Apr24

Update 24 April 2025

Update 24 April 2025

It has been fairly quiet on the healthcare front these last few weeks due to Easter, public holidays, and school vacations. However, there is still news to report. In this update we cover:

  • Acquisition in the cosmetic treatments sector. Can more consolidation be expected?
  • Government proposals to improve disability insurance meets resistance. What are the most likely outcomes?
  • Acquisition in the maternity care sector. Who is the entrant in the sector?
  • The Dutch Authority for Consumers and Markets to reduce its supervision of the healthcare sector. What are the likely consequences?

Acquisitions in the cosmetic treatments sector

The Dutch sector for cosmetic treatments is growing, and the sector is in a process of consolidation. Cosmetique Totale is one of the largest Dutch companies active in the sector. In recent years, it has made acquisitions both in the Dutch market and internationally (Belgium, Germany, and France). In one day in 2024 it announced three acquisitions in three different countries. Cosmetique Totale is clearly following a buy-and-build strategy, and is expected to grow further through more acquisitions.

Another Dutch operator in this sector is De Huiskliniek. De Huiskliniek was established in 2003 and currently has seventeen locations across the country. Its service portfolio includes hair transplantation, injectables, and light- and laser therapy. De Huidkliniek has recently acquired CoolSculpting, a company specializing in a technology that is an alternative to liposuction, where fat cells are frozen and removed by the body itself. De Huidkliniek will close the current locations of CoolSculpting and move equipment, and staff to existing De Huiskliniek locations.

Given that all the services provided are paid out-of-pocket the ongoing economic uncertainty might put a dent in patients’ ability and willingness to pay, but long-term growth in the market can be expected and we are likely to see more consolidation. De Huiskliniek is owned by two local private equity companies (Amazing Whale Ventures and 5square). Will they be buyers or sellers?

Government proposals to improve the disability insurance system meet resistance.

In our update in February we described that the government had not chosen for radical change to the system for long-term work-related disabilities but had rather chosen an approach based on incremental changes to the current system. Since then there have been scandals related to the Employee Insurance Agency (UWV) paying clients incorrect amounts and a growing level of arguments against the changes suggested by the government.

While the unions agree with several of the suggested changes (reducing the level of incapacitation required for getting payments from 35% to 25%, etc.) they also see the suggested changes as a vehicle for reducing the overall payments to work incapacitated people and thus reducing costs for the government. The insurance companies that provide medium-sized employers with own-risk coverage as an alternative to payments to the UWV, claim that the suggested changes will make their business model untenable. Apparently, several companies providing such coverage are thinking about leaving the market. Finally, employers fear that the new system will increase their costs.

Changing a complex system would never be easy and probably making incremental changes to an existing system where all parties have their favorites is probably even more complex. Both the OCTAS report and the recent chaos at the UWV both highlight the need for change, so hopefully a way forward will be found.

Acquisition in the maternity care sector

Maternity care has not been the most attractive sub-sector in the Dutch healthcare market. It has therefore not been the most favorite hunting ground for investors (Private equity owned companies in the sub-sector have a total of €70 million in annual revenues). It is therefore interesting that Morefield Group has recently acquired Naviva. Morefield Group is a stock exchange listed company with investments in various companies with links to healthcare such as Kersten Group (a supplier of medical devices). Naviva is a large supplier of maternity care with more than 1.300 healthcare employees. Naviva was until recently a subsidiary of Zorg van de Zaak, that appears to be focusing on its occupational healthcare related activities. It will be interesting to see whether Morefield will make further acquisitions in the maternity care sector.

The Dutch Authority for Consumers and Markets pulls back from healthcare sector

The Dutch Authority for Consumers and Markets (ACM) has a broad range of responsibilities with a focus on the interest of consumers. As a consequence mergers and acquisitions above a certain threshold have to be acceptable to the ACM. Since 2015, the ACM has been paying special attention to the healthcare sector and has taken over a number of tasks from the Dutch Healthcare Authority (NZA). In the last few years the ACM has been fairly aggressive in denying various acquisitions in the healthcare sector. In some of these cases, courts have rebuffed the ACM decisions.

The ACM activities focused on healthcare have been conducted by the Directorate Healthcare with 34 FTEs. This team has been financed by a special subsidy. The government has recently announced that this subsidy will be stopped at the end of 2027. The ACM has therefore decided to reduce its activities in the healthcare sector “to a normal level” (i.e., similar to that of other sectors). The special team will gradually be disbanded in the coming years. While oversight of M&A activities in the healthcare sector is needed, this is probably good news for the sector. The increased ACM activities have definitely slowed down the consolidation needed in some sub-sectors, and increased the uncertainty related to individual deals (especially when ACM rulings are reversed through court cases.