A care company may distribute profit if it exclusively provides care for which a profit motive is permitted. This includes allied health care, GP care, dental care, pharmaceutical care, maternity care and nursing, personal care and support without Wlz accommodation. If the company provides other insured care, such as medical specialist care for physical conditions or Wlz care with accommodation, the profit ban applies.
A profit ban does not mean that you may not make a profit. It means that you may not distribute profit to shareholders, and that your articles of association may not allow it either.
In short
- The profit ban is in article 5 of the WTZi. The exceptions are in article 3.1 of the WTZi Implementing Decree and only apply if the institution exclusively provides those types of care.
- If you may distribute, the NZa checks whether the distribution was orderly and verifiable: who decided, and can the money be traced from source to destination.
- With the Wibz the government wants to allow profit distribution for all providers in insured care and youth care, under strict conditions and with a maximum percentage of invested capital. That is a proposal, the level of the maximum is still being studied.
In this article
May your care company distribute profit?
That depends on the care it provides. The act says that an institution has no profit motive, except for the categories designated by order in council (Care Institutions Admission Act, article 5). An institution here is an organisation that provides care under the Wlz or the Zvw (NZa, Policy rule TH/BR-033).
A profit motive is permitted for institutions that exclusively provide one or more of these types of care (WTZi Implementing Decree, article 3.1):
- allied health care, GP care, dental care, pharmaceutical care, midwifery care and maternity care
- personal care, nursing, support, cleaning or treatment, if not combined with Wlz accommodation
- behavioural science treatment for a psychiatric condition, and medical specialist care only for a psychiatric condition without Zvw accommodation
- audiological care, thrombosis care, aids, loan of nursing supplies, transport and care in a small-scale residential facility
A home care company providing district nursing, a physiotherapy practice, a GP practice, a dental practice or a pharmacy in a company may therefore distribute profit. An independent treatment centre providing medical specialist care for physical conditions is not on the list and falls under the ban.
What exactly does the profit ban involve?
The NZa checks two things: whether profit is distributed in a specific case, and whether the institution has created the intention or the possibility to distribute profit. If an institution that falls under the ban includes in its articles that it may distribute profit, it is already in breach of the ban, even if nothing has been distributed yet (NZa, Policy rule TH/BR-033, explanation of article 5).
The ban is not a ban on a positive result. It also does not apply to subcontractors (NZa, Policy rule TH/BR-033). A subcontractor is a care provider that provides part of the care within the care of another provider.
If profit has nevertheless been distributed wrongly, the NZa can issue an instruction and impose an order subject to a penalty. It can thereby force the institution to reclaim the amount distributed (NZa, Policy rule TH/BR-033).
What does the NZa look at if you may distribute profit?
On order and verifiability. The NZa checks whether the tasks and responsibilities for distributing profit are clearly divided and recorded, whether execution and supervision are separated, and whether the distributed profit can be traced in the accounts from source to destination (NZa, Policy rule TH/BR-033, article 5.2).
The NZa takes the size of the provider into account. If under the Wtza you do not need an internal supervisory body, the NZa does not expect one either when assessing a profit distribution (NZa, Policy rule TH/BR-033). For a small practice company this means in practice: a shareholders' resolution, a written dividend resolution and a payment with a clear description.
That assessment is linked to the general requirement of transparent financial management. Every care provider must separate its care activities financially from other activities and make receipts and payments traceable to source and destination (Healthcare Market Regulation Act, article 40a). That the NZa takes this seriously is shown by the fine of € 100,000 for a home care organisation and € 30,000 for its director in September 2026 (NZa, 21 September 2026).
What will change with the Wibz?
The government wants one rule for everyone, with a maximum. On 3 July 2026 the minister presented an addition to the bill on Integrity in the Business Operations of Care and Youth Care Providers (Wibz). All providers in insured care and youth care would then be allowed to distribute profit if they meet strict conditions, and there will be a maximum (Government of the Netherlands, 3 July 2026).
Under the proposal a profit distribution may not exceed a maximum percentage of invested capital. The government is still having the level of that percentage studied. Anyone who does not file the annual accountability report may not distribute profit, and in case of repetition the admission licence can be withdrawn (Government of the Netherlands, 3 July 2026).
