First it was private cosmetic and eye surgery units and now private orthopaedic units opening in the Netherlands. Dick Westerveld, the head of MRI Centrum, a private imaging and radiology group with four centres in the Netherlands says 5-6 ambulatory day surgery units have opened in the last few years.

The largest, Zestienhoven Kliniek has some 12 orthopaedic specialists, and is part of the Nova Medi, a three clinic group which also specialises in cosmetic and eye surgery. Others include Sint Maartens Kliniek in Arnhem. Mediferia, a start up in January 2008, specialises in scanning and diagnosing joint and back pain, although it doesn’t actually carry out surgery itself. The idea is to adopt a holistic approach and to often refer patients for physiotherapy rather than operating thus saving insurers money and improving patient outcomes.

In fact, private clinics in the Netherlands are still in their infancy, according to Frank van Ham at Mediferia: “Around 140 have applied of which 80 are operational. Many of these are in psychiatry and care of the elderly and around 60 are owned by the local public or not for profit hospitals so there are only around 20 self-standings clinics run as private enterprises.”

Dick Westerveld expects more private clinics to open. “A lot of specialists are now going part time and spending maybe 70% of their time privately and 30% working in the public sector.”

The new ambulatory surgery clinics claim to be able to deliver high quality treatment at lower prices which is good for the large statutory insurers who, following privatisation, are now either privately owned or are large mutuals.

But there are long lead times to prove the case for pioneers like Medifiera. Frank van Ham says: “We are running a big research programme to prove that our holistic approach works better – it is going to take two years for the results.”