Achmea Real Estate: Curative healthcare real estate is wrongly seen as a wallflower

June 30, 2025

_{This article was originally written in Dutch. This is an English translation.}

Curative care real estate offers investors high, stable returns and social value. This niche receives little attention, while health centres and treatment clinics offer significant opportunities within institutional real estate portfolios in a changing healthcare landscape.

By Joost de Baaij, Research Manager, Achmea Real Estate

Curative care is an essential building block in the Dutch healthcare system.1 It focuses on treatment and recovery, prevents more intensive care programmes and increases patients' independence. This makes this form of care not only medically essential, but also financially and socially relevant. Nevertheless, institutional attention within real estate investments has traditionally focused primarily on care segments such as retirement homes. Curative care remains – unjustifiably – neglected.

Within curative care, different layers can be distinguished. Primary care includes general practitioners, pharmacies and physiotherapists. This care is increasingly being bundled in integrated health centres, often in urban care areas. Secondary care focuses on plannable, less complex treatments, increasingly carried out in independent treatment centres or day hospitals. In between, a growing category of “one-and-a-half-line care” is emerging: care centres where general practitioners and medical specialists work together to treat chronic patients. Secondary care, such as orthopaedics or ophthalmology, is shifting to independent treatment centres or day clinics. These locations offer efficient, plannable care outside the hospital structure.

This development calls for flexible and future-proof real estate. Modern healthcare locations must not only be practical for doctors and patients, but also meet requirements for collaboration, scalability, accessibility and sustainability. Curative healthcare real estate thus forms a spatial link in a more efficient and agile healthcare system.

Structural trends

Various fundamental trends are accelerating developments in the healthcare landscape. As a result, the role of curative care is becoming increasingly important.

1) Demographics and demand for care
The Dutch population is ageing rapidly. By 2040, the Netherlands is expected to have 4.8 million people aged 65 and over. This will increase the need for well-organised primary care and specialist secondary care.

2) Labour market shortages
Healthcare providers are facing staff shortages. Well-designed real estate can contribute to more efficient processes, better collaboration between disciplines and more attractive working environments.

3) Policy initiatives and decentralisation
Partly as a result of the above trends, the Integral Care Agreement (IZA) is accelerating the move towards primary care, stimulating network care and promoting substitution of hospital care. At the same time, it is encouraging the decentralisation of care to neighbourhoods and regions. This requires new care concepts and suitable accommodation in locations other than those previously used.

4) Digitisation of care
E-health and hybrid care models are changing the requirements for buildings. Locations must support digital consultations, triage and home treatment. This requires ICT infrastructure, flexible layouts and fewer traditional waiting rooms.

5) Sustainability and investment pressure
The healthcare sector faces major sustainability challenges. At the same time, many institutions are unable to bear these investments on their own. External capital provision through investors is becoming crucial. Sustainable healthcare real estate is also well aligned with ESG objectives.

Curative healthcare real estate responds to all these trends. It enables healthcare providers to organise care differently, smarter and more locally. As a result, the real estate not only generates a return, but also adds social value.

Underestimated investment segment

Despite the social urgency and political tailwind, institutional allocation to curative healthcare real estate remains limited. This is striking, as the segment has a strong investment profile. Some of the investment characteristics are:

1) Predictable rental income
Tenants operate within a regulated healthcare system, often financed through the Healthcare Insurance Act. This ensures predictable income and low vacancy rates. Contracts of ten years or more are common, with indexation.

2) High net return
Practical data shows that curative healthcare real estate has consistently delivered a higher net initial return in recent years than many traditional real estate segments, such as offices or shops (see Figure 1). It combines return with social impact.

3) Low volatility
Curative care real estate is less affected by economic cycles. This makes it a defensive investment with stable cash flows. The combination of return and risk in terms of volatility is attractive.

4) Functional ties
Buildings are tailored to care processes. This creates location loyalty and a low risk of change. General practitioners and pharmacists in particular have strong local ties.

5) ESG value
Investments in this segment make a demonstrable contribution to social goals: better access to care, shorter waiting times, lower pressure on the healthcare system and more sustainable use of real estate.

Curative healthcare real estate therefore offers a powerful combination of financial returns and social relevance. This is particularly attractive in times of rising healthcare costs, ESG accountability pressure and economic uncertainty.

Manageable risks

Like any real estate segment, curative healthcare real estate also has risks.

The risks are mainly policy-related, with additional attention to technological obsolescence of real estate and limited market liquidity. These risks can be managed through active monitoring, portfolio diversification and a sharp focus on future-proof concepts that are in line with social and policy developments, such as the Integral Care Agreement.

The biggest challenge for investors lies in the limited scale and access to suitable properties. Curative care real estate is a fragmented, relatively small-scale market in which suitable investment properties are scarce. This requires specialist knowledge, local market knowledge and an active acquisition strategy.

At the same time, this niche position offers a clear opportunity: investors who manage to overcome these barriers will benefit from higher initial yields than other healthcare real estate categories. The segment therefore constitutes a distinctive asset within a diversified real estate portfolio, with an attractive risk-return profile and direct social impact.

A healthy building block for institutional portfolios

Curative care real estate offers institutional investors an attractive and robust profile, combining solid net returns, predictable cash flows and social value. In an environment of demographic pressure, rising healthcare costs and sustainability challenges, this segment is a powerful tool for combining financial and social returns.

The distinctive advantage lies in the structurally higher net returns, the limited correlation with economic cycles and the direct link to social needs. This makes curative care real estate an excellent fit for portfolios with a low risk profile and a long investment horizon.

Successful investment does require specialist knowledge, an active acquisition strategy and cooperation with healthcare parties. Investors who take steps now in this relatively unexplored market are positioning themselves for attractive long-term prospects.