Update 8 September 2026

It is the second week of September, and life is slowly returning to “normal” after weeks of holidays, warm summer days, and kids off from school. Clearly people in the healthcare sector are also back to work, and there is news to report from the Dutch market. In this update we cover:

• Different views on overcapacity in nursing homes. What is the story?
• EY report highlights lower earnings and insufficient investments. Can the structural problems of the Dutch healthcare sector be solved?
• Small physiotherapy providers have improved their financial situation. What does this mean for consolidation of the sector?

Different views on overcapacity in nursing homes

In our update in June we explained how a report from healthcare insurance companies highlighted increasing vacancy-rates in nursing homes. The report believed that this was structural and caused by clients staying longer in a home setting and shorter stays in nursing homes.  However, a recent study by the RIVM (National Institute for Public Health and Environment) shows a situation where occupancy rates in nursing homes  have been stable at approximately 95% during the last few years.

The study does highlight variations on the overall picture. While occupancy rates grew in almost 50% of the nursing homes almost a quarter saw declining occupancy rates. There were no clear regional differences visible nor differences between urban and rural areas. Differences between the nursing homes with increasing or decreasing occupancy rates seem to depend on attributes related to very local situations and specific issues related to the individual nursing home. This can include the overall attractiveness of the location, but also the organization’s ability  to deal with the ongoing change in clients staying longer at home, coming to the nursing home at a later stage in their decline and requiring more intense and complex care.. The study clearly goes against earlier fears related to overcapacity in the sector, but a key weakness is that the study only covers the period up to 2024.

EY report highlights lower earnings and insufficient investments

EY has recently published its Barometer on the Dutch Healthcare Secor 2026. The key point of the analysis is that while the current financial situation of the Dutch healthcare sector looks quite good, a deeper analysis highlights structural issues related to margins and investments. Looking at the overall healthcare sector profitability decreased slightly after having increased for the previous two years. However, due to low investments most balance sheet KPIs are very positive. Investments have been declining for the last few years as a share of revenues, and this is directly translated into the average age of key assets such as real estate.

The sector where these effects have been most visible is elderly care. Average return on sales (ROS) declined by 0.9% points from 2024 to 2025 and this decline was entirely due to lower EBITDA margins caused by higher personnel-related costs. The elderly sector has also been very slow in investing in new, modern real estate. This is not due to balance-sheet limitations as the sector now has a negative net debt to EBITDA ratio (i.e. it can pay its outstanding loans with existing free capital). EY’s hypothesis is that old real estate is a contributing factor to those providers seeing lower capacity utilization.

It is clear that the elderly care sector will need to substantially increase investments in order to meet its ongoing challenges (increased staffing costs, move to home-based services, new technological developments, etc.). However, the EY analysis also shows that increasing investments will lead to decreasing profitability in the next five years.

Improved financial situation for small physiotherapy providers

In the last few months we have written several times about the physiotherapy sector. Much of the news has been negative – In April we wrote about regulators refusing to set minimum tariffs for physiotherapy services and in June we wrote about a judge rejecting the physiotherapists’ demands that fees be increased by 45%. All the bad news seems to have resulted in many small physiotherapists wanting to sell their businesses to the consolidators in the sector (TopZorgGroep, FGN).

A recent analysis from HU University of Applied Sciences presents a more positive picture of the situation facing small physiotherapy providers (solo practitioners or small stand-alone locations). The participants in the panel report growth in revenues, fairly good profitability (with almost 90% of owners able to pay themselves more than minimum salary and 40% earning more than twice the Dutch median income), and a strong wish to both continue their work and innovate.

The panel was not asked about their interest in being acquired, so it is not clear what this means for consolidation in the sector.  Probably the effects are mixed, as the favorable situation makes it less likely that the owners will sell, but probably more likely that the big chains would be interested in acquiring the location.