Update 20 December 2022

As I am writing this, we are having freezing weather here in the Netherlands and there is even some snow on the ground. Unfortunately, it is unlikely that it will remain until Christmas. Everybody seems to be busy setting up Christmas trees and buying gifts so work-related activities are starting to slow down. However, there is still news to report from the Dutch healthcare sector:

• Waiting lists for clients requiring nursing home care have doubled in 2022. How does this fit with government plans not to finance additional nursing home capacity?
• It is that time of the year again. Why does the Dutch system lead to waiting lists at the end of each year?
• Hospital merger to take finally take place. Is a hospital still a hospital if all complex care is removed?
• In our snapshot we give an overview of a niche in the Dutch dental care market

Waiting lists for nursing homes double in 2022

The number of elderly clients on waiting lists for acute nursing home care in the Netherlands has almost doubled from 2.762 in January to 4.737 in November. These are clients with severe dementia and/or complex physical issues that cannot safely remain in their current setting and requiring immediate access to nursing home care. According to the lists published by Zorginstituut Nederland some of the clients have been on the waiting lists for more than six months.

The Minister of Health (Conny Helder) claims to be “worried” by these numbers but as reported earlier, she has said that the Government will stop financing the development of new nursing homes. How does the Minister then expect this growing problem to be solved? The answer is that the Government statement has to be read as the government stopping the financing of the real estate component of nursing home care. As a consequence, any new capacity built to meet the growing need for the provision of complex care to the elderly must be met by new locations where clients pay for their own accommodations and healthcare is covered by VPT-financing.  This is likely to be a challenge for the traditional providers of elderly care who are used to getting real estate costs financed by the government but give new opportunities for the new commercial operators who already use VPT-financing.

Patient stop at BuurtzorgT due to annual contracts with revenue ceilings

BuurtzorgT is a sister company to Buurtzorg providing outpatient mental healthcare with self-managing local teams. BuurtzorgT has recently announced that they will not accept any new patients from Zilveren Kruis (one of the largest healthcare insurance companies). The reason for this is that BuurtzorgT has reached the revenue ceiling of their contract with Zilveren Kruis.

There are currently long waiting lists for patients requiring mental healthcare and BuurtzorgT claims to have capacity to serve these patients, but Zilveren Kruis refuses to increase the ceiling stipulated in the contract with BuurtzorgT. In this situation, if BuurtzorgT starts providing care to a new patient insured by Zilveren Kruis it is very probable that it will not get paid for the services provided.

Operators refusing new clients from one or more insurance companies is something that happens every year here in the Netherlands. This is due to a combination of annual contracts between operators and insurance companies and contracts covering a wide range of services but with an overall revenue ceiling. There is an ongoing move towards multi-year contracts and the Government programs to contain increasing healthcare costs (IZA and WOZO) both include multi-years contracts as one of the suggested tools. Hopefully, this issue will disappear soon.

Hospital merger confirmed

Two years ago we reported that a planned merger between three hospitals in the western part of the country was being called off after a process lasting seven years. The process of stopping the merger has also been complex and time-consuming. The final outcome (after a court-case) is that the Reinier de Graaf hospital in Delft will leave the merged entity, but that the two other hospitals (Haga in The Hague and Langeland in Zoetermeer) will definitely merge.

The Langeland hospital was always the weakest partner in the merger discussions as it had (and has) a weak financial position and requires large investments in its key location. In the new deal the combined hospital will be called the Haga Hospital and all complex activities will be concentrated in the location in The Hague (the current location of the Haga hospital). The only remaining activities in Zoetermeer will be standard care.

There are too many hospitals in the Netherlands and many smaller regional hospitals are having a tough time due to challenges related to:

• Healthcare insurance companies requiring minimum annual number for complex operations (essentially concentrating these in larger hospitals) thereby reducing revenues
• Plannable care increasing taking place in specialized clinics
• Activities related to chronic care being moved to a home setting
• Increased costs due to high energy bills and higher personnel-related costs

The planned merger between Haga and Langeland is certainly one way to reduce the number of hospitals.

Snapshot of the provision of dental care for clients in a nursing home

Typically a snapshot looks at one specific company or organization. This snapshot looks at a specific niche of the Dutch dentistry market, namely dental care for clients in a nursing home (or other locations where long-term care is provided).

Dental care is an important, but often overlooked, aspect of healthcare for the elderly. Bad dental health leads to issues such as diminished social contacts (due to bad breath), infections that can spread to other parts of the body, pain, and lowered appetite that can lead to undernourishment. Seventy-five percent of new clients entering Dutch nursing homes have untreated dental issues. To optimally address this aspect of care Dutch nursing homes have agreed guidelines for dental care but specific analysis at locations show that these are often not followed.

Nursing homes (and other types of locations) can follow different strategies for providing dental care to clients:

• Own service provision: this is usually only possible for large organizations
• Mixed practice: standard / daily activities are conducted by own staff while specialized activities are outsourced. Typically this will be to a local dentist and involve transport to and from the dentist office
• Outsourced: most or all activities related to dental health are conducted by a third party

Several Dutch companies have specialized in providing outsourced dental services to nursing homes and other long-term care locations. The largest of these is MondZorgPlus. The company was established in 2006 and currently has more than ninety employees providing dental care to 10.000 clients in 110 locations. MondZorgPlus is part of European Dental Group.

Another large player in this niche market is NoviaCura. The business concept is to provide dental care on location with mobile vans / trucks. Each vehicle has a complete self-sufficient dental office and are wheelchair accessible. Another company, Vitaaldent provides on-location dental care to nursing homes, locations for disabled care and locations providing psychiatric care. Vitaaldent has a wide range of employees ranging from dentists to assistants and provides a mixture of daily and specialized activities.