Healthcare procurement 2026: exercise your rights in good time

All healthcare insurers must publish their 2026 healthcare procurement policy by 1 April 2025 at the latest. This publication marks the start of the 2026 healthcare procurement – and at a time when the healthcare landscape is under increasing pressure. Staff shortages and an aging population are undermining access to healthcare. Securing a sound contract with healthcare insurers is more important than ever, also in light of the cost increases that healthcare providers are faced with. Both healthcare providers and healthcare insurers have rights and obligations during the healthcare procurement process. Healthcare insurers are bound by the following, for instance:

• their statutory duty of care;
• contractual and peri-contractual good faith and reasonableness and fairness (see the STAR ruling and our video briefing);
• the Code of Conduct for Healthcare insurers;
• provisions of the Comprehensive Care Agreement (“IZA”);
• the NZa Regulations on Transparency in the Healthcare Procurement Process under the Healthcare Insurance Act (the “Healthcare Procurement Regulations”);
• the NZa Regulations on the Provision of Information by Healthcare insurers (the “Regulations on the Provision of Information”); and
• case law, e.g. as on the application of realistic rates and the allocation of the Government Contribution to Labour Cost Developments (Overheidsbijdrage in de Arbeidskosten Ontwikkeling or "OVA) within the framework of the IZA.

Experience shows that it is important for healthcare providers to make effective use of these rights and obligations. This blog explains in 11 steps how you can exercise your rights in the 2026 healthcare contracting process to secure a sound contract with your healthcare insurer(s) – because well begun is half done.

1. Check the healthcare insurer’s 2026 healthcare procurement policy immediately after 1 April 2025

• Under the Healthcare Procurement Regulations, the healthcare insurer’s procurement policy must be announced by 1 April 2025 (see also this blog). The procurement policy is usually presented in outline, but must in any event meet the requirements listed in Article 4 of the Healthcare Procurement Regulations.
• Healthcare insurers must, among other things:
  • • • clearly inform healthcare providers beforehand which contract variant is being offered;
      • state in the procurement policy how additional contracting will be handled;
      • give healthcare providers sufficient time to study a proposal for additional contracting or an amendment to a multi-year agreement, and to ask questions;
      • publish both substantive and procedural changes in the procurement process in good time and in the same manner as the procurement policy (see our blog here); and
      • if the healthcare insurer uses discounts, explain the basis for those discounts.
• Check whether the procurement policy provides sufficient information on the seven requirements set out in Article 4 of the Healthcare Procurement Regulations. Do so in good time and, if necessary, submit written questions to the healthcare insurer, requesting a prompt and sufficiently specific response. In principle (unless otherwise agreed), healthcare providers and healthcare insurers must respond to each other’s questions and comments within two weeks (see Article 5).
• The NZa (Dutch Healthcare Authority) is also responsible for enforcing the NZa Regulations on the Provision of Information on Healthcare insurers to Consumers. These regulations set out mandatory rules for healthcare insurers regarding the information they provide to consumers. These rules also have consequences for healthcare providers, for instance with regard to information on healthcare providers in the healthcare insurer’s Healthcare Finder (see our blog on this subject).
• Healthcare providers, in turn, must comply with the Regulations on Transparency for Healthcare Providers. In those regulations, the NZa explains what information healthcare providers may provide to consumers. Healthcare providers may share objective and factual information about the healthcare they provide and about healthcare insurers with consumers. Consumers may not be misled in this regard.

