Update 21 April 2026

Spring is in the air, and I am just back from a great weekend in Lyon and the Rhone Valley with friends from university. Now it is back to work and checking out what is news in the Dutch healthcare sector. In this update we cover:

• Private equity winning terrain in the Dutch healthcare market. What is happening?
• New laws and rules are coming into effect. What are the main consequences for commercial providers?
• Length of stay in nursing homes has decreased. What are consequences for capacity utilization?

Private equity winning terrain in Dutch healthcare market

The Dutch Healthcare Authorities (NZA) have the duty to assess all mergers and acquisitions in the healthcare sector if at least one of the parties has more than fifty healthcare providing employees. Each year the NZA provides an overview of the cases they have analyzed (see here for the analysis for 2024). The NZA has recently published an analysis of the cases it has evaluated in 2025. While the remit of the NZA does not cover acquisitions where both parties (buyer and seller) are small, the NZA does see the vast majority of M&A activity in the healthcare sector.

Key findings from the report include:

• The number of mergers and acquisitions in the sector has grown almost every year since 2020. In 2025 there were 220 cases compared to 214 in 2024
• Dental care is the sector with the most acquisitions. In 2025 almost 30% of the cases were related to dental care
• Almost all the acquisitions involve larger organizations acquiring smaller operators. Key reasons for the acquisitions are economies of scale. For the acquired companies, the key reason is often ensuring continuation of the provider. Often these sellers are dentists or pharmacists going into retirement
• 30% of all acquisitions were carried out by international parties. This is an increase from 24% in 2024
• Private equity played a significant role in the ongoing consolidation process. In 54% of the cases private equity was involved. This is 54% of all cases, compared to 46% in 2024. The sectors where private equity is active include dental care, eye and hearing care, and physiotherapy

The NZA data highlights the continuing popularity of the Dutch healthcare sector and international and private equity companies. While there are negative noises in Parliament it is clear that investors believe that the Dutch regulatory environment is safe and stable and the overall dynamics of the market are very positive.

Effects of new laws and rules on commercial providers

In earlier updates we have written about the Act on Ethical Business Operations for Healthcare and Youth Care Providers (Wibz). This is a new law that is intended to make it more difficult for operators to transfer money out of the healthcare sector. The law covers a broad range of areas, but one of the key changes to the current situation is strengthening rules related to payment of dividends. Currently operators in certain sectors (including hospitals and specialized clinics) are not allowed to pay dividends. As described in previous updates there is an ongoing debate regarding whether these rules should be tightened or relaxed.

The Wibz does not concern itself with this discussion, but will limit the freedom of healthcare providers to pay dividends and other transfers in many other ways. Firstly, the Wibz will prohibit any payments to owners that are “excessive”. This will include exorbitant payments for products or services and interest payments that are higher than relevant market rates. In addition, healthcare providers will not be allowed to buy back shares from owners at prices that will result in profits for the owners.

For providers working in sectors where dividend payments are allowed, the Wibz will put in place conditions for when dividend payments can take place. Key limitations will include:

• Dividends cannot be paid if administrative measures have been taken against the company and/or fines have been levied related to quality or administrative issues related to other laws
• Dividends cannot be paid if the company has not recently (in the last two years) published the results of a client satisfaction survey
• Dividends cannot be paid if it is not reasonable to expect that the company can continue to provide quality care and pay debtors
• Dividends cannot be paid if the company has not had a profit margin above 2% and an EBITDA(R) margin above 4% for the last three years and if certain balance-related ratios are not acceptable after dividend payments

The new rules are clearly intended to make life more difficult for the “healthcare cowboys” and their “smash and grab” strategies for taking money from the Dutch healthcare system. Some of the new rules (limitations on interest payments, etc.) will work against the practices of some private equity companies, but in the main, the new rules should not be onerous for serious owners of serious healthcare providers. The new law is currently being debated in Parliament, and it is unsure when it will be ratified and put into effect.

Length of stay in Dutch nursing homes decreasing

A recent article in ESB (journal covering economic research) has looked at the average length of stay in Dutch nursing homes. The main conclusion is that this has declined from 930 days in 2012 to 853 days in 2022. The main reason for the reduction is that clients typically enter a nursing home older and with more complex healthcare needs than earlier. In the Netherlands, the long-term care that you get (type and intensity) depends on the indication that you receive. The higher the number the more intense the care. The share of clients with an VVT4 indication going to nursing homes has decreased dramatically as these clients now typically receive care at home. The typical length of stay for a client entering with a VVT4 indication is 1.000 days while the typical length of stay for a client entering with a VVT6 indication is 500 days. The article also outlines other factors driving the change including overall demographics, a decrease in the difference of expected length of life between men and women, etc.

The increase in the complexity of care required for clients, the increase in revenues-per-day, and the shorter average stay have large consequences for the optimal strategies for different types of elderly care providers and also for real estate investors focusing on nursing homes. The effects of these changes will be less dramatic for the commercial nursing home providers in the Dutch market as they have more attractive real estate, more experience in providing VPT-financed home care, and more flexibility in adapting to changing needs.