In early 2025, an amended version of the Ethical Business Practices Care Providers Act (Wet integere bedrijfsvoering zorgaanbieders, “Wibz”) was submitted to the Lower House of Parliament. This bill was created both to improve the practices of care institutions and to fight excesses in the distribution of profits.
Early in July 2026, Minister Sterk announced a tightening and amendment of the Wibz bill. The cabinet regards the Wibz as an important step towards promoting responsible entrepreneurship in health care, but deems the present proposals still inadequate to fight abuse of health care funds and undesirable financial constructions effectively. This tightening was prompted by case law of the Administrative Law Division of the Council of State in the proceedings of Radiology Holland B.V. versus the Minister concerning the ban on distribution of profits, and by the wish to create a more uniform and more feasible system.
The proposed tightening of the Wibz bill focuses in particular on profit distributions and the financial business operations of providers of care and youth care. The aim is to fight abuse of care funds and excessive profit distributions, while keeping room for responsible entrepreneurship and investments in health care. In this article, we will examine the proposed amendments to the Wibz.
Additional conditions for profit distributions
The most remarkable change concerns the system for profit distributions. The cabinet proposes to replace the current system of partial bans on profit distributions by one uniform regime for all providers of care and youth care. At present, the rules differ according to sector and form of delivery. Some care providers are subject to a ban on distribution of profits, whereas others are allowed to distribute profits. The cabinet believes that this results in a fragmented system that is insufficiently clear and enforceable.
The new regime will in principle give all care and youth care providers the option of distributing profits. On the other hand, the conditions for distributing profits will be tightened sharply under this regime. The cabinet intends to create a level playing field for all providers, regardless of sector or form of delivery, while simultaneously preventing the withdrawal of public funds from care via high returns or complex constructions.
The cabinet proposes to cap profit distributions in the health care sector. Besides, profits can only be distributed if the following conditions are met:
- Compliance with the obligation to publish annual accounts;
- Compliance with the standard of conducting large transactions with related parties under normal market circumstances;
- Compliance with the ban on taking irresponsible risks when raising or repaying equity or debt.
The most remarkable change is the introduction of a statutory maximum return. It is proposed that a distribution of profits cannot exceed a percentage to be determined of the equity invested. The level of the maximum return is still under review and has not yet been fixed at present. The cabinet intends to clarify what return can be deemed acceptable in the health care sector. In the cabinet's opinion, there must be room for reasonable returns on investments, while on the other hand excessive profit distributions must be countered.
The proposed changes to the ban on profit distributions may be especially relevant for private equity parties and other investors active in the health care sector. Investments and financing structures based on the assumption of high returns may need to be reassessed. At the same time, distributing profits will also become possible in sectors where a ban on profit distribution currently still applies.
Other amendments to the Wibz
Besides the proposed amendment in respect of the ban on profit distribution, the cabinet also proposes several other amendments to the Wibz.
Business operations
The cabinet also tightens the standards for business operations. They propose to regulate more clearly what transactions with affiliated parties are subject to supervision. In addition, a prior reporting obligation to the Nza [the Dutch Health Care Authority] is proposed for real estate transactions with affiliated parties. The NZa will also get more powers to supervise financing constructions. Restrictions are especially urgent for takeover constructions in which the buyer's financial debt is passed on the care provider.
Stopping regime
The cabinet also introduces a “stopping regime” to prevent providers from evading supervision or enforcement by ending their activities or winding up the legal entity. Even after a provider has stopped, this regime should guarantee the survival of specific obligations, such as the obligation to keep records, to submit annual accounts, or conditions for distributing profits. Directors or their legal successors may be called to account for these obligations.
Annual accounts
In conclusion, the importance of the public annual accounts is further underlined. If a care provider fails to comply with this obligation incorrectly or not at all for several years, the cabinet proposes to make this an individual ground for withdrawing an admission permit.
What does this mean for practice?
Although the bill has not yet been adopted, it is clear that the cabinet aims for the increasing regulation of financial flows in the health care sector. In a letter to Parliament of 3 July 2026, the cabinet announced that it would tighten the Wibz on various points. These changes will be recorded in a memorandum of amendment to be subsequently offered to the Lower House of Parliament. It will depend on the parliamentary debate whether the tightening measures proposed will actually resulted in an amended Wibz in the end.
