Update 9 June 2026

Welcome back to another update on the Dutch healthcare sector. In this update we cover:

• Increasing vacancy rates in nursing homes. Are new investments in nursing homes required?
• Delivery of healthcare services without a contract to be stopped. How will this work?
• Hospitals are not investing sufficiently. Why is this a problem?
• Large cost reductions are possible in complex home care for the elderly. How is this possible?

Increasing vacancies in nursing homes

In earlier updates we have written about the structural decrease in the average length of stay of clients in Dutch nursing homes. The last few months have seen various elderly care providers reporting increasing vacancies at their nursing home locations and decreased waiting lists. In a recent report, VGZ  (one of the largest Dutch healthcare insurance companies) shows the results of an internal analysis of the situation in the regions where they are responsible for the financing of long-term care.

VGZ is seeing stabilizing numbers of requests for WLZ-indications (needed to get long term care in the Dutch system). In addition, clients are increasingly choosing to receive their complex elderly care in a home setting. VGZ believes that this is made possible by structural changes such as improved technology, more use of social innovation, and a healthier elderly population. This leads to clients either never going to a nursing home, or going at a later stage with more complex problems and a shorter stay. Using new assumptions, VGZ concludes that in many regions where there is currently an expected increase in required nursing home capacity there will in the next few years less capacity required. This will have consequences for ongoing plans for new locations, and VGZ is in active discussions with municipalities and real estate developers.

VGZ has not looked at the overall market, but believes that the situation will be similar in other parts of the country. VGZ also clarifies that the analysis only looks at nursing homes and that there is still a growing need for senior living locations. In addition, the overall stock of nursing homes in the Netherlands is old, and there will definitely be a need for replacement investments.

Delivery of healthcare services without a contract to be stopped 

In previous updates we have written about the overall programs (ASWA, etc.) that are designed to fundamentally change the way that healthcare services are provided in the Netherlands. The current healthcare Minister (Sophie Hermans) feels that progress in these programs is hindered by providers that are not cooperating in improving regional care (focusing on “lighter” forms of care, not taking a fair share of evening and week-end services, etc.). She believes that one tool to improve cooperation is to force all providers to have contracts with healthcare insurance companies.

In the Netherlands healthcare insurance companies are responsible for contracting and purchasing all (with a few exceptions|) healthcare services. However, there are providers who provide uncontracted care as well. Traditionally, patients have the right to freely choose their healthcare provider, and the insurance companies are not allowed to unreasonably hinder this choice. Typically, this translates into patients having to pay non-contracted providers directly and then submitting invoices to the insurance companies and typically maxing payments at 70% of tariffs paid to contracted parties. Non-contracted providers will mostly set their tariffs such that patients do not have out-of-pocket costs.

Not having a contract with insurance companies can be a choice (as it tends to limit growth) but it is also a fact-of-life for new providers as insurance companies will typically not give a provider a contract for the first two years of operations. In addition, most providers will not have contracts with all health care insurance companies as the process to get a contract is a yearly time-consuming process with each individual insurer (four large ones with approximately 80% market share and 5-10 others).

There have been several other attempts to end non-contracted care that have not succeeded. It will be interesting to see how the change is structured (will providers need to have contracts with all insurance companies? Will insurance companies be forced to give contracts immediately to new providers, etc.), and whether courts will allow the reduction in patient rights.

Hospitals are not investing sufficiently

Hospitals have recently had their fair share of bad news due to the  Chipsoft hack. A recent study from Gupta Strategists will probably not make the hospital management teams happier. Gupta has analyzed the financial results of all Dutch hospitals. 2025 was a pretty good year for the hospital sector with an average profit margin of 2.1% and an average EBITDA margin of 7.2%. However, the main focus of the Gupta analysis is that hospitals are structurally investing insufficiently. In the last five years the sector has had a capex-to-depreciation ration of less than one (corrected for inflation) and in most years under 0.8.

Most hospitals have fairly old real estate and also need to make considerable investments in modern technology, AI-based solutions, etc. The hospitals will need to finance any future investments in today’s high interest environment, and this will put more pressure on their low profitability. Will they be able to manage costs, or will the tariffs paid by the insurance companies need to increase?

Large cost reductions possible in complex home care

In the previous update we wrote extensively about VPT financing. VPT financing can be used either to provide clustered care in a setting where the client pays rental costs (and therefore officially lives “at home”) or for nursing-home similar care provided to clients living individually in their own homes. There is growing pressure to move the financing of patients living in their own homes (non-clustered) to MPT. MPT is similar to VPT but is structured  in such a manner that different providers can provide individual parts of the overall service packet. This also means that if one operator provides all services it has to invoice the individual services provided (whereas the provider gets a standard fee for all services with VPT financing).

DSW is one of the smaller healthcare insurance providers and is known for often going its own way. It is very against VPT financing for non-clustered patients because 1) it believes that it leads to very inefficient use of scarce healthcare staff (due to travel time between clients) and 2) the tariffs are too high compared to the care that the patients get. VPT tariffs are set as ZIN-tariffs minus the elements for real estate costs. According to DSW this means that the operators providing non-clustered VPT-financed care get paid for services that they cannot or are not providing. Examples include fast response to alarms, food provisioning, support, and daytime activities, etc.

According to DSW a move to MPT financing will save healthcare insurance companies (and society) €850 million per year. The move to MPT financing for non-clustered complex home care is highly likely  to take place. A key question is how this will be differentiated from VPT-financed care provided in a clustered setting. This is the financing form used by all the commercial nursing home providers in the Dutch market and is also increasing being used by tradition non-profit providers as well.