2. Procurement policy not in line with the Healthcare Procurement Regulations? Notify the Nza.

• If a healthcare insurer fails to present a procurement policy by 1 April 2025, or if that policy is incomplete, that may constitute a violation of the Healthcare Procurement Regulations.
• The NZa may be requested to compel the healthcare insurer to amend or supplement its healthcare procurement policy by means of a signal or an enforcement request. The aim in doing so is to ensure the desired transparency. Please note that the healthcare insurer must amend its procurement policy in accordance with the mandatory rules set out in the Healthcare Procurement Regulations. For instance, certain amendments to the 2026 procurement policy after 1 April 2025 must be made not only in a timely and substantiated manner, but also in the same manner as that in which the policy was previously announced by the healthcare insurer in question. The NZa warned both Menzis (here) and Zorg en Zekerheid (here) about this in 2023 because they had failed to publish amendments to their healthcare procurement policy in the correct manner.
• If healthcare insurers violate the Healthcare Procurement Regulations, it may also be worthwhile for aggrieved healthcare providers to take legal action in the civil courts. Practice shows that courts are increasingly critical of healthcare insurers that refuse to enter into contracts with healthcare providers on grounds that are not or not clearly stated in their procurement policy – all the more so in the case of increasing waiting lists, e.g. in specialist medical care, mental healthcare or general practitioner care. Recent rulings against Zilveren Kruis and CZ also show that the courts are increasingly drawing a line for healthcare insurers that fail to comply with procurement rules. The case against CZ builds on the earlier victory before the Court of Appeal of The Hague against Zilveren Kruis. The Court of Appeal of The Hague confirmed that Zilveren Kruis had to include both the OVA (Government Contribution to the Labour Cost Development) and an indexation for the costs of equipment and capital in its rates for 2024 and 2025. In the CZ case, the court also ruled that CZ could not categorically refuse to index its rates, because healthcare providers are dependent on CZ. In both rulings, the court emphasised that healthcare insurers must take sufficient account of the legitimate interests of healthcare providers. This demonstrates that courts are becoming increasingly critical of the practices of healthcare insurers.

3. Request a clarification if a healthcare insurer’s procurement policy is too vague

• If, for instance, the healthcare insurer wishes to base its policy on selective healthcare procurement, you should immediately inquire about the priorities and associated criteria that it applies (and refer to Article 4 of the Healthcare Procurement Regulations). If these are insufficiently clear, see points 2, 4, and 9.
• If a healthcare insurer is unclear about the possibilities of indexation due to increased costs, it is advisable to inquire about this in writing, to ensure that clarity is provided on this point in a timely manner. In principle, healthcare insurers must respond to questions by providing a sufficiently clear answer within two weeks.
• If you suspect that a procurement requirement imposed by the healthcare insurer will give rise to an increase in administrative burdens, you should inform the healthcare insurer immediately (see this blog for tips).

4. Request a clarification if the procurement policy is unclear and in the event of discounts or reductions

• Waiting before doing so might later be detrimental to the healthcare provider. It could then be argued that clarification was only requested after a considerable period of time and that it is no longer expedient to clarify or adjust certain points, or that the healthcare provider has forfeited its rights (see point 8).
• If necessary, always request a clarification (while referring to Articles 5, 6, 7 and 8 of the Healthcare Procurement Regulations). Do not settle for a partial or ambiguous answer. The NZa requires healthcare insurers to provide clear and substantive responses to questions and comments from healthcare providers (see also here and here for our blogs). Both healthcare insurers and healthcare providers must respond to comments or questions in a timely manner (within two weeks).
• If necessary, inform the healthcare insurer that if it fails to provide a (sound) response, you will be forced to consider legal action, while referring to Article 5 of the Healthcare Procurement Regulations (see point 8). This could include requesting the NZa to take enforcement action on the grounds of violation of the Healthcare Procurement Regulations.

5. Take the lead in the process and provide information

• Submit a proposal (with procedural agreements) to the healthcare insurer and/or state which points must be included in order to arrive at a contract.
• Indicate as early as possible where bottlenecks are anticipated in the contracting process, such as a lack of indexation for increased wage and other costs.
• If necessary, draw the healthcare insurer’s attention to any imminent breach of obligations under the Healthcare Procurement Regulations (see point 2) and/or the duty of care (see also point 11).
• If the healthcare insurer insists on exclusive contracting and you are consequently unable to obtain a contract, but if that is incompatible with the proper fulfilment of the healthcare insurer’s duty of care, inform the relevant stakeholders. These include the NZa, but also patient associations. The reason for this is to ensure that they are aware of the consequences in good time and that they too can take timely enforcement action (NZa) or hold the healthcare insurer accountable (patient association).

