HEALTHCARE

Keypoints

  • Limited investment activity and stable pricing
  • Policy focused on cost control and extramuralisation
  • Structural mismatch in nursing home capacity
  • Digitalisation and consolidation reshaping the care landscape

Limited investment activity

The healthcare real estate market shows limited transaction activity at the start of 2026. Investment volume reached just over € 100 million in the first quarter, in line with the same period last year. This remains modest relative to the underlying demand and the capital available for both healthcare and residential real estate.

The transaction market is dominated by smaller deals, with over 70% of transactions below € 10 million. Large portfolio deals and individual high-value transactions remain absent, keeping overall volumes subdued. At the same time, activity is broad-based across subsegments, with the majority of volume concentrated in senior housing and care-related residential concepts, together accounting for more than 70%.

On the buyer side, private investors remain the most active, while international capital has been largely absent for an extended period. Transactions in healthcare real estate typically involve longer lead times, driven by user-specific requirements, lengthy decision-making processes, and the structural mismatch between relatively high construction costs and revenues that do not always adjust accordingly. This dynamic continues to characterise the current market.

INVESTMENT VOLUME (€, BILLIONS)

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

SHARE INVESTMENTVOLUME (%)

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

Stable pricing

This dynamic is also reflected in yield development. Initial yields have remained relatively stable over multiple quarters. As a result, returns in healthcare real estate are primarily driven by direct income rather than capital appreciation. This aligns with the sector’s profile, where tenant quality, lease structures and operational performance are key value drivers.

Total returns have remained above 10% on an annual basis for the third consecutive quarter. Supported by strong rental growth and increases in vacant possession values, healthcare real estate—alongside residential—continues to be the best performing segment within the Dutch MSCI benchmark.

Looking ahead, the key question is whether available capital and projects in the pipeline will translate into higher transaction volumes in the coming quarters. Stable pricing provides a foundation, but external factors such as interest rates, geopolitical developments and their impact on inflation and construction costs will remain decisive for market momentum. As a result, the investment market is expected to develop gradually.

SHIFT IN INITIAL YIELDS Q1-2026 (%-POINT)

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

Quarterly view: demand remains strong, but suitable supply lags

Demand for healthcare real estate remains structurally strong, but the way this demand translates into real estate is changing for longer now. Policy continues to steer towards extramural care and cost containment, while in practice a growing mismatch emerges between demand and available product. At the same time, the sector is shifting towards hybrid care models, making operational performance and user quality increasingly important relative to the real estate itself.

Policy focused on cost control and extramuralisation

The new government is clearly focused on controlling healthcare expenditure and further promoting care delivery at home. Policy emphasises cost containment, system reforms and limiting the growth of intramural capacity. At the same time, ageing-in-place remains the dominant direction, with continued emphasis on mobility within the housing market and appropriate care-related living solutions.

This direction is structurally logical, but it also exposes tensions within the current market. Demand for care remains intact, but shifts away from traditional intramural settings. As a result, pressure builds not on overall volume, but on the alignment between demand, supply and real estate.

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

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

Mismatch in nursing home capacity

These tensions are clearly visible in the debate around nursing home capacity. Rather than a straightforward shortage, the market is characterised by a structural mismatch. On the one hand, some analyses point to a potential overestimation of required capacity. On the other, research by Zilveren Kruis shows that vacancy and waiting lists can occur simultaneously.

This reflects a lack of alignment between demand and supply. Part of the existing intramural stock no longer meets current care requirements or is difficult to operate, while waiting lists largely consist of non-urgent or preference-based demand. At the same time, underlying demand continues to grow due to ageing and increasing care intensity.

A similar mismatch is present in the housing market. The supply of suitable senior housing and care-oriented residential concepts remains insufficient, limiting mobility and sustaining pressure on higher-intensity care settings. The key challenge therefore lies less in expansion and more in replacement and better-aligned product.

Digitalisation and consolidation reshaping the care landscape

Alongside these spatial and programmatic shifts, the organisation of care itself is changing. Digitalisation and consolidation are accelerating a transition in which care increasingly takes place outside traditional institutional settings.

This becomes tangible through the emergence of AI-driven applications. OpenAI has introduced ChatGPT Health to support patients in interpreting medical information, while other players such as Anthropic are entering the market with similar propositions. At the same time, the Dutch sector is developing its own alternatives. Thuisarts, supported by the Dutch College of General Practitioners, is working on a solution focused on validated information and direct integration with primary care.

In parallel, the structure of care provision is evolving. Independent treatment centres are gaining share in elective care, while consolidation is taking place in primary care through acquisitions and network formation. The acquisition of FysioHolland has positioned TopzorgGroep now as the largest physiotherapy provider in the Netherlands.

Together, these developments point towards a hybrid care system: more care delivered digitally and at home, while physical locations remain essential as part of integrated care networks. As a result, the role of real estate shifts from standalone asset to a functional link within the care chain.

ChatGPT Health

Image from Openai.com

Operations define the risk profile

These developments ultimately converge at the operational level. The focus on cost control limits financial headroom for healthcare providers, putting pressure on rental affordability and investment capacity.

As a result, the risk profile of healthcare real estate is increasingly driven by the user rather than the asset itself. Financial resilience of the operator becomes the key determinant. While the number of bankruptcies increased slightly in the first quarter, levels remain historically low, indicating a sector that is under pressure but still functioning.

HEALTHCARE BANKTRUPTCIES (2 QUARTER MOVING AVERAGE)

Source: CBS (2026), edited by Achmea Real Estate

Outlook

The market is expected to remain broadly stable in the coming quarters. Underlying demand for healthcare real estate remains strong, but continues to translate only gradually into deliverable and investable product. As a result, scarcity persists in the right type of assets, rather than in capital or demand. An increase in transaction volume is likely given the current pipeline, but a meaningful acceleration depends on execution. Construction costs, permitting processes and operational feasibility will remain key constraints.

Yields are expected to remain broadly stable. At the same time, uncertainty in capital markets is increasing due to geopolitical developments, with potential implications for interest rates, inflation and financing costs. This is particularly relevant for development activity. The user market in healthcare real estate remains relatively insensitive to economic and geopolitical fluctuations. Demand for care is structurally driven and largely independent of the economic cycle. However, macroeconomic developments do have an indirect impact through rising costs and financing conditions, affecting both project feasibility and operator performance.

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