The silent siphon in Dutch healthcare, how more than 600 consultancy agencies drain millions meant for patients
Dutch healthcare is under enormous pressure. Aging, staff shortages, rising drug prices, and increasingly complex administrative rules pose significant challenges. At the same time, there is a growing but underreported crisis: a consultancy industry deeply embedded between policy, administration, and care delivery. According to 2025 rankings of consultancy firms in the Netherlands, over 500 agencies are active in the healthcare sector (Beste adviesbureaus van Nederland per sector 2025, consultancy.nl). Including smaller and medium-sized firms, this means over 600 consultancy agencies operate around healthcare institutions, insurers, and related organizations.
The implications are enormous: money intended for direct patient care often ends up in reports, advisory projects, and administrative overhead, rather than at the bedside or in community care.
This article explains why this consultancy culture can lead to the waste of resources, higher costs, weakening of internal expertise, and ultimately reduced effective care, often invisible, but systemic and significant.
A sector driven by advice rather than trust
The Netherlands has a highly regulated healthcare system. Administration, oversight, accountability, and digitalization are standard. Institutions must comply with countless rules: patient safety, quality measurements, reporting obligations, and regulatory requirements. This creates bureaucratic pressure, and consultancy agencies present themselves as guides through this complexity.
Healthcare institutions, often understaffed and overworked, rarely question whether changes could be implemented internally. External consultants are seen as a solution: they can design strategies, suggest reorganizations, and implement systems. However, outsourcing in this way creates structural dependency.
Dependency feeds itself: the more an institution hires external consultants, the more internal expertise diminishes, making it increasingly difficult to manage without external support.
Where the money goes
High fees and turnovers
Consulting in healthcare is far from part-time. Studies of Dutch consultancy firms show average hourly rates around €112 per hour (Gemiddeld uurtarief van Nederlandse consultancybureaus 112, consultancy.nl). Senior strategic consultants can charge significantly more. According to research on healthcare consultants, mid-level to senior consultants can earn €4, 000 to €9, 000 per month (Zorgconsultant, Zorgjob.nl).
For a medium-sized project with five consultants working full-time for several months, costs can quickly reach the equivalent of the annual salary of dozens or even hundreds of healthcare workers.
This is concerning in a sector already facing severe staff shortages and difficulties filling positions.
Growing overhead, shrinking patient care
Research shows that administrative and overhead costs in Dutch healthcare are substantial. For nursing care (VVT), disability care (GHZ), and mental health care (GGZ), overhead percentages range from about 16% to 21% (Bladerpdf 4811, ESB). In hospitals, overhead can approach 20%.
This overhead includes not only traditional administrative costs but also consultancy, interim management, project management, and external hires. The growth of the consultancy industry indirectly reduces the share of funding for direct patient care: more money goes to “management costs” instead of beds, staff, medication, prevention, or quality improvements. A medical publication has long warned of rising overhead costs, noting that every euro spent on bureaucracy is one euro not spent on patient care (De verborgen kosten van ons zorgsysteem, Medisch Contact).
Reports, plans, and implementations — rarely lasting
Many consultancy projects end as thick reports, reorganization plans, or digital projects. Yet implementation often proves cumbersome, expensive, slow, or ineffective. New systems frequently increase administrative burden rather than relieve it, particularly when nurses, doctors, or logistics staff are not involved in the design or advisory phase.
The danger is that these projects have only temporary effects or, worse, increase workload. In such cases, investments of millions are little more than paper, often invisible to patients but recorded in institutional budgets.
Long-term contracts and vendor lock-in
Consultancy agencies rarely provide only advice; they offer entire trajectories: analysis, implementation, training, maintenance, support, and updates. Once a healthcare institution enters a project, it may be tied to the same provider for years due to contracts, licenses, support agreements, or vendor-specific systems.
This creates vendor lock-in, increases continuity and budget risks, and forces institutions to repeatedly hire external parties instead of building internal capacity.
Effects on healthcare professionals, patients, and society
Higher costs, higher premiums, reduced care
As consultancy and overhead grow, costs must be covered somewhere. Often, this means cutting personnel, materials, or resources. It may also reduce flexibility to open new beds, hire staff, or invest in quality or prevention.
In the long term, this translates into higher healthcare premiums or reduced services. Citizens ultimately pay as premium holders, covering the hidden cost of the consultancy industry.
Demotivation, workload, and attrition
Healthcare workers experience it directly: new processes, additional registrations, changes in workflows, often without consultation and without easing their work. This leads to frustration, cynicism, and, at times, leaving the profession.
