Care without a contract: what the Dutch government plans, and what Europe shows

By Maarten Zoomers · October 20, 2026 · 7 min read

In the Netherlands, a patient with an in-kind policy (naturapolis) is currently reimbursed for part of the cost when they go to a care provider that has no contract with their health insurer. This sits in Article 13 of the Health Insurance Act (Zorgverzekeringswet). The government wants to abolish that reimbursement from 1 January 2029. The bill does not exist yet and still has to pass both chambers of parliament.

For a specialist thinking about starting their own clinic, this may be the most important policy question of the next few years. Almost every new clinic starts without a contract. Below I set out what we know: what exactly the government wants, where the proposal stands, how large non-contracted care actually is, and what we see in other European countries.

Where the proposal stands

This is not the first attempt. In 2014 the Senate voted down a similar bill, 33 to 38. In 2024 the then health minister, Agema, withdrew a bill that would have allowed lower reimbursement per sector, because people on lower incomes would lose access. The current coalition of D66, VVD and CDA takes it up again and goes further: not lower reimbursement, but none at all without a contract.

Date	What happens
30 January 2026	Coalition agreement: abolish from 1 January 2029, with a transition period. Insurers must offer a restitution policy (restitutiepolis), which reimburses non-contracted care in full. Expected saving €150 million a year.
24 April 2026	Health ministry policy letter: the bill will follow in the fourth quarter of 2027.
23 June 2026	The House of Representatives rejects a motion to keep the reimbursement, 71 to 78.
12 October 2026	Letter on appropriate care: there will be a transition scheme, and how new providers can still enter the market “is being explored”. Details early 2027.
17 March 2027	Provincial elections, which determine the make-up of the Senate.
Fourth quarter of 2027	Bill to the House of Representatives (planned).
1 January 2029	Intended start.

The government is a minority cabinet, with 66 of 150 seats in the House and 22 of 75 in the Senate. It needs other parties for a majority, and the new Senate elected in 2027 will have the final say.

In the Senate, the government holds 22 of the 38 seats it needsCoalition seats in the current Senate (75 seats)

Senate, 2014abolition rejected

House, 2026motion to keep it rejected

Source: Senate, vote on bill 33 362 (16 December 2014); vote on motion 25 424, no. 792 (23 June 2026). Dark green = votes in the direction of abolition.

I do not think anyone can say with confidence whether, or when, the law will pass. Anyone planning a clinic would do well to take both scenarios seriously.

How big non-contracted care really is

Smaller than the debate suggests. In 2026, a study for the Dutch Healthcare Authority (NZa) set out the facts on medical-specialist care:

Care without a contract is less than 1% of revenueMedical-specialist care, 2024. Each dot is one in a thousand.

Revenue€7 of every €1,0000.7% of €25.6 billion

Patients18 of every 1,0001.8% of 7.4 million

Source: fact base on a level playing field, for the NZa (parliamentary paper 29 689, no. 1330).

0.7% of the €25.6 billion revenue in medical-specialist care was non-contracted in 2024.
1.8% of 7.4 million patients went to a provider without a contract.
Hospitals and academic medical centres are fully contracted. In this sector, non-contracted care is almost entirely a matter of independent treatment centres (ZBCs).
Reimbursement without a contract ranged from 52 to 85% of the academic hospital tariff, the lowest of all tariffs.

On top of that, restitution policies, which reimbursed non-contracted care in full, have been off the market since 2025. The route is already narrower than it was a few years ago.

Supporters of abolition, including hospitals and insurers, argue for a level playing field: hospitals work with contracts, volume caps and quality agreements, and non-contracted providers do not. Insurers also want more control over quality and costs. Opponents point to patient choice and to the role of new providers in a market where waiting times are rising. Both sides have a point.

What we see in Europe

Over the past few months we looked at how twelve European countries handle care outside contracts. The pattern is fairly consistent: where a free route existed, it is narrowing.

Country	What is changing
France	From 1 January 2027, prescriptions by doctors working outside the agreed tariffs (secteur 3) are no longer reimbursed.
Norway	Free choice of treatment at approved private providers was abolished in 2023. Private care is now only funded under contracts awarded through tenders.
Germany	Unchanged: care from a non-approved provider is only reimbursed with prior approval, at no more than the standard tariff.

In tax-funded systems such as Denmark, Sweden and Spain, public money already only flowed through contracts or tenders.

This is about who pays, not about where care happens. On that second point, things move the other way: most countries want more care outside hospitals. Germany introduced a single tariff in 2024 for treatments that can be done without admission, and England plans to move most outpatient care into the community by 2035. Almost everywhere, though, that shift runs through contracts and regional agreements, not through an open route.

What I find more interesting is what some of those countries offer instead. Denmark gives patients the right to treatment at a private clinic if the hospital cannot help within thirty days. Sweden has a statutory waiting-time guarantee. In both cases the money goes to clinics with a regional agreement. The principle differs from the Dutch one: not an open route for any provider, but a right for the patient when regular care falls short.

What it means for specialists

If the law passes as the coalition agreement describes it, a new clinic can no longer start without a contract while its patients are still partly reimbursed. The route to a contract currently takes about three years. Without a separate route for new providers, it would then become virtually impossible for a specialist to start a new clinic, other than by taking over an existing contracted clinic or joining a chain.

The government acknowledges this: how new providers can still enter “is being explored”. My own view is that this will be the most important part of the law. Three things should be well arranged:

A real entry route. A way for a new clinic with a sound plan to get a contract within reasonable time, rather than a three-year track record it cannot build without reimbursement.
A transition that fits practice. Clinics now working without contracts need time to secure one or adapt their model.
A patient right when waiting times are long. The Danish and Swedish approach shows that access to care outside regular provision can be tied to waiting times rather than to the provider’s contract.

For anyone considering a clinic now: I would plan for two scenarios. One where non-contracted care stays reimbursed until at least 2029, and one where you work towards a contract or an acquisition from the start. At Seeve we do the same. If you would like to discuss this further, you can reach me at maarten@seeve.ai.

Frequently asked questions

What does Article 13 of the Dutch Health Insurance Act do? It gives patients with an in-kind policy a right to reimbursement when they use a provider without a contract. Courts have ruled the reimbursement may not be so low that it effectively blocks access.

When does the government want to abolish it? From 1 January 2029, with a transition period. The bill is planned for the fourth quarter of 2027.

Is abolition certain? No. The bill still has to be submitted and pass both chambers. The government holds 22 of 75 seats in the Senate.

How large is non-contracted care in medical-specialist care? 0.7% of revenue and 1.8% of patients in 2024, almost entirely at independent treatment centres.

What do other European countries do? France, Norway and Finland are restricting reimbursement without a contract. Denmark and Sweden link care outside regular provision to a waiting-time guarantee.