Starting up in the Healthcare Sector in the Netherlands

Do you want to start a healthcare business in the Netherlands?

Those starting as self-employed healthcare professionals such as physical therapists, dentists, GP’s and medical specialists. If you are starting up a new medical clinic, even if you are not a health professional, this is also worth reading.

There are many things you need to take into account. In this article, we will provide an overview of all the steps you need to take and all the things you need to know. For example, did you know that healthcare professionals in the Netherlands must register with the BIG register? And that there are specific rules and regulations healthcare businesses must comply with? We will cover all of this and more in this article. So if you’re interested in starting a healthcare business in the Netherlands, keep reading!

Why start up in the Dutch Health Sector?

The healthcare sector in the Netherlands is one of the most developed in the world. The Netherlands has successfully implemented a hybrid model with public and private health providers, that are paid partially through taxes and partially through a mandatory private health insurance.

Dutch healthcare is also a very lucrative sector. With a rapidly ageing population with a high life expectancy, there is demand for more healthcare providers in many areas. On top of that, there is demand for smarter solutions to make Dutch healthcare even more efficient and of higher quality.

There are a number of different healthcare businesses in the Netherlands, and the sector is growing rapidly. The Dutch healthcare sector is expected to grow by 2.5% per year until 2020. This makes the Dutch healthcare sector an attractive option to start a new clinic, practice or an other healthcare-related business.

Requirement to work as a self-employed healthcare professional

In the Netherlands clinics are often but not always owned or partially owned and run by health professionals themselves. In order to operate a clinic or practice, you should have a valid residence and work permit:

• If you are from an EU/EEA country or Switzerland, you can freely live, work and set up a business in the Netherlands.
• Are you coming from outside EU/EEA or Switzerland? Then you probably need a work/residence permit in order to live and work here. There are several exceptions and programs that facilitate highly-skilled migrants to come to the Netherlands. For example the EU Blue Card program.

In order to provide healthcare services in the Netherlands, healthcare professionals must comply with the following terms and conditions:

• If you are running a business you should register it at it the Chamber of Commerce. The exact process depends on the type of legal entity (see more information about that below)
• Healthcare professionals must register with the BIG register
• The professional’s diplomas and certificates should be acknowledged by the Dutch authorities
• Healthcare professionals must comply with all relevant rules and regulations in their specific field of practice.
• Healthcare professionals must maintain a high level of quality care
• A professional does not need to speak Dutch to be registered as a healthcare professional in the Netherlands. However, healthcare professionals who want to work at publicly funded hospitals or clinics must be able to provide healthcare services in D

Register your healthcare business

Every self-employed health professional must register at the chamber of commerce (KvK). How exactly you should register your business depends on the type of company you are setting up.

If you are operating mostly on your own, you can either set up a sole proprietorship (‘Eenmanszaak’) or a BV. If you are in business with several professionals or you have a slightly larger business including employees, you should opt for a maatschap or a BV.

If you are planning on working together with other self-employed healthcare professionals, you can arrange that collaboration in various ways. The most common examples are a BV and the maatschap.

Eenmanszaak (sole proprietorship)

There are a number of advantages to using an eenmanszaak or sole proprietorship to start a healthcare business in the Netherlands. First, an eenmanszaak is a very simple and easy to set up. The owner of the eenmanszaak only needs to register with the Dutch Chamber of Commerce and obtain a business number. There are also few administrative requirements for running an eenmanszaak. In addition, there are no healthcare specific tax implications for running an eenmanszaak.

Maatschap (partnership)

The main advantage of the maatschap for medical professionals lies in how it arranges the partners’ liability. Each partner’s personal liability is namely limited to their share of ownership in the business.This is where the maatschap is different than the General Partnership (VOF) where each partner is fully liable for the company’s debt.

Despite the emergence of other forms of enterprise, the partnership is still a popular way for medical specialists to form associations. Traditionally, this type of partnership is the legal form par excellence for practitioners of a profession (e.g. lawyers, notaries, specialists) and the general partnership is the legal form for managers of a business (e.g. a construction company). A partnership is a company without legal personality. A partnership is in fact little more than a set of written agreements to work together: to contribute something together (knowledge, capital, etc.) and then to reap the benefits together. A partnership is sealed by means of a partnership agreement (maatschapsovereenkomst). It is important to note that a partnership agreement is completely free of formalities. The advantage is that you can determine everything yourself. The disadvantage is that it is easy not to be very strict, which can lead to conflicts later on due to gaps or ambiguities in the agreement.

BV – private limited company

When starting a healthcare business in the Netherlands, one of the most common legal structures healthcare professionals will use is the Besloten vennootschap (BV). A BV is a private limited company with shares that is regulated by Dutch law. The advantage of using a BV to start a healthcare business is that it is a very flexible legal structure. The BV can be used for a wide range of activities, including healthcare services.

The process of incorporating a BV in the Netherlands is relatively straightforward. The shareholders of the BV must sign and notarize the articles of association, and then submit them to the Dutch Chamber of Commerce. The Dutch Chamber of Commerce will then register the BV and issue a business number.

The setup costs of a BV are higher than that of a partnership and sole propriertorship but in most cases is cheaper because of the business-friendly Dutch tax regime. For example, Dutch corporate taxes for small- and medium sized business are relatively low:

Healthcare businesses should carefully consider which legal entity is best for them. The most important factor to consider is how much personal liability the owners want to carry. Besides that, you should look carefully at the tax implications of the company type. You can read much more about this in our Guide. Or feel free to request a quote.

