Ùpdate 14 July 2026

Another heat wave expected this week, but again this has not stopped the appearance of news related to the Dutch healthcare sector. In this update we cover:

• Physiotherapy court case rejected by judge. What are possible next steps?
• Government considering maximizing dividend payments of healthcare suppliers. Is this likely to happen?
• Most nursing home providers make losses on operations. How is this possible?
• Government takes big steps in financing senior living. What is the situation?

Physiotherapy court case rejected by judge

In the previous update we wrote about 1.600 physiotherapists taking the healthcare insurance companies to court to increase tariffs by 45%. The physiotherapists had chosen to force the hand of the insurance companies by asking for an interim relief proceeding due to the urgency of the situation. Unfortunately for the physiotherapists, the judge did not agree that the situation was urgent. This conclusion was based on a) while the physiotherapists claim that the tariffs paid by the insurance companies have been too low for twenty years they are only now going to court, and b) the recent report by the NZA (Dutch Healthcare Authority) that the physiotherapy sector is functioning well.

The healthcare insurance companies are happy with the court decision. The lawyer for the physiotherapy sector says that the decision is likely to be appealed and that the judge did not provide a ruling on the specific claims but rather refused to review the case due to what he felt was low urgency. It seems quite unlikely that the sector will win the battle for 45% rise in tariffs, but the continuing pressure on the insurance companies might lead to marginally better tariffs in ongoing negotiations for 2027 tariffs. We will keep you updated.

Government is considering maximizing dividend payments

The current Dutch (minority) government has promised to reduce healthcare expenditure by €10 billion. Ten billion euros also happens to be a much-used number for fraud in the Dutch healthcare system. Given the assumption that all fraud in the healthcare system is carried out by commercial operators organized as limited companies that pay dividends to their owners the Minister responsible for long-term care believes that fraud can be eliminated and saving targets achieved by making it less attractive for private investors to finance healthcare companies. The government has therefore recently announced that it wants to limit dividend payments to a certain percentage of investments. The exact percentage still needs to be determined, as (I assume) the calculation methodology. The resulting changes to laws will also need to  gain a majority vote in Parliament.

Low quality care and potentially fraud by companies run by the so-called “healthcare cowboys” is definitely a problem and the new laws (WTZa) and WIBz) making it more difficult for “fly-by-night” operators to set up companies providing healthcare and take money out of any such company are good additions to the regulatory environment. However, the new suggestion to also limit the actual dividend payments is based on weak assumptions and is unlikely to fit within Dutch and EU commercial law:

• The €10 billion fraud assumption is based on one statement in a 2024 article and is literally based on the assumption that 10% of spending is fraud. Numerous other analyses have come out with much lower numbers (ranging from numbers in the millions to 3-5% of spend. Even the Minister has backtracked and now says that the number can be between 1-10% and includes “mistakes and fraud”
• I am not a lawyer, but would be very surprised if such limitations on the rights of owners would fit within the current legal framework.

This is a statement / plan that is likely to disappear in the summer heat, but we will continue to follow up on it.

Nursing home operators make losses on operations

BDO has recently released their benchmark on the financial situation of Dutch long-term care providers. Overall results for nursing providers were down 20% from the previous year and ROS decreased from 3.5% to 2.7%. The lower financial results are mainly caused by the movement of care to a home situation and increased vacancy rates in nursing homes. Staffing costs are high due to factors such as high wages, use of temporary staff and high absenteeism due to illness. The report highlights that further tariff reductions can be expected and the sector needs to prepare by improving use of technology.

The report also highlights that the numbers are worse than they appear. Most traditional non-profit operators are financed used ZIN, where the operators get paid a fixed fee per client by the government to cover real estate related costs. When the real estate of an operator is fairly old and depreciated these fees are a major contributor to the profitability of the operator. In fact, many of these operators make a loss on the health care services that is balanced by large profits on the real estate financing. This is unhealthy in itself, but when combined with low depreciation of and low investments in real estate results in unattractive locations leading to higher vacancies. In addition the old locations are often not organized in the most logical way and are often energy-inefficient, which leads to higher costs and a less attractive working environment for staff.

Government increases financing of senior living

Senior living is a thriving sub-sector in many European countries. However, in the Netherlands it is struggling to make much of an impact. This is strange, because it is definitely a movement that is required. The growing elderly population is looking for alternatives that are safer and more comfortable than their current residences. Often elderly people live in houses that are too big for their needs and if they could move it would help solve the Dutch housing crises. The development of senior living solutions is blocked by many factors including lack of attractive locations, long processes related to building permits, complexities related to the coordinated provision of real estate and healthcare services, etc.

A key problem is how to make the development of affordable senior living complexes attractive for developers. Building such complexes entail extra costs related to making all rooms barrier-free, increased space in bathrooms, communal spaces, etc. The government has set a target to get 170.000 senior living homes built in the next few years and has now set aside €420 million to help developers cover the extra cost and keep the senior housing affordable.

This is good news for the elderly seeking a safe and comfortable environment and for developers and service providers interested in this sector. Hopefully, the extra financing will lead to stronger growth.