Replacing one healthcare worker can cost institutions up to €30, 000 per employee (Verloop zorg, Zorggids Nederland). Investing in external consultants can indirectly accelerate staff attrition and loss of internal knowledge.
Weakening internal knowledge and autonomy
When institutions continuously rely on external expertise, internal knowledge is not developed. Processes, systems, and policies are designed, monitored, and updated externally. Internal staff lose control, over time, the organization loses the capacity to manage, innovate, or recover independently.
Lack of transparency and political oversight
Consultants are private entities. They operate on contracts and are not publicly accountable. When major policy decisions, reorganizations, or IT transformations are implemented based on their reports, it is difficult for citizens or politicians to exercise real oversight.
Decisions with substantial impact on patients and healthcare workers are made based on industrial advice, often without transparency about costs, results, or conflicts of interest.
Why this debate must happen now
Hidden costs are growing
Dutch healthcare expenditures are substantial. Institutions, insurers, and the government together spend tens to hundreds of billions annually (Zowerktdezorg 2023, Zowerktdezorg.nl). Even a small percentage of overhead translates to hundreds of millions or billions of euros.
When overhead and external hiring increase without measurable patient benefits, the system becomes unbalanced. Consultancy is intended as an aid, not the core. But aid now threatens to become the main component.
Urgency due to staff shortages and increasing demand
The healthcare sector faces chronic shortages, attrition, high workload, and growing demand from aging and complex patient needs. Resources are scarce, making efficiency and targeted spending essential.
Unnecessary spending on advisory projects that yield minimal results is not only inefficient but ethically problematic. Every euro spent on consultancy is one less euro for direct care.
Lack of transparency sustains waste
As long as consultancy contracts, amounts, goals, and outcomes are not publicly available, it is impossible to assess whether millions spent are justified. This opacity structurally perpetuates waste.
Possible alternatives and reforms
To curb this creeping waste and refocus healthcare on patients, measures must be implemented.
Mandatory insight into consultancy expenditures
- Institutions should be required to publish all consultancy contracts, including costs, duration, and intended objectives.
- Final reports and project evaluations should be publicly available, showing tangible results.
Transparency enables critical assessment, prevents managerial misuse, and allows political oversight.
Maximizing internal knowledge and capacity
Rather than routinely outsourcing, institutions should invest in staff training and capacity, for example in:
- Data analysis
- Process and quality management
- Governance and digital skills
Internal expertise ensures continuity, reduces dependency, and provides a better understanding of healthcare realities.
Independent review before large consultancy projects
Major projects, reorganizations, IT implementations, mergers, should be assessed by independent committees, examining:
- Necessity (is external advice really required)
- Alternatives (can it be done internally)
- Cost-benefit analysis (3–5 year outlook)
- Conflicts of interest (consultant relationships with suppliers)
Avoid vendor lock-in with open and modular systems
IT projects should prioritize open standards, modular systems, and vendor-independent solutions. This prevents institutions from being locked into a single provider and allows future flexibility without expensive new contracts.
Reducing overhead and management costs
The goal must be to minimize overhead and maximize patient-directed spending, critically evaluating what is truly needed versus what is superfluous.
Criticism and caveats
- Consultancy is not inherently bad. External advice can help with complex problems, digitalization, or temporary reorganizations. The problem is scale and structural dependency, not consultancy itself.
- Exact annual spending on consultancy in Dutch healthcare is hard to measure — administration is fragmented, contracts are not always public, and overhead is often aggregated with other costs.
- Some overhead is unavoidable: administration, accountability, oversight, and quality control are necessary in modern healthcare. The question is when advisory services and management become the norm rather than the exception.
Nonetheless, available data and accounts from professionals warrant serious concern.
Conclusion: returning focus to care, not consultancy
The consultancy culture in Dutch healthcare has slowly become a structural cost, sometimes at the expense of care itself. With hundreds of agencies, thousands of projects, contracts, and reports, healthcare funds risk being absorbed into overhead, advisory reports, and long-term IT contracts.
At a time when staff shortages, workload, and waiting lists are real, it is socially irresponsible to let money intended for patient care vanish into consultancy services and management.
It is time for transparency, assessment, and reevaluation: fewer external contracts, more internal knowledge, clarity on costs and outcomes, and a clear focus on patient-centered care.
Healthcare funds are not a playground for private companies; they are a societal responsibility.
