Update 29 October 2024
Welcome back to another update on the Dutch healthcare market. This update covers the following news items:
- Actief Zorg has been sold. Who is the purchaser?
- HBI list of largest European healthcare companies. What is the Dutch presence?
- Zorgdomein is celebrating its 25th What is the role of the company in the Dutch healthcare sector?
- In a snapshot we give an overview of HartKliniek, a chain of clinics specializing in coronary issues
Actief Zorg sold
Actief Zorg is a company that we have often written about during the last few years. Actief is a large provider of home care services with more than 5.000 employees, that has grown strongly through a series of acquisitions. The acquired companies were typically other commercial home care providers with financial issues. It appears that Actief Zorg was not able to turn the acquired companies around quickly enough, and last year it had financial issues of its own. The company claimed that the financial problems were due to higher costs not being covered by the tariffs paid by municipalities and healthcare insurance companies. The solution was to put a sizable portion of the support staff in a separate company and then declare the company bankrupt.
Last week it was announced that Actief Zorg has been acquired by JHB Group. This is a holding company owned by Hans Brus, who made a fortune by selling a telecom company. JHB Group has a social focus and invests in a broad range of companies (catering, building, energy technology) with the goal of providing a “positive impact” to customers and clients. Hopefully, Hans Brus and his “professional staff” will be able to help Actief Zorg provide excellent care to its more than 20.000 clients and become financially sound.
Dutch presence in HBI list of 100 largest European healthcare companies
Typically, Healthcare Business International (HBI) is inspired to write articles based on things we have written about in these updates, this time it is the opposite. Late last week HBI published an overview of the largest (commercial) 100 healthcare providers in the EMEA region. Very interesting to see what the large companies are doing and where they are based.
The Dutch presence is fairly limited with only three companies in the top 100. One of them, Affidea (nr 54 on the list with revenues of €856 million), has no operations in the Netherlands and probably has its central office in the Hague for tax reasons. European Dental Group (nr. 76 on the list with revenues of €660 million) originated as a Dutch company and operates several brands in the country, but is essentially a holding company for Nordic Capital’s dental: investments in Europe. Finally, Bergman Clinics (nr 96 on the list with revenues of €553 million) can be seen as a true Dutch company with an expanding European footprint.
What will be the next Dutch commercial healthcare operator to make it to the list? The Netherlands is with a population of 16 million not a large market, but Sweden, with half the population has five companies on the list, all with major operations in the country. Clearly, truly commercial healthcare is at an earlier stage of development in the Netherlands and most of the existing companies therefore are relatively small. There are many interesting smaller companies that might grow, but they face challenges in the area of negative political views regarding commercial healthcare and the financing of further growth.
ZorgDomein – key activities and responsibilities
ZorgDomein is a healthcare IT company majority owned by Visma (a Norwegian IT group). In early 2021 RaboBank bought the shares of another external investor and is still a shareholder. In 2023 ZorgDomein had revenues of €31 million and made a profit of €7 million. The key activity of ZorgDomein is organizing and conducting communication between different organizations with the healthcare sector. More than 90% of all GPs are connected to ZorgDomein and use its system to pass patients and relevant information on to hospitals and other secondary care providers. In total, more than 8.000 healthcare locations (including all hospitals) are connected to the ZorgDomein communication system.
The company plays a key role in the overall healthcare sector. This was highlighted in recent months when the ZorgDomein system twice had multi-day outages forcing GPs and other users to manually refer patients to each other. Given the key role that the company plays as the only provider of crucial services, discussions have been raised concerning possible nationalization. The company itself claims that it can balance its social and commercial responsibilities, and is working on both reducing the risk of outages and limiting the consequences of outages on its users.
ZorgDomein is an interesting example of how it is possible to develop a strong position in a niche market. ZorgDomein appears to be fully concentrated on the Dutch market, but is expanding its range to include services focusing more on patient needs and improving the ability of secondary care providers to market their services to GPs.
Snapshot of a Dutch commercial healthcare company: HartKliniek
Hartkliniek was started ten years ago by Menno Baars and Chris Hie, both cardiologists. They both had fifteen years of experience in hospitals, and were convinced that cardiology-care could take place both more efficiently and more patient-friendly than was the case in typical hospitals. The chain currently has sixteen clinics.
The focus of HartKliniek is diagnostics and the preliminary phases of treatment. Hartkliniek has excellent relationships with hospitals that forward patients to Hartkliniek as they can typically schedule faster than the hospitals. Hartkliniek does not conduct complex treatments and operations, these patients are referred back to hospitals. Hartkliniek has a different approach, where the doctors typically only see twelve patients per day instead of the forty-eight patients per day typical of standard hospitals. HartKliniek claims that the extra time per patient improves diagnostics, thereby reducing the need for follow-up tests. The doctors do their own echocardiograms instead of scheduling a separate patient visit for this activity. This speeds up the diagnostic process and improves the patient-perceived quality.
The company has separate companies per location and does not provide any consolidated financial information.