6. Establish beforehand who will be in contact with whom and at what time

• This will prevent suboptimal consultation during the contracting process, because matters that have already been explained or agreed do not need to be discussed again with other persons.
• Ensure that consultations are conducted with persons who have the authority to take the desired decisions on behalf of the healthcare insurer. If in doubt, for the sake of efficiency, ask by email before any action is taken whether the relevant contact at the healthcare insurers has a mandate and what exactly it entails.

7. Explore the possibility of more efficient contracting in good time

• Among other things, healthcare insurers must aim to reduce the administrative burden for healthcare providers in accordance with the Comprehensive Care Agreement. Be alert to procurement and other requirements that increase your administrative burden and draw the healthcare insurers’ attention to them in good time (see also this blog for further tips on this point).
• Explore the possibilities for cooperation within the framework of the Mededingingswet (Competition Act), such as cooperation between non-competing healthcare providers or cooperation that benefits from the de minimis provision in the Competition Act. Or make use of benchmarking; see our video briefing for more information.
• The use of a healthcare broker or other representative may relieve the burden on the healthcare provider and result in a more efficient healthcare procurement process for both the healthcare provider and the healthcare insurer. According to the NZa, exploring the possibility of using a healthcare broker also constitutes one of the Good Contracting Practices.
• The Minister of Health, Welfare, and Sport has also stated that there is room for cooperation between healthcare providers in healthcare procurement and refers to this example.
• Please note that a collective boycott of healthcare contracts is contrary to the Competition Act, as ACM (the Netherlands Authority for Consumers and Markets) previously confirmed. In principle, contacts between healthcare insurers on whether or not to contract healthcare providers is also prohibited. Healthcare insurers and Zorgverzekeraars Nederland (the umbrella organisation of eleven Dutch healthcare insurers) must also respect the cartel prohibition.

8. Be alert to timing and deadlines

• According to Article 7(1) of the Healthcare Procurement Regulations, the healthcare insurer must allow healthcare providers a reasonable period of time to study the proposal and ask questions during the healthcare procurement process. This also applies to a proposal for additional contracting or an amendment to a multi-year agreement (see our blog here).
• Under Article 7(2) of the Healthcare Procurement Regulations, that reasonable period is at least four weeks, unless the parties agree otherwise.
• Check in good time whether the periods applied are reasonable. If necessary, request the NZa to take enforcement action on the grounds of violation of Article 7 of the Healthcare Procurement Regulations.
• If a response period for the submission of certain data is too short, ask the healthcare insurer for an extension, while referring to Articles 5 and 7 of the Healthcare Procurement Regulations. If applicable, state that points in a contract proposal are insufficiently clear or that relevant documents of the healthcare insurer have not been made available or have been made available later than expected.
• Article 6 of the Healthcare Procurement Regulations states that in sectors where the healthcare provider submits a tender, it must do so by 1 October 2025 at the latest.
• Under Article 8 of the Healthcare Procurement Regulations, healthcare insurers must announce all changes to the information made available in the 2026 procurement policy by 1 April 1 2025 under Article 4 of the Healthcare Procurement Regulation, both (i) in a timely manner and (ii) stating reasons, in the same manner as that in which the procurement policy was published. If the healthcare insurer fails to do so, it should be notified accordingly and, if necessary, the NZa should be requested to take enforcement action.
• The government and the NZa want healthcare to be contracted in good time. All healthcare insurers must announce the new policy values by 12 November 2025 (no later than seven weeks before the end of 2025). According to the NZa, it must also be known by that time which healthcare provider the healthcare insurer has contracted.

