Update 29 June 2019

Update 29 June 2019

I hope that you and your family are doing well. After a slow start, corona-vaccination here in the Netherlands has picked up speed. I will get my second shot next week and even my daughters (1995 and 1997)  now have appointments for their first shots. I hope that the situation is also positive in your country.

In this update we cover:

  • Trend towards multi-year contracts continue. Is this good news for commercial providers of mental healthcare services?
  • Thomashuis opens first location in Belgium. Will other countries follow?
  • New law for registration of healthcare companies will be active as of 1 January 2022. What are the consequences?
  • In our snapshot we give an overview of FYEO an ophthalmologist chain

Multi-year contract signed with traditional mental healthcare provider

Pro Persona is a large traditional (non-profit) provider of a broad range of mental healthcare services active in the eastern part the Netherlands. As is the case for most of the large Dutch traditional operators, it is the end-result of numerous mergers between smaller organizations.

Instead of the usual one-year contracts, Pro Persona has recently signed a three-year contract with Menzis (one of the large Dutch healthcare insurance companies). As part of this contract Pro Persona has agreed to reduce waiting lists for the treatment of depression and anxiety to a maximum of eight weeks and to also reduce the time before start of treatment for clients with more complex issues. Another key part of the new contract is that Pro Persons agrees to work more closely with other parties such as municipalities, general practitioners, and providers of social services. Pro Persona also commits to passing clients on to other providers when it is not able to directly provide the required care itself.

Menzis clearly sees a growing need for mental healthcare in the Netherlands. As opposed to the long-term contracts made with general hospitals, this contract does not specify any reductions in volumes or revenues. The agreement to pass on clients when these cannot be served in a timely manner clearly puts pressure on Pro Persona to improve its own processes in order to increase the number of clients served. This agreement should also be of interest to the commercial mental healthcare providers as these typically claim not to have any waiting lists. A possible development is similar to what we have seen with hospitals and specialty clinics where the commercial providers focus on the plannable care while the traditional providers focus on more complex care.


Thomashuis expands to Belgium

Thomashuis is a highly successful  franchise organization providing disabled care in a home-setting. It is part of De Drie Notenboomen, which also owns De Herbergier (franchise organization with small-scale nursing homes). There are currently 118 Thomashuis locations in the Netherlands. There have been talks for many years about expanding the concept internationally, but this has proven difficult due the concept’s dependence on specific Dutch rules for financing long-term care.

Talks about opening a Thomashuis location in Belgium started in 2207, and the building of a location started 1.5 years ago. Finally, earlier this month the first location in Belgium has been opened. The key driver for this has  the introduction of a system of personal financing in the Belgian system for long-term care. The plan is to open a total of twenty Thomashuis locations in Belgium.

New law for healthcare organizations to be activated as of January 2021

In the update of 15 October 2019 we gave an overview of new laws and regulations to be put in place to enable improved control and oversight of companies providing healthcare services. One of the laws mentioned was “Wet Toetreden Zorgaanbieders” (WTZA) (Registration of Healthcare Providers Law) which is a replacement of an old law (WTZI). This law is expected to be active as of January 2022. The new law will have four main consequences for healthcare operators active in the Dutch market:

  • All operators have a duty to register – In the current law (WTZI) registration is only an obligation for certain types of operators and demands related to registration are quite simple.  According to the new law, all parties providing healthcare related services (regardless of sector or size) must register.
  • Most operators must be licensed – In the new law all providers of healthcare services covered by the Long-Term Care law (WLZ) or Healthcare Insurance Law (ZVW)  with more than ten employees must be licensed. Providers only offering services to municipalities (WMO), or youth care are exempted.

    In order to get a license the healthcare provider must comply with a set of rules regarding processes, quality management, financial administration, tariffing and governance.
  • Rules regarding independent oversight are tightened – Every organization providing healthcare services (except very small ones) must have an independent supervisory board consisting of (at least) three people from outside the company.
  • Rules regarding financial reporting will be tightened – As today, operators will be obliged to publish annual reports. In addition, there will be rules regarding the organization of financial management and reporting and the allocation of tasks and responsibilities for financial reporting.

The main goal of the new law is to make it more difficult for “fly-by-night cowboys” to make high profits while providing low quality healthcare services. The new law will probably create extra work in the transition for existing healthcare operators and might entail extra administrative activities, but none of this should be of worry for serious companies committed to a long-term presence in the market.

Snapshot of a private Dutch healthcare operator : FYEO

FYEO (For Your Eyes Only) is a chain of ophthalmology clinics specializing in lens implants. The company was started in 2003 by Paul Holtman  (still active as a board advisor to the company). The company has four locations (including an acquisition in Amsterdam in April 2021), and has a stated goal of developing an international presence (Germany).

Most of the services provided by FYEO are not covered by Dutch healthcare insurance. The company has revenues of less than €12 million and has 40 employees, including 5 surgeons. Since 2018 a Dutch private equity investor (Committed Capital) owns a majority share of the company.