Should I register for VAT?

That depends. If your business has a duty to be VAT-registered, you will automatically receive a VAT number within 2 weeks from registration at the chamber of commerce. Most healthcare professionals are exempt from the VAT-registration and therefore do not need a VAT number. Do note, that if you are conducting other activities than treating patients, such as selling health products (besides your practice) you might need to register for VAT.

Fill out the Health Inspection’s Form

A relatively new requirement is that new healthcare providers need to fill out a form. This is to ensure that you are aware of the quality requirements that apply to you as a healthcare provider.

BIG register

Healthcare businesses in the Netherlands are required to comply with a number of specific rules and regulations. One of these is registration with the BIG register, which is mandatory for healthcare professionals in the Netherlands. The BIG register (Beroepen In Gezondheidszorg) is a public registry that contains information about all healthcare professionals in the Netherlands.

Acknowledgement of foreign diplomas and certifications

Foreign healthcare professionals who want to work in the Netherlands must have a diploma or certification that is acknowledged by the Dutch health authorities. There are 3 possibilities:

• Most diplomas obtained in the EU or Norway, Switzerland, Iceland or Liechtenstein receive automatic recognition and direct enroltment in the BIG register.
• In some cases those from EU/EEA or Switzerland need to go through a process to have their certifications recognized. After which BIG registration follows. This makes max. 12 weeks.
• Finally, those who come from outside the EEU/EEA should have valid proof that their qualifications from abroad meet the Dutch standards.

Here you can check which procedure you should follow.

Set your rates

Public healthcare in the Netherlands is free for everyone, regardless of their income or nationality. This means that everyone has access to the same healthcare services, regardless of their financial situation. Private healthcare in the Netherlands can be expensive, and is not always affordable for everyone. To make sure that healthcare stays affordable, the Dutch health authorities have set fixed maximum rates on a number of professions, such as dental surgeons and psychologists. Doctors (General practitioners) have a hybrid model, meaning that some services have a fixed rate while other types of treatment are not regulated.

Draft your General Terms and Conditions

Healthcare businesses in the Netherlands should have general terms and conditions. These set out the rights and obligations of both the healthcare business and the patient. They should include information such as:

– The healthcare business’s contact and business details

– The healthcare services offered by the business, along with a description of each service

– Optionally the rates of healthcare services (either in the terms or referral to website or other document with the rates)

– How to make a complaint

– How to cancel an appointment

– The healthcare business’s refund policy

Take out insurance as a healthcare professional or clinic

There are no specific insurances you are obliged to take out but we strongly recommend every healthcare professional to take out professional indemnity insurance. Other insurances may be required or recommended. There are numerous insurance providers in the Netherlands who can provide you with an offer.

Meet Healthcare Quality Standards

meet certain quality standards to be registered as a zorgverlener with one of the Dutch healthcare insurers. The most important quality standard is that the healthcare professional must be able to provide quality healthcare services. Other quality standards include that the healthcare professional must:

• Have adequate knowledge and skills to provide healthcare services
• Comply with medical ethics
• Maintain professional boundaries
• Comply with privacy laws

Keep patient records

Healthcare professionals in the Netherlands must maintain patient records in accordance with the regulations set by the Dutch healthcare authorities. The healthcare professional must keep a record of all the healthcare services they provide to a patient, as well as any medication the patient is taking. The healthcare professional must also keep a record of any consultations with other healthcare professionals. The healthcare professional must keep these records for at least 20 years.

Be compliant with GDPR

As a health care professional you deal with sensitive personal and medical data. Therefore a healthcare professional must normally comply with GDPR. This means that the healthcare professional must take appropriate steps to protect the personal data of their patients.

The healthcare professional must ensure that all employees who have access to patient data are aware of their obligations under GDPR.

In addition to that, healthcare professionals often consult with other healthcare professionals to get a second opinion, to refer patients to other healthcare professionals, and to receive advice on how to best treat their patients. That communication should be GDPR-proof.

The healthcare professional must also have a data protection policy in place, and must implement appropriate technical and organisational measures to protect the personal data of their patients. Perform our GDPR compliance check to make sure you have the right documents and procedures in place to be fully compliant.

Applying to work at a Dutch healthcare clinic

If you’re interested in finding a job in a private health clinic in the Netherlands, the best place to start is by looking on job websites such as Indeed, Nationale Vacaturebank or LinkedIn. You can also check healthcare-specific job websites

Healthcare professionals who want to work at publicly funded hospitals or clinics must apply through ZonMw’s recruitment website (in Dutch). You can also check CZ’s jobs page or VGZ’s jobs page for job openings.

The healthcare sector in the Netherlands is growing rapidly, so there are often many jobs available. It’s important to make sure your CV is up to date and tailored to the Dutch healthcare market. You should also be prepared to interview in Dutch.

Finding a location for your clinic or medical practice

The easiest place to check out commercial real estate for healthcare practices is Fundainbusiness. Here you find an overview of all properties for sale and rent.

The Dutch healthcare sector is one of the most developed in the world, but it is also highly regulated. That is why it can feel difficult to enter. We can help you navigate your business from start to fully operational. Contact us below if you have any questions or you would like a full quote or talk.

Get in touch for more information