9. Monitor the procedure and deadlines and seek advice in good time

• Monitor the procedure. If necessary, send a reminder by email as soon as deadlines are (or are about to be) exceeded by the healthcare insurer and make a new proposal. This way, if there are significant delays, you can state that this may not be detrimental to the response time that the healthcare provider is given by the healthcare insurer, and that an appropriate solution must be found (while referring to the obligation to apply reasonable deadlines set out in Article 7 of the Healthcare Procurement Regulations).
• If a healthcare insurer refuses to answer a question, or to do so in a sufficiently clear manner, point out that Article 5 of the Healthcare Procurement Regulations provides that the healthcare insurer must be sufficiently available to answer questions and comments from healthcare providers until such time at which the contracts are entered into. The healthcare insurer must also provide a clear, substantive response to questions and comments from the healthcare provider in a timely manner (see here and here for our blogs).
• Prepare the contracting process in good time, or arrange for that to be done for you (see point 7). In order to communicate with and respond to the healthcare insurer in a substantiated manner during the contracting process, it is advisable to have relevant data available in good time. Benchmarking is permitted, provided that it is done within the framework of the Competition Act. Click here for more information.

10. Monitor your legal position

• It is particularly easy to obtain legal advice and take legal action rapidly and efficiently, if necessary, if you have thoroughly documented the case.
• Partly in light of the above, it is advisable to keep records (e.g., by email) of consultations with a healthcare insurer. Send these to your contact person at the healthcare insurer after any consultation.
• Do not be discouraged by a response stating that no action will be taken on the report or that no response will be provided. In order to invoke the Healthcare Procurement Regulations quickly and successfully at the NZa, it is helpful to be able to immediately demonstrate why the healthcare insurer is in breach of its obligations under those regulations and why enforcement action by the NZa is required. Sound documentation is equally useful if civil proceedings have to be brought.
• Bear in mind that also if healthcare insurers do not have a dominant position under the Healthcare Insurance Act, they are bound by the duty of care and healthcare procurement obligation, and that the NZa supervises compliance with the duty of care (see also point 11). More information on this point can be found in this blog.

11. Focus on duty of care enforcement request

• The duty of care and healthcare procurement obligation are set out in Article 11 of the Healthcare Insurance Act and apply exclusively to healthcare insurers (not to healthcare providers). Practice shows that proactive compliance with this duty of care is not always self-evident for healthcare insurers.
• The NZa appears to be increasingly aware of the importance of enforcing the duty of care. In March 2025, it placed CZ under stricter supervision for violating the duty of care. This took place after CZ was found not to have taken sufficient measures to meet the demand for care, particularly in regions where waiting lists were increasing.
• If you believe that healthcare insurers are not procuring sufficient care (or are unwilling to do so) to meet the demand for care in your region, explore your legal options. You could, for instance, apply to the courts and/or submit a signal or enforcement request to the NZa. This is a formal request to the NZa to enforce the duty of care against a healthcare insurer. This blog provides further information on what supervision of compliance with the duty of care can mean for healthcare providers.

Explore your legal position in good time

Healthcare providers have been confronted with significant cost increases these past few years. Many healthcare providers are unable to absorb the current cost increases (or to do so in full) without realistic rates. Healthcare will have to be organised differently in the future in order to meet the increasing demand for care. The increasing administrative burdens (including additional requirements) are also giving rise to increased work pressure, a drop in job satisfaction, and, above all, a shortage of staff. This has consequences for the care and its continuity, while the demand for care is increasing. Contracts that allow healthcare providers to cope with a tightening labour market are now more important than ever. If, as a healthcare provider, you feel that your healthcare insurer is not taking your interests into account, or is doing so insufficiently, it is wise to explore in good time whether legal or other steps need to be taken.

See also the briefing below, in which Leah Peeters provides tips and points to consider to arrive at a sound contract for 2026.

For more information, please visit www.zorgcontractering.com

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