operators continue to decline?

Best wishes for 2022. Let us hope that it will be a year in which we learn how to deal / live with COVID19, and that pleasant things such as eating out in restaurants and travelling again become possible. After a quiet period at the end of last year there has recently been a fair amount of healthcare related news here in the Netherlands:

• The Netherlands now has a new government with interesting candidates for healthcare related ministers. What will be the consequences for the sector?
• The Dutch anti-competition watchdog has recently stopped two healthcare-related acquisitions. Is this a new trend?
• Mentaal Beter to acquire HSK. What does this mean for the commercial mental healthcare market?

I hope that you are doing well. Here in the Netherlands Sinterklaas has been celebrated and now all the shops are focused on Christmas. In the healthcare sector most of the attention has been focused on the new omicron variant and capacity issues related to COVID19. Other healthcare related news from the Netherlands includes:

• Onzorgd Wonen Groep is bankrupt. Are there more commercial nursing home providers at risk?
• DC Klinieken acquires small chain. Will there be more consolidation in the specialty clinic market?
• In our snapshot we give an overview of De Vijf Meren Kliniek, a chain of specialty clinics focusing on EMT

I hope that you are doing well. As in other countries the Netherlands is again tightening COVID19-related restrictions such as requiring masks in shops, reduced opening hours for bars and restaurants and asking people to work from home. The new rules have been put in place for the next three weeks with the goal of reducing the level of infections. This will hopefully reduce the number of corona-patients taking up space in intensive care departments thereby increasing the ability of hospitals to carry out other (plannable) operations. Let us hope that these interventions work. Other healthcare related news from the Netherlands includes:

• Report  highlights how senior executives in the Dutch healthcare sector expect to lose market share but stay financially viable. What does this entail for innovative commercial companies?
• Financing of light homecare to be revised due to increasing costs. What will be the consequences for homecare companies?
• In our snapshot we give an overview of Clinium, a provider of sterilization services for hospitals

Autumn has definitely come to the Netherlands with a mixture of gray and rainy days and days where we can enjoy the incredible fall colors. Not my favorite time of the year, but it has its charms. In this update on the Dutch healthcare sector, we cover:

• Insurance companies do not want to transfer catch-up activities to commercial clinics. What will be the effect on waiting times for non-critical operations?
• Another acquisition by Bergman Clinics. Are they moving into Equipe’s key market segment?
• Three rehab clinics to work closer together. First step to a merger?