Update 1 April 2025

Last week I spent three days in Paris visiting the HBI conference. As always, a very good mixture of relevant content, an opportunity to meet old friends and to get to know more interesting people. It was also nice to interact with many of the readers of these updates, Due to the conference, the update has been delayed one week, which means that there is a fair amount of news to report:

• Bergman Clinic is making a new acquisition. Is the relationship with ACM and NZA improved?
• Co-payments for social care are to be increased. What will be the consequences for demand?
• Hospital staff get 8% higher salaries. How will hospitals finance this?
• The Ministry makes a choice for a country-wide data exchange system. What are the next steps?
• Report from Deloitte highlights reduction in healthcare related M&A activity. Will it pick up again?

Bergman Clinics makes a new acquisition

Recently it was announced that Bergman Clinics has acquired Oogklinieken Limburg, a chain with three ophthalmology clinics in the southern part of the Netherlands. The clinics specialize in treating patients with glaucoma, cataracts, and macular degeneration. In the short term the clinics will continue to operate under the existing name, but a rebranding will take place at a later date.

This is the second recent acquisition of Bergman that has been accepted by Dutch regulatory watchdogs. As reported in the previous update, this appears to be a more relaxed attitude towards further growth by Bergman than we have seen in recent years when several acquisitions were blocked by the ACM (Dutch Authority for Consumers and Markets) based on the assumption that Bergman Clinics was becoming too strong in its negotiations with the healthcare insurance companies.

Co-payments for social care to be increased

In 2018 the system for co-payments for social services financed by the municipalities was simplified to a standard payment per four-week period independent of wealth and income. This lead to a strong increase in in clients requesting cleaning-related home care, as this was much cheaper than buying home-cleaning services directly. The system was therefore sometimes called a “house-cleaning subsidy for the rich.” In 2022 increasing co-payments for these services was mentioned as one of many opportunities for reducing government spend on healthcare. It has now been announced that a new law will be passed for a new system that bases co-payments on the financial situation of the client.

For clients with a low income the co-payment will not change from the current situation (€21 per four-week period). With increasing income and wealth the co-payments will increase to a maximum of €328 per month. Speaking from personal experience, at this level it will be much cheaper to hire house cleaners directly. However, the municipalities have complained, as they feel that the maximum co-payments are still too low.

Hospital staff to get 8% higher salaries

As in most other countries, finding and keeping staff is a growing challenge for healthcare providers. One of the reasons for this has been lower salaries than in competing sectors. During the last few months there have been intense negotiations between unions and the national hospital organization (NVZ) concerning a new collective labor agreement. The NVZ had suggested a salary increase of 6%. This resulted in the unions threatening a nationwide strike in the hospitals. However, late last week, agreement was reached on a new collective bargaining agreement that will give hospital employees 8% more salary. The first part of the salary increase is retrospective to February (2%), and a further 2% will be given in August, February 2026 and August 2026. In addition to salary increases, the new agreement also improves other aspects such as overtime pay, decreased work pressure, increased safety in the workplace, etc.

Dutch hospitals have thin profit margins, and many hospitals reported losses for 2023. This raises the question of how hospitals will be able to finance the suggested wage increases. As tariffs paid to hospital for the activities they conduct are cost based this will eventually take place. The bad news is that there is a certain time lag. As explained in an earlier update, the maximum tariffs set by the NZA (Dutch Healthcare Authorities) are based on a complex average cost calculation of all providers. This is a complex process that is conducted every 4-5 years. In the years between, tariffs are adjusted based on cost increases in individual cost components (such as salary costs).

Minister makes a choice for a nationwide data exchange system

In previous updates we have written extensively about healthcare related IT, with snapshots of commercial providers such as ChipSoft, ZorgDomein, and CumuluZ. We have also written about the challenges facing the Dutch providers of patient portal solutions. One of the challenges facing many of these services is scale and scope, and how to integrate across different providers. After recently making clear choices regarding suppliers of patient portal solutions, the Minister of Health has recently announced that she is making a choice for CumuluZ as the main tool for ensuring a national infrastructure for exchanging information and data between healthcare providers. The Dutch government believes that “data availability should not be a business model” and compares the required infrastructure building highways and roads. The government will therefore invest €11 million in CumuluZ.

CumuluZ will be rolled out in the next few years. In addition, the sector is also working on protocols such as Twiin (structures and agreements for transfer of information across different systems), Mitz (national system where patients can give permission for their healthcare data to be used by individual providers, and Dezi (national system for the (digital) identification of healthcare providers).

Reduced M&A activity in the healthcare sector in 2024

As in earlier years, Deloitte has recently published an overview of M&A activities in the Dutch healthcare sector. The key trend is that for the first time in five years there has been a reduction in the number of transactions (104 in 2024 compared to 131 in 2023). The key driver for the reduction has been a slowdown in deals where private equity is the buyer. According to Deloitte, PE-buyers have been more careful due to uncertainties related to the overall economic environment and the specific regulatory environment in the Dutch markets (with discussions on forbidding PE-investments in the healthcare sector).

However, Deloitte believes that M&A volumes will pick up as the overall sector is still very attractive. Key reasons for this are a growing elderly population, staff shortages, low sensitivity to economic developments, and the presence of specific sub-sectors where consolidation still has to take place (elderly care, occupational healthcare, etc.).