Political debate on private equity in healthcare: what does the Act on Integrity of Business Conduct in Healthcare and Youth Care Governance bring?

At the end of January, Minister Agema (Public Health, Welfare, and Sport) submitted the Act on Integrity of Business Conduct in Healthcare and Youth Care Governance (Wibz) to the Dutch House of Representatives. With this bill, the minister aims to impose stricter financial management requirements on healthcare providers and limit irresponsible financial risks. The goal is to ensure that healthcare funds remain within the sector. Additionally, the bill seeks to address the potential negative consequences of private equity in healthcare—a topic that has sparked much debate in recent years. In this blog, our colleagues Door van Leeuwen Boomkamp and Daan de Haas analyze the contents of the bill and its potential impact on private equity in healthcare.

“Healthcare providers that are solely focused on profit have no place in the sector.”

This was the response of former Minister Kuipers (Healthcare) to the increasing attention on private equity’s role in healthcare. After Dutch magazine De Groene Amsterdammer highlighted private investors’ profit-driven models in 2023, MP Hijink (Socialist Party) raised critical parliamentary questions. In 2024, the bankruptcy of the commercial general practitioner chain Co-Med—although not funded by private equity—kept the political debate alive. That same year, Parliament passed several motions calling for a total ban on private equity in healthcare.

However, former Minister Helder (Healthcare) opposed such a ban, though she did announce several measures in 2024. Interestingly, current Minister Agema (Healthcare) follows this approach, despite having been a fierce opponent of private equity in healthcare as an MP. In her new role, she acknowledges certain benefits, such as joint procurement of diagnostic equipment. Moreover, a total ban proved legally unfeasible. This stance led to a debate during the 2025 Ministry of Health budget discussions with PVV MP René Claassen, who continues to push for a ban. Minister Agema referred to the upcoming bill and left the decision to Parliament: how far does the House want to go in regulating private equity in healthcare?

Two of the five measures in the Wibz specifically target the potential negative effects of private equity in healthcare. The bill strengthens the existing ban on profit distribution and introduces new conditions for permitted distributions. Additionally, it establishes that healthcare providers must not take irresponsible financial risks when raising or repaying capital.

Profit distribution ban: stricter conditions and broader scope

The Wibz further restricts profit distribution in healthcare, particularly in intramural care sectors such as hospitals, mental health care, and long-term care. The ban on profit distribution will move from the Healthcare Institutions Admission Act (WTZi) to the Healthcare Market Regulation Act (Wmg), consolidating all healthcare pricing regulations in one place. This prevents providers from indirectly distributing profits, for example, by charging excessive fees for loans or services.

Furthermore, the definition of profit distribution is expanded to include excessive payments for services, goodwill, and share buybacks. However, healthcare institutions may still transfer profits in the form of donations to other non-profit healthcare providers. The government is also exploring the possibility of extending the ban to subcontractors, which would have a broader impact.

Risk management with an open-ended approach

The second key measure in the Wibz prohibits healthcare providers from taking irresponsible risks when raising or repaying debt or equity. The principle is straightforward: foreseeable risks that threaten healthcare continuity or quality are not allowed. Examples include taking out large loans without considering potential revenue declines. Healthcare providers are expected to conduct a risk analysis. However, the explanatory memorandum to the bill does not specify concrete requirements for how this analysis should be substantiated. Annual financial statements and decision-making documents are deemed sufficient. This raises the question: how effective will this measure be in practice?

Will parliament tighten the rules further?

The proposed measures could be further tightened, potentially making private equity investments in healthcare less attractive or even unfeasible. Since the Wibz currently lacks concrete requirements for the mandatory risk analysis, Parliament may push for more clarity. Minister Agema has stated that the House will determine the extent of these regulations, but the legal feasibility of an outright ban remains a key issue. At the end of last year, Agema promised a letter outlining the legal and financial implications, which Parliament is still awaiting.

The bill and the parliamentary response could sharpen coalition dynamics. The PVV strongly supports a total ban, while the VVD opposes it, with BBB and NSC increasingly siding with the VVD. On paper, there is a majority in favor of a ban, but whether that majority will hold when faced with a concrete proposal remains uncertain.

Conclusion

The coming year will determine whether there is sufficient political will to push through stricter regulations and whether the legal obstacles can be overcome. Public Matters supports various organizations in analyzing the bill’s impact and repositioning themselves in response to the Wibz and the broader societal debate on healthcare financing. Now that the bill is under discussion in the House of Representatives, numerous opportunities arise for organizations to make their voices heard. Given the urgency of this issue and the challenges facing the healthcare sector, many stakeholders are expected to engage with Parliament in the coming months.