Many of the medical specialists I speak with are considering starting their own clinic, often for a few days a week alongside their current role in the hospital. What drives them is usually a passion for their field: helping patients within their own subspecialty even better than they can now. Few take the step. I think that comes down to three barriers: (1) setting up and running a care business, (2) years of working without contracts from the large health insurers, and (3) an administrative load that grows rather than shrinks. Together they mean that in the first years, an independent clinic often earns a specialist less than a hospital position, at higher risk. And all that work comes out of the very time for patients that made them want to start in the first place.
My background is in mergers and acquisitions, and I built and sold a software company myself. At Seeve I look mostly at the business side of a clinic. Below I set out the barriers as we have mapped them over the past months, in conversations with specialists, clinic owners and investors.
Barrier 1: setting up and running a care business
What has to be arranged before the first patient walks in is a longer list than most specialists expect. A selection, from large to small:
- Legal form and KvK registration
- Business bank account
- Wtza licence (CIBG)
- AGB code (Vektis)
- Quality system
- Complaints procedure
- Supervisory board
- Privacy and GDPR
- Insurance
- Accountant
- Premises zoned for medical use
- Treatment rooms that meet hygiene rules
- Sterilisation
- Medical equipment
- Medical waste
- AED and first-aid responder
- Cleaning
- Waiting room and name plate
- EHR linked to ZorgDomein and Vecozo
- UZI passes
- Rates
- Website and booking system
- Marketing and referrers
- Staff and payroll
- Keeping up with innovation
You get the point: it is a lot of work. We zoom in on a few of the biggest pain points.
The licence. Medical-specialist care requires a licence under the Wtza, whatever the size of the clinic, and it must be in place before you see the first patient. The CIBG looks at, among other things, your quality management system, your governance and your administration.
The costs up front. Clinics we spoke with say the EHR alone costs 5 to 6% of revenue. That, and the rest of the list, you pay largely before a single claim has come in.
What you may take out. Medical-specialist care currently falls under a ban on distributing profits. The government wants to replace the ban with a cap, as a percentage of invested capital (letter of 3 July 2026, with the Wibz bill). How high that will be is not yet known.
Barrier 2: years without a contract
A new clinic almost always starts without a contract with the health insurers. That is allowed: a patient with a benefits-in-kind policy (naturapolis) is still reimbursed for part of the cost, between 52 and 85% of the tariff. The patient pays the difference, or the clinic absorbs it. Either way it makes patients harder to attract and keep.
Getting a contract is not a matter of applying for a new clinic. We put the 2027 purchasing policies of the five largest insurers side by side:
Source: 2027 purchasing policies for medical-specialist care of Zilveren Kruis, VGZ, Menzis, CZ and Salland. Scale 0–4 years. Zilveren Kruis counts from the start date of the AGB code.
On top of that, each insurer sets its own conditions. Zilveren Kruis “in principle” contracts no new providers, only if its duty of care requires it. CZ asks for demonstrable added value or innovation, and at least two specialists. Every insurer can refuse if enough care has already been bought in the region. And with one application round a year and contracts starting on 1 January, the period without a contract often runs to three or four years in practice.
The clinic misses the 2029 round, because the cut-off date is 1 April. Source: 2027 purchasing policies; application windows Zilveren Kruis 1 April–1 June, VGZ 1 April–29 May.
There is political uncertainty on top. The government wants to end reimbursement of care delivered without a contract.
Barrier 3: admin grows rather than shrinks
In a hospital, a department handles billing, HR and purchasing. In your own clinic you do it yourself, or you buy it in. Working without contracts makes it even more complex. The patient receives an invoice and claims it themselves, wants to know what they will get back and calls when the reimbursement disappoints. There are questions about goodwill payments, payment reminders and objections to the insurer. That takes people at the front desk and in the back office, and those costs come straight off what the clinic keeps.
What it adds up to
Take a specialist who wants to start with one day a week, alongside the hospital. That is how many of the doctors I speak with want to do it at first. Even a start like that quickly calls for an investment of at least €100,000. That one day a week then has to earn back the fit-out, the systems and the fixed costs, which keep running the rest of the week.
A specialist who starts alone carries all three barriers personally: the investment, the income risk of years at a lower reimbursement, and a business that takes time they would rather spend with patients. It does not surprise me that many who do make the move join an existing chain or clinic.
That does not mean it cannot work. Some clinics grow fast without contracts, precisely because they focus on one condition with long waiting times. What we think makes the difference:
- Sharing overhead. Premises, front desk, systems and back office shared with other clinics.
- Starting small. Part-time alongside a hospital job, growing as the patient flow builds.
- A clear care pathway. A clinic that does one thing very well is easier to explain to referrers, patients and, later, insurers.
That is exactly why we started Seeve.
Frequently asked questions
Do I need a licence to start my own clinic as a specialist? Yes. Every organisation delivering medical-specialist care needs a licence under the Wtza, applied for at the CIBG before you see the first patient.
Can I work without a contract with a health insurer? Yes. Patients with a benefits-in-kind policy (naturapolis) are then reimbursed between 52 and 85% of the tariff. The government wants to end this reimbursement; that is the subject of a separate article.
When does a new clinic get a contract? At Zilveren Kruis only after at least three years and a minimum revenue, and even then in principle not. CZ sets no minimum period but does require a minimum revenue and demonstrable added value. In practice it often takes three to four years.
Can an independent clinic distribute profits? Not at present for medical-specialist care. The government wants to replace the ban with a cap as a percentage of invested capital, under conditions. The level is not yet known.
Sources
- Dirkzwager, Healthcare Providers Admission Act: licence requirement (in Dutch)
- Zilveren Kruis, purchasing policy for medical-specialist care 2027 (in Dutch)
- CZ, purchasing policy 2027 medical-specialist care (pdf, in Dutch)
- VGZ, Menzis and Salland, purchasing policies for medical-specialist care 2027 (in Dutch)
- Overstappen.nl, reimbursement of non-contracted care (updated July 2026, in Dutch)
- Dutch government, cabinet tightens rules on profit distribution and business operations in care (3 July 2026, in Dutch)
- Loyens & Loeff, From profit distribution ban to a new cap-and-conditions regime in Dutch healthcare
- Seeve, review of the 2027 medical-specialist care purchasing policies of Zilveren Kruis, VGZ, Menzis, CZ and Salland, and conversations with clinics (2026)
