Update 28 July 2026

I assume that many of you are on vacation, and I will be on vacation myself the first two weeks of August. However, news from the Dutch healthcare sector does not stop. In this update we cover:

• Breaking news – Implementation of new financing form for complex elderly care delayed until 2029
• Reduced investments in Dutch healthcare real estate. What are the key reasons?
• Private equity acquires commercial nursing home providers. What is the situation?
• Regulatory bodies to receive more power to stop smaller healthcare acquisitions. What will this mean for “buy and build” strategies?

Implementation of new financing form for complex elderly care delayed until 2029

In the Dutch financing system there are three main flavors of financing for complex elderly care:

• ZIN – intended for traditional nursing home care where the operator is paid a daily fee covering healthcare-related services, real estate costs and food, etc. Typically used by traditional, non-profit providers
• VPT – intended for complex elderly care provided in a home setting where the provider is paid a daily fee. Essentially covers all the same services as ZIN, except for real estate costs as clients are assumed to be living at “home”. Financing form used by all commercial nursing home providers as clients pay rental costs and are therefore defined as living “at home”
• MPT - financing form for complex care provided in a home setting where the individual service components are paid per unit delivered giving the client the opportunity to use different providers

The use of VPT has grown strongly in the last few years based both on the growth of commercial nursing home providers and increased use by traditional operators to provide home care services. Provision of home-care services financed by VPT has been very profitable, sometimes due to under-delivery of services. It has therefore been decided that a new financing form should be developed essentially combining VPT and MPT into one payments structure with MPT as the primary model.

This is worrying for both commercial and traditional providers of complex elderly care, as a move to MPT-financing would lead to 30-40% lower tariffs and a dramatic increase in administration. The new financing form is under development, and until recently the plan had been to move financing for new clients to MPT from 2027 and have a new model implemented in 2028. Development is taking longer than expected. Therefore it was announced this week that the implementation of the new (to be developed) financing form has been moved to January 2028.

It is still unclear what this means for contracts in 2027 and 2028. The worst case scenario for commercial nursing home providers will be that new clients will be given the current version of MPT-financing. This will have a slow but sure effect on existing locations as the share of new clients increases and will make the business case for opening new locations very difficult. We will keep you updated.

Reduced investments in Dutch healthcare real estate in 2026

A new report from Capital Value gives interesting insights into the Dutch healthcare real estate market. Investments in Dutch healthcare real estate grew  by a factor-3 in the period 2016 to 2022(from €465 million to €1.5 billion). In 2023 investment volume was reduced by more than 50%, but since then there has been a steady growth from €653 million in 2023 to €867 million in 2025. Ongoing growth in the market is threatened by developments in the first half of 2026.

2026 started with a 23% reduction in investments from the same period in 2025 (from €450 million in 2025 to €347 million in 2026). It is interesting to note that the reduction is not due to lowered interest from investors, but rather issues related to the availability of new projects. There are currently several large investors with a specific focus on Dutch healthcare real estate active in the market (Aedifica / Cofinimmo with a portfolio of €1.2 billion, Bouwinvest with a focused fund with €0.9 billion invested, Amvest Living & Care Fund with investments totaling €0.7 billion, etc.) . International investors were not active in the first six months of 2026, but appear to be coming back into the market.

Private Equity acquires commercial nursing home operator

Het Gastenhuis is a highly successful commercial nursing home provider with thirty-seven locations focusing on elderly clients with dementia in the Dutch market. The company has operated independently with financing of real estate investments by Amvest. There have been rumors on the street that the company was in a sales process and last week it was announced that Gilde Healthcare will acquire the company. Gilde is a Dutch private equity company with a strong focus on healthcare. They were one of the first investors in Dutch commercial elderly care (Stepping Stones, later sold to Clariane), and this investment is a return to the elderly care sector. According to Het Gastenhuis, the new owner will not result in any dramatic new plans. The company will follow its existing plans, with some new locations in development and an ongoing process to open new locations in geographic areas where Het Gastenhuis is currently not present.

The Dutch commercial nursing home sector is facing several challenges (decreasing demand due to clients staying longer at home, uncertainties related to VPT-financing (see previous note), negative sentiments towards commercial healthcare operators, etc.) so it is interesting to see that private equity still believes that the sector is a worthwhile investments area. Het Gastenhuis staying independent is against the overall trend of consolidation in the elderly care sector. It will therefore also be interesting to see how long Gilde keeps Het Gastenhuis in its portfolio and who the next buyer will be.

Regulator to receive more power to stop smaller healthcare investments

The ACM (The Dutch Authority for Consumers and Markets) has the overall responsibility of ensuring that consumer interests are not damaged by mergers and acquisitions. Healthcare is a core area where the ACM is active and it has actively been controlling, and frequently denying healthcare acquisitions. Due to the relatively small size of most providers in the Dutch market, the threshold size for ACM involvement has been lower in the healthcare sector than in the rest of the market. This is in the process of being changed.

A specific challenge for the ACM in the healthcare sector is operators (often PE-owned) that follow a buy-and-build strategy (dental care, primary care, etc.). In these cases the acquired companies are small and do not meet the size thresholds for ACM intervention. However, the longer-term effects of many small acquisitions can give the acquiring company monopolistic powers in certain regions and improved negotiation positions towards the healthcare insurance companies. Changes to the Competition Law are in the process of being implemented and that will give the ACM the opportunity to get involved in such cases.

The new situation will make life more complicated for companies conducting a buy-and-build strategy as many acquisitions that previously did not need ACM approval will need to go through the ACM process. Whether this will result in more acquisitions being blocked will need to be seen, but it will in any case slow down acquisition processes.