The bill has number 36 686, was submitted on 28 January 2025 and is still before the House of Representatives (Senate, bill 36 686, status 1 November 2026). There is no commencement date. For a physiotherapy or GP practice that may now distribute freely, the Wibz may therefore mean a new limit. For a provider that now falls under the ban, it may actually give room.
What do you keep net from the dividend as an owner-director?
Dividend from your company is income in box 2. In 2026 you pay 24.5% on the first € 68,843 and 31% on the excess (Belastingdienst, Box 2). Before that, the company has already paid corporate income tax on the profit.
If you work in the company yourself, you must first pay yourself a customary salary. In 2026 that is at least € 58,000 (Belastingdienst, Salary and substantial interest). You can work out the choice between more salary or more dividend with the calculators (salary or dividend, owner-director salary).
Under the plans accompanying the 2027 Tax Plan the higher box 2 rate will temporarily go to 29.2%. The government also wants to reduce the limit for excessive borrowing from your own company in steps from € 500,000 to € 100,000 from 2027 (Accountancy Vanmorgen, 29 September 2026). These are proposals. The House of Representatives votes on the Tax Plan on 12 November 2026.
What does research say about profit in care?
The picture is mixed, and depends on country and type of care. A systematic review of 55 studies, mostly from the United States, found that private equity ownership was most often associated with higher costs for patients or payers, and with mixed to harmful effects on quality (Borsa et al., 2023).
Dutch research on small-scale living for people with dementia, using claims data from 2017 to 2021, found no evidence that commercial providers, including private equity owned ones, selected clients or provided worse care than non-profit providers (Krabbe-Alkemade et al., 2025).
Another Dutch study showed that commercial nursing homes were able to grow while the profit ban applied, partly through changes in the rules and capital from private investors (Bos, Kruse & Jeurissen, 2020). That explains why the government now opts for a maximum for everyone instead of a ban for part of the sector.
Sources
- Care Institutions Admission Act (WTZi), article 5, version 1 January 2022, read via the BWB repository (in Dutch). wetten.overheid.nl
- WTZi Implementing Decree, article 3.1, version 1 January 2022 (in Dutch). wetten.overheid.nl
- NZa, Policy rule TH/BR-033 Transparent business operations and ban on profit motive, valid from 1 January 2022 (in Dutch). puc.overheid.nl
- Healthcare Market Regulation Act, article 40a, version 1 September 2026 (in Dutch). wetten.overheid.nl
- NZa, Fine for home care organisation Balans Thuiszorg B.V. for deficient financial management, 21 September 2026 (in Dutch). nza.nl
- Government of the Netherlands, Cabinet tightens rules on profit distributions and business operations in care, 3 July 2026 (in Dutch). rijksoverheid.nl
- Senate, Bill 36 686 Integrity in the Business Operations of Care and Youth Care Providers, status, accessed 1 November 2026 (in Dutch). eerstekamer.nl
- Belastingdienst, Box 2 (in Dutch), accessed 1 November 2026. belastingdienst.nl
- Belastingdienst, Salary and substantial interest (in Dutch), accessed 1 November 2026. belastingdienst.nl
- Accountancy Vanmorgen, Cabinet wants to lower the excessive borrowing limit to € 100,000 and the higher box 2 rate to 29.2 percent, 29 September 2026 (in Dutch). accountancyvanmorgen.nl
- Borsa, A., Bejarano, G., Ellen, M. & Bruch, J.D. (2023). Evaluating trends in private equity ownership and impacts on health outcomes, costs, and quality: systematic review. BMJ, 382, e075244. doi.org
- Krabbe-Alkemade, Y., Makai, P., Canoy, M., Kemp, R.G.M. & Portrait, F.R.M. (2025). Market distortions in the Dutch mixed long-term care market: an exploratory analysis. Health Economics, Policy and Law, 21(3), 324-348. doi.org
- Bos, A., Kruse, F.M. & Jeurissen, P. (2020). For-profit nursing homes in the Netherlands: what factors explain their rise? International Journal of Health Services, 50(4), 431-443. doi.org