Update 6 May 2025
We enjoyed the fantastic weather last week, and I hope that you have had the same. Even with beautiful weather there is still news to report. In this update we cover:
- Physiotherapy will not be moved to basic healthcare insurance. What are the consequences?
- Arts en Zorg gets contract with national police, but also faces headwinds. What is the good news / bad news?
- “M&A flood” expected in the Dutch healthcare sector after decision to close ACM department. Is this realistic?
Physiotherapy will not be moved to basic insurance package
The Netherlands has a system of compulsory healthcare insurance for everyone. This covers almost all cure-related medical activities except dental healthcare and physiotherapy. People can voluntarily purchase an additional insurance that typically always includes coverage of these two services as well. The physiotherapy sector is struggling financially, and in the November update we wrote about the sector requesting the Dutch Healthcare Authorities (NZA) to determine minimum tariffs for the sector.
Parallel to this process the Zorginstituut (National Healthcare Institute, responsible for determining the coverage of the compulsory basic insurance package), has been analyzing whether physiotherapy should become part of the basic insurance package. They have decided NOT to change the current situation. The main reasons given are that the sector does not have a common quality framework and that the care provided is often not in line with the state of scientific evidence regarding outcomes and effects. The Zorginstituut does suggest that use of physiotherapy within the basic insurance package can be increased by improving regional cooperation and providing physiotherapy as part of a multidisciplinary process, increasing use of physiotherapy for indications where physiotherapy is proven to reduce use of acute care, and intensifying the use of physiotherapy with a focus on enabling the elderly to live independently.
The sector is disappointed and claims that a continuation of the current situation will increase the divide between those who are able to afford additional insurance and the poor. The current government also wants more physiotherapy-related activities to be moved to the basic insurance, so it will be interesting to see what follow-up steps are taken. In addition, the first results of the NZA study looking into minimum tariffs are expected later this summer.
Arts en Zorg gets contract with national police, but….
In October 2023 we published a snapshot of Arts en Zorg, describing its dual business strategy. On the one hand it is a highly successful provider of primary healthcare with more than twenty locations across the Netherlands and a contact center and outline app providing 24/7 online care to patients. The second line of business is providing primary care to specific populations such as asylum seekers, military personnel, and prisoners in certain jails.
It was recently announced that Arts en Zorg has recently won a country-wide contract with the national police to provide medical care for prisoners. Unfortunately, the police have decided to review its decision process after news emerged that an Arts en Zorg subsidiary (GZA) has had difficulties in providing adequate care to asylum seekers.
Unlike almost all the other commercial chains providing primary care, there have never been complaints about the level of service provided by Arts en Zorg. It will be interesting to see whether the police believe that the company can provide adequate care for its prisoners.
“M&A flood” expected in healthcare sector
In our previous update we described how the Dutch Authority for Consumers and Markets (ACM) has decided to scale back it scrutiny of M&A deals in the healthcare sector. The ACM decision was big news, with several parties claiming that this would lead to an “uncontrolled” growth in M&A that would have negative consequences for the sector and patients. Zorgvisie (a magazine focusing on the Dutch healthcare sector) ran a poll among its readers to understand whether they think that the reduced focus is positive or negative. Views were split 50/50. It is interesting to see that all comments, both positive and negative, were focused on the consequences for the traditional non-profit operators and that none of the commentators have any thoughts, positive or negative, on what this could mean for commercial providers.
We believe that it will be easier to carry out M&A activities in the healthcare sector, but that there will not be an “M&A flood” firstly because there probably is not any pent-up demand for more mergers / acquisitions and , secondly because the ACM is not stopping its watch-dog role for the healthcare sector, but bringing it back to a level comparable to that of other sectors.