Jan28

Update 28 January 2025

Update 28 January 2025

January is almost at its end and those of us doing Dry January are looking forward to the first beer (IPA I think) in a month. As always there is news to report from the Dutch healthcare sector.

  • Continuing consolidation of the physiotherapy sector. Who will be the next target?
  • Many patients have long waits before getting an appointment with their GPs. Can this be improved?
  • The Ministry has chosen three key suppliers of patient portal solutions. What will happen to the other providers?
  • Overview of promising Dutch healthcare start-up - MyTomorrows, a company helping patients and physicians find and access clinical trials.

Continuing consolidation of the physiotherapy sector

In November we wrote about the growing role of physiotherapy services in reducing use of other, more expensive healthcare services, but that the sector is facing an exodus of physiotherapists due to low tariffs and low salaries. In reply, the sector has asked the Government to set minimum tariffs for key services. These issues, however, have not stopped investments in the sector by private equity and an ongoing consolidation process.

The latest example of consolidation is the acquisition of Fysiomed by TopzorgGroep. TopzorgGroep is a country-wide chain with more than one hundred locations and four hundred employees. The company provides a broad range of services in addition to traditional physiotherapy including psychological assistance, diet and lifestyle programs and rehab services. It has grown through a large number of smaller acquisitions, and had €45 million in revenues in 2023. The group has plans to grow to more than two hundred locations in the coming years. The target, Fysiomed, is a specialized provider of physiological advice to (professional) athletes (including the Dutch national football team) and physiotherapy for patients with chronic illnesses.

The physiotherapy sector is in an early stage of consolidation. The sector has attractive growth opportunities due to demographics and the ongoing move to less invasive (and cheaper) medical treatments. The NZA (Dutch Healthcare Opportunity) is analyzing the need for minimum tariff’s, which would improve the negotiation position of the sector vis a vis the insurance companies. All this indicates that the attractiveness of the sector is likely to grow and that we will see more investments and consolidations.

Long waits for patients to get GP appointments

A few months ago we wrote extensively about Co-Med and the overall issues facing Dutch primary care. The target for getting a GP-appointment in the Netherlands for a non-critical issue is two days, with three days being acceptable if it a very busy time for the primary-care clinic. A recent survey of more than 8.000 Dutch adults shows that only half of the population is able to get an appointment within the three-day target, another 20% within 3-5 days and almost 10% having to wait up to two weeks.

While probably is not bad compared to the situation in other countries, it does highlight the challenges that Dutch primary care is facing. Foremost among these are growing shortages of primary care staff (especially in rural areas) and a slow move towards digital care. This is due to the low acceptance of digital solutions from both professional staff and patients. Luckily, there are interesting and successful companies working on developing such care such as Buurtdocters and Arts en Zorg.

The government chooses three key suppliers for patient portal solutions

As part of its ongoing process to improve the provision of healthcare through increased digitalization, the Dutch government tried to implement a national Electronic Patient Record (EPR) in 2015. This failed due to privacy concerns. Instead, the government has developed a system of Personal Health Portals (in Dutch PGO) that would enable patients to access all their health records in one system and enable patients on a per-case basis to give healthcare providers access to these records. Development of the PGOs was left to the market and more than thirteen companies have developed solutions. However, the systems have not been successful with an overall uptake of around 1% of the population. Kery reasons for this include:

  • The large number of providers (often small start-ups)
  • Weak business case for providers due to low fees paid (€7,50 per year per active user) and small number of users
  • Limited use case for patients. As part of a project I signed up to a PGO but it was very unclear what the actual value to me as a user was
  • Limited use case for healthcare providers, as there are other solutions to get access to patient data directly from other healthcare providers (see ZorgDomein and CumuluZ)

The government has not given up on the idea of PGOs, but has decided to develop a central register for all the required data within the Ministry of Health and contract three providers (Topicus, Curavista, and Health Cloud Initiative) to develop the required functionalities and patient-facing interfaces. The Ministry claims that this will not have any effect on the current providers of PGOs but one has already decided to stop its activities. It is also difficult to see how this decision can help the other providers to get a positive business case. It would also not be surprising if the idea of a central register awakens privacy concerns.

 

Overview of promising Dutch healthcare start-up - MyTomorrows

In 2012 MyTomorrows was started by Ronald Brus, MD, after a frustrating process to find a treatment in development for his father who was suffering from an aggressive form of lung cancer. Based on this experience, he decided to develop an easier and faster way for patients to access treatments in development. Since then, MyTomorrows has helped more than 14.000 patients access treatments, and developed a community of more than 2.100 healthcare professionals and 50+ BioPharma partners.

The services are free for patients and doctors. MyTomorrows’ business case is based on payments from BioPharma companies who pay for access to difficult-to-find patients for clinical trials and assistance in developing and executing Expanded Access Programs. MyTomorrows is headquartered in Amsterdam and has a New York office. The company has approximately 80 employees.