The MedTech
market in the
Netherlands
Produced for the Dutch Ministry of Health,
Welfare and Sports
—
2017

Disclaimer
This report was commissioned by the Dutch Ministry of Health, Welfare and Sports (VWS) on general terms that limit the liability of KPMG. Our
conclusions are the results of the exercise of our professional judgement, based in part on information from secondary sources and in part on
information gained through an extensive interview programme. Use of this report by any third party for whatever purpose should not, and does not,
absolve such third party from using their assessment in verifying the report’s contents.
Any use which a third party makes of this document, or any reliance on it, or decisions to be made based on it, are the responsibility of such third party.
The views and opinions expressed in this report are purely those of KPMG and do not necessarily reflect the opinion of VWS. KPMG accepts no duty
of care or liability of any kind whatsoever to any such third party, and no responsibility for damage, if any, suffered by any third party as a result of
decisions made, or not made, or actions taken, or not taken, based on this document.

© 2017 KPMG Advisory N.V., registered with the trade register in the Netherlands under number 33263682, a member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (‘KPMG International’), a Swiss entity. All rights reserved.

2

Executive summary
The purpose of this study is to provide an
objective snapshot of the current medical
technology market in the Netherlands
Our analyses confirm that the outlook for the
global market for medical technology is very
optimistic as the sheer size of the global market
(valued at €385bn in 2016) presents a huge
opportunity and technological advancements
continue to allow for new and improved
applications across all therapeutic fields.
Consequently, we observe an increasing variety of
technological applications that are being
developed and used for the treatment and support
of patients in hospitals, nursing homes and in the
home environment.
The rapid development of these new medical
technologies is causing the supplier and provider
landscape to evolve constantly. Both from the
supply and demand side, new business models
and ways of working are being introduced that
have an effect on the way in which MedTech is
used for the treatment of patients. Furthermore,
new European regulations governing market
access of new medical devices (MDR, 2020) and
in vitro diagnostics (IVDR, 2022) are expected to
impact the MedTech market in the next decade.

The Dutch medical technology sector reflects the
international landscape as Dutch suppliers cover a
broad range of technologies and service
practically all segments of the healthcare sector.
Given evolving patient needs and technological
possibilities, the dynamics in the MedTech market
are therefore constantly changing. Innovation in
the sector is fast-paced and it is difficult to predict
which innovations in MedTech will actually add
long-term value in terms of quality of care.

the market structure and most important actors;
2. In addition, this report (in combination with the
RIVM horizon scan which is planned for Spring
2018) aims to identify emerging trends and
technologies that are shaping the Dutch medical
technology market today and will do so in the
future. This knowledge will help VWS to formulate
its policy more effectively going forward,
especially in the context of the new MDR/IVDR
regulations.

These changes and developments in the global
and local Dutch medical technology market entail
a multitude of challenges and opportunities for
various stakeholders. In order to put these
developments into perspective, the Dutch ministry
of Health, Welfare and Sports (VWS) asked
KPMG to conduct a study which will serve as a
baseline for future measurement.
In light of this, our study aims to provide an
objective snapshot of the current status of the
medical technology market in the Netherlands. As
VWS itself indicated, this research has two main
purposes:
1. Current status update (status quo) of the sector
including an independent estimate of the market
size measured by value, as well as an overview of

© 2017 KPMG Advisory N.V., registered with the trade register in the Netherlands under number 33263682, a member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (‘KPMG International’), a Swiss entity. All rights reserved.

3

Executive summary
Conclusion
The overall results of our research show that the
medical technology market in the Netherlands was
valued at an estimated €4.7bn in 2016 (broken
down on the following pages). This estimate is
split between intramural (within the walls of an
institution/hospital) and extramural care (outside of
the walls of an institution/hospital), which are
valued at about €2.4bn and €2.3bn respectively.
Moreover, a gradual shift from intra- to extramural
MedTech seems to be taking place.
Most of the MedTech purchased in the
Netherlands is covered by basic health insurance
or municipality reimbursements. In total, some
85% of the MedTech market is covered by some
form of reimbursement.
An estimated 500-700 medical technology
suppliers are active in the Dutch MedTech market,
95%-97% of which are small and medium
enterprises (SMEs). Large suppliers are often
preferred by larger hospitals because of their
ability to deliver consistent quality in terms of
volume and performance. As a result of the small
number of larger Dutch MedTech players, a robust
view on the profitability of the industry is not

possible. Our limited dataset suggests that
profitability (EBIT) has slowly decreased to an
estimated 10%.

Internet of Things are further evolving to enable
seamless delivery of care remotely, as well as
in clinical/hospital settings;

Given the vast scope and size of the healthcare
industry and technological developments, many
trends are observed. We consider the following
medical technology trends most relevant for the
Dutch market:

— Large MedTech suppliers are making a gradual
shift towards customer-centric business and
service models;

— Hospitals are making a gradual shift from
invasive to less invasive technologies, which
potentially can reduce the duration of
treatments and the complexity of the resulting
wounds;
— Large medical devices are increasingly
becoming smaller;
— There is a continual shift from therapy and
treatment to prevention, especially driven by ehealth solutions and smart apps;

— The traditional supply chain for MedTech could
be disrupted owing to developments such as
vendor-managed inventory systems, the
Internet of Things and direct sales by medical
device manufacturers in the extramural market,
although we acknowledge that the structure of
the institutional landscape is partly responsible
for this;
— There is increasing use of smart apps that are
integrated with medical devices to provide realtime access to patient data and help to improve
clinical decision-making.

— Healthcare is becoming increasingly
personalised and medical technology is
becoming more focused on the specific patient;
— Patient care is making a gradual shift from
intramural care to care in the home
environment, aided by advancements in
medical technology. Patient-data-sharing
technologies, such as wearables and the

© 2017 KPMG Advisory N.V., registered with the trade register in the Netherlands under number 33263682, a member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (‘KPMG International’), a Swiss entity. All rights reserved.

4

Executive summary
Size of the medical technology market in 2016

Size of the medical technology market in 2016

Therapeutic categories

€bn

Patient care categories

€bn

Care products (incl. stoma and wound management)

0.6

Preventive care/self-care

0.1

Diagnostics and imaging (including lab diagnostics and patient monitoring)

0.5

General practitioner

0.1

Ophthalmic (incl. implants, prostheses and glasses)

0.4

Dentist

0.3

Cardiology (incl. prostheses and implants)

0.4

Pharmacy/medical specialty store

0.5

Orthopaedics (incl. prostheses and orthopaedic shoes)

0.3

Optician

0.4

In vitro diagnostics

0.3

Audiologist

0.2

General hospital and plastic surgery

0.3

Gynaecology

0.0

Medical aids (incl. communication, signalling, food delivery, mobility, and
arm-hand-finger function)

Paramedical care

0.2

0.3

Independent treatment centre (ZBC)

0.1

Dental

0.3

Mental healthcare (GGZ)

0.0

Ear, nose and throat (incl. hearing aids)

0.2

Rehabilitation care

0.3

Drug delivery (incl. dialysis)

0.2

General hospital

0.9

Diabetic care (incl. implants and prostheses)

0.1

Top clinical hospital

0.7

Respiratory equipment

0.1

University hospital (incl. labs)

0.5

Home adaptation equipment/supplies

