HEALTHCARE

Keypoints

  • Recovering investment volumes with a shift in focus
  • Stable prime yields despite rising long-term interest rates
  • High total returns driven by a strong occupier market
  • Residential: rent increases create room within a regulated framework
  • Senior housing: preference for smaller, but not too small
  • Elderly care: broad-based agreement
  • Policy clarity enhances investability of intramural care
  • Government backstop clearly visible in case of systemic risk in healthcare
  • Waiting lists and vacancy: short-term fluctuations, structural demand
  • Hospitals taking a stronger lead

Recovering investment volumes with a shift in focus

In the fourth quarter of 2025, total healthcare real estate investment volume amounted to €226 million. This was higher than in the third quarter (€177 million), but lower than in the same quarter of 2024 (€275 million). For the full year 2025, cumulative volume reached €846 million, an increase of 16% compared with 2024 (€732 million). While investment activity is clearly higher than last year, volumes remain below the levels recorded in the 2019–2022 period.

The composition of investment volume has shifted. Compared with 2024, a relatively larger share of capital in 2025 was allocated to intramural and extramural healthcare real estate, while the share of primary care facilities and private residential care declined. On the demand side, a clear shift towards institutional investors and healthcare operators can be observed. Their share of total investment volume increased significantly, while private investors were considerably less active in 2025.

Almost the entire investment volume (99%) was accounted for by Dutch parties. In previous years, the share of foreign investors—particularly from Belgium—was higher. According to Capital Value, foreign investment activity may increase again in 2026, supported by improving market conditions.

On the supply side, developers once again represented the largest group of sellers, with a market share of nearly 60%. The share of new development in total transaction volume increased from 37% in 2024 to 59% in 2025, reflecting sustained demand for modern and future-proof healthcare real estate. Transaction sizes remained stable, with the majority of deals still falling within the sub-€10 million range.

INVESTMENT VOLUME (€, BILLION)

Source: CBRE (2015-2018), Capital Value (2019-2026), edited by Achmea Real Estate

SHARE INVESTMENT VOLUME (%)

Source: Capital Value (2026), edited by Achmea Real Estate

Stable prime yields despite rising long-term interest rates

Prime yields for healthcare real estate remained broadly stable in the fourth quarter. This occurred against the backdrop of a gradual rise in long-term interest rates during 2025, from approximately 2.4% at the start of the year to nearly 3.0% by year-end. Over the full year, a modest compression of prime yields can be observed across several healthcare segments, ranging from 5 to 20 basis points. The sharpest tightening occurred in secondary care, at 20 basis points.

High occupancy levels, continued rental growth, a relatively elevated inflation environment and reduced macroeconomic uncertainty have led to lower risk premiums. This supported yield stability despite higher capital market rates.

SHIFT IN PRIME INITIAL YIELDS Q4-2025 (%-POINT)

Source: Capital Value (2026), edited by Achmea Real Estate

High total returns driven by a strong occupier market

Demand for high-quality healthcare real estate remains strong. The occupier market is characterised by robust demand, low vacancy rates and rental growth, resulting in stable income returns and positive valuation effects. According to the MSCI benchmark, annualised total returns increased to over 11.5% in the third quarter, bringing healthcare real estate broadly in line with residential property investments.

For investors, this confirms that healthcare real estate continues to offer attractive risk-adjusted returns under current market conditions, combined with relatively low volatility. Within institutional portfolios, the sector therefore retains its position as a defensive, stable-performing real estate category.

TOTAL RETURN (% ANNUALISED, QUARTERLY RETURN)

Source: MSCI Netherlands Quarterly Property Index (2026), edited by Achmea Real Estate

Residential: rent increases create room within a regulated framework

In December, maximum rent increases for 2026 were announced. In the mid-market rental segment, rents may rise by up to 6.1%, while the free-market segment is subject to a cap of 4.4%. In the social housing sector, the maximum increase is lower, but indexation remains predictable. These caps are consistent with policy objectives aimed at maintaining housing affordability while allowing landlords sufficient scope to invest in maintenance and new construction. Within the legal framework, this provides relatively attractive indexation potential. Actual rental growth, however, remains dependent on maximum permitted rent levels under the housing valuation system (WWS) and on local market conditions.

Senior housing: preference for smaller, but not too small

Recent research into senior housing preferences shows an increasing concentration of demand for medium-sized, life-cycle-proof dwellings. In particular, three-room apartments are popular among both older movers and younger seniors: smaller than a family home, yet sufficiently spacious to support independent and comfortable living. This type of housing is currently structurally undersupplied.

For investors, this research highlights that ageing does not automatically translate into demand for very small dwellings. Instead, there is growing demand for high-quality, accessible apartments with flexibility for homebased care. Such products align with policy objectives focused on ageing in place and support mobility within the housing market, creating a clear long-term investment opportunity—especially in the mid-market segment.

Elderly care: broad-based agreement

In the fourth quarter, the Elderly Care Framework Agreement was formally signed by all stakeholders. With the final institutional reservations removed, a shared direction for elderly care has now been explicitly confirmed. The agreement aims to manage growing care demand by promoting independent living for as long as possible, reducing administrative burdens, and safeguarding sufficient intramural capacity for elderly people with complex care needs.

For the real estate market, the key implication is that the agreement confirms policy continuity rather than signalling an abrupt change in direction. Intramural care remains essential for a growing group of vulnerable elderly people, while new housing-care concepts and enhanced support in the home environment continue to be encouraged. This underlines the importance of a diversified supply of care-suitable housing, in which intramural and extramural care complement one another.

Policy clarity enhances investability of intramural care

In the fourth quarter, definitive clarity emerged regarding adjustments to the Normative Housing Component (NHC) for intramural care. With the publication of the amended policy rule by the Dutch Healthcare Authority in October, it was confirmed that long-term care providers will have structurally more financial room to invest in real estate from 2026 onwards. This follows the 2026 Wlz framework letter from the Ministry of Health, Welfare and Sport, which incorporates the impact of stricter sustainability and fire safety requirements.

This clarity comes at a relevant moment. Strongly rising construction costs and uncertainty around reimbursement had placed renovation and new development projects under pressure, often rendering business cases unviable. The increase in the NHC not only expands the investment capacity of healthcare providers but also improves the investment climate for investors.

Government backstop clearly visible in case of systemic risk

In the fourth quarter, it became clear that the government is willing to intervene in cases of systemic risk. In December, the Ministry of Health, Welfare and Sport announced financial support to prevent an uncontrolled bankruptcy of healthcare organisation De Trans. Continuity of care is being ensured through integration into Cosis and Vanboeijen, with involvement from healthcare insurers Zilveren Kruis and Menzis. New development capacity forms part of the continuity plan.

This case demonstrates that continuity policy is actively applied in practice for critical long-term care capacity. At the same time, a clear “last resort” approach remains in place: healthcare providers remain primarily responsible for maintaining sound operations. For healthcare real estate, this further reduces the already limited bankruptcy risk among care providers.

HEALTHCARE BANKTRUPTCIES (2 QUARTER MOVING AVERAGE)

Source: CBS (2026), edited by Achmea Real Estate CBRE (2015-2018)

WAITING FOR LONG-TERM CARE HOUSING (Q3 2020 = 100)

Source: Zorginstituut Nederland (2026), edited by Achmea Real Estate

Waiting lists and vacancy: short-term fluctuations but structural demand

In the fourth quarter, the discussion around waiting lists and vacancy in nursing homes resurfaced. While waiting lists had declined earlier, the most recent figures show a slight increase again. ActiZ and the Ministry of Health, Welfare and Sport emphasise that this dynamic is related to shorter lengths of stay and later admission, rather than a structural decline in care demand. Research by Erasmus School of Health Policy & Management and Radboud University Medical Center confirms that residents stay in intramural care for shorter periods and enter with more complex care needs. For real estate, this underscores the long-term need for flexible, care-suitable housing that can adapt to changing care concepts and regional differences.

Hospitals taking a stronger lead

Within the curative care segment, policy attention in the fourth quarter increasingly focused on the balance between hospitals and independent treatment centres. Zorgverzekeraars Nederland publicly supported hospitals’ concerns about the growth of non-contracted clinics and the implications for accessibility, affordability and staffing. At the same time, the Ministry of Health, Welfare and Sport is exploring adjustments to reimbursement systems, including differentiation by care complexity.

Hospitals are increasingly repositioning their real estate by concentrating planned care in focus clinics and dedicated care environments such as healthcare boulevards. In addition to Haga Hospital, Franciscus, Diakonessenhuis, Rijnstate, Deventer Hospital, Noordwest Hospital Group, Gelre Hospitals and Alrijne have all established their own focus clinics. Research by Zanders indicates that more than half of Dutch hospitals expect to increase real estate investment by approximately 25% in the coming years. This is driven by ageing building stock and the need to expand capacity.

Outlook

At the start of 2026, we expect current market conditions to persist. Investment volumes are likely to continue to increase gradually, while prime yields are expected to remain broadly stable. Moderating capital value growth will somewhat temper total returns, which nevertheless remain attractive. From a healthcare perspective, the new cabinet and coalition agreement are expected to bring limited shifts in emphasis rather than fundamental change. The long-term direction of healthcare policy is likely to remain unchanged. The key challenge continues to be whether new development and the transformation of ageing healthcare real estate can keep pace with occupier demand. Against this backdrop, investor demand is expected to remain more than sufficient in the coming quarters.

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