Apr09

Update 9 April 2026

It was great meeting many of you a few weeks back at the HBI conference in Paris. It was a wonderful start to the conference to meet old friends and make new friends while sipping champagne and enjoying the view of the Eifel Tower. After that, a week vacation in Berlin was also great, but now I am back to the nitty-gritty of the Dutch healthcare sector. In this update we cover:

Growing demand for small scale elderly care, but growth in supply is slowing. What is the issue?
Chipsoft hacked. What are the consequences for Dutch hospitals?
Phitaal acquired by Mentaal Beter. Who are they?
Commercial specialized clinics. What are the facts?
More unwelcome news for physiotherapists. What is happening with the financing of physiotherapy care?

Mismatch supply and demand for small scale elderly care

ABN Amro have recently published a very interesting report (in Dutch) where they look at the Dutch market for extramural elderly care in small locations typically run by commercial operators. The report has collected historical data on the sector and shows how the number of apartments in the sector has increased by a factor-3 in the last 15 years. According to ABN Amro there are currently 715 small-scale locations with a total of 16.000 apartments (an average of 22 apartments per location). The market has consolidated and the top 5 providers now have almost 45% of the market. These are not named in the report but will include Emeis, Clariane (still branded as Korian in the Dutch market), Het Gastenhuis, etc.). The top 20 operators have a total of 11.650 apartments (73% of the total market). The remaining market is divided among small local operators with 2-5 locations and “mom and pop” locations where the owners also provide care.

The report highlights that the need for this type of care will grow by 60% in the next 15 years, requiring an additional 91.000 apartments. Unfortunately, the strong historical growth in elderly care apartments has flattened. This is caused by three reasons:

The Netherlands is a small and overfull country, and it is difficult to find appropriate physical locations
There is uncertainty regarding the financing of this type of care. Clients living in the small-scale locations always pay rental and service costs and are therefore officially seen as living “at home”. Healthcare related services are paid by the government via the care office run by the healthcare insurance companies. The most-used contracting form is VPT, however the Government is working on changing this to a contacting form that is (probably) less attractive for providers
Some care offices (regionally organized) are hesitant in giving contracts to the small-scale providers as they see traditional nursing homes having difficulties filling their capacity

The elderly care market in the Netherlands is in an interesting period of change, where the government is (desperately) searching for manners to limit the growth in healthcare costs. However, there is one constant and that is demographic change leading to a growing elderly population of which a certain part (barring medicines that help control dementia, etc.) will need to be cared for.

Chipsoft hacked

In our last update we wrote about the growing strength of Chipsoft in the Dutch EPD-market and how this is turned into high profitability. Earlier this week it was announced that Chipsoft has been hacked with access to some of its online/SaaS versions of its key software being blocked. Apparently the hack is part of a ransomware attack. Fortunately, it appears that there are limited consequences for hospitals and primary care providers.

Recently there was a ransomware attack on one the leading Dutch telco providers where the ransom was not paid and data on millions of customers was made public. The Chipsoft situation will certainly be seen by the public and the government as (even) more sensitive, and it will be interesting to see the reactions that will come from regulators and other parties.

Phitaal acquired by Mentaal Beter

In our previous update we wrote about Phitaal, a mental healthcare provider focusing on helping patients with psychosomatic issues leading to physical pain, entering receivership. It was recently announced that the company is making a “relaunch” as part of Mentaal Beter and has been rebranded as Mentaal Beter Vitaalpunt. Mentaal Beter is one of the largest commercial providers of outpatient mental healthcare in the Dutch market and is owned by PE-company Seven2 (previously Apax). Phitaal had ten locations, but Mentaal Beter is pruning the geographic scope of the company by not acquiring some of the locations and combining multiple locations in one city into one location. Mentaal Beter is acquiring 200 of the 260 employees of Phitaal and 3500 new clients. According to Mentaal Beter the insurance companies have agreed to the take-over.

Commercial specialized clinics – what are the facts

In the months leading up to the recent elections there has been intense lobbying from the Netherlands Association of Hospitals (NVZ) and Zorgverzekeraars Nederland (the umbrella organization for the Dutch healthcare insurance companies) against commercial specialized clinics. The lobbying has been successful and many of the points raised in the lobby process have become part of the coalition agreement of the new minority government.

Zorgvisie, a magazine focusing on key issues in the Dutch healthcare sector, has recently authored a critical article looking at some of the statements made in the lobbying process.

Growth / market share – The NVZ has claimed that the revenue of the commercial specialized clinics has grown by 70% in the period 2017 – 2021 compared to “only” 15% in the non-commercial hospital sector. Zorgvisie points out that the growth of the specialized clinics has only been 36% and, more importantly, from a much smaller starting point. Revenues from the commercial specialized clinics grew by €500 million in the period 2021 to 2024 while the hospital revenues grew by €3.8 billion in the same period
Non-contracted care – The hospitals claim that the commercial clinics “hollow-out” the healthcare system by providing non-contracted care. As pointed out by Zorgvisie, the large commercial clinic chains typically have multi-year contracts with the major healthcare insurance companies and that there are good reasons for providers to sometimes provide non-contracted care (new innovative companies will typically not get a contract in the first years of operations, etc.). In addition, Zorgvisie points out that non-contracted care is less than 1% of the total medical / hospital care financed by the healthcare insurance companies
Profits and dividend payments – The hospitals claim that the specialized clinics make large profits and pay out high dividends to owners (PE and others). Zorgvisie has looked at the annual reports of the largest commercial specialized clinics and concludes that the average after-tax profit margin is 4.0%. According to an analysis by the Dutch Healthcare Authorities (NZA) providers of specialized medical care (hospitals and clinics) only paid a total of €48 million in dividends in 2024.

It is interesting that Zorgvisie, a magazine mainly written for the established / non-profit part of the Dutch healthcare sector publishes an article in support of the commercial part of the sector. I believe that this can be seen as another sign of growing general acceptance of commercial healthcare providers.

More unwelcome news for physiotherapists

Physiotherapy is becoming an common theme in these updates and often the news has not been positive for the sector (NZA deciding not to set minimum tariffs). The NZA (Dutch Healthcare Authorities) had suggested that physiotherapy for patients with certain chronic afflictions should become part of the basic obligatory insurance package. The new Minister of Health, however, has announced that while this would structurally improve the position of physiotherapists there currently is no room in the overall healthcare budgets for financing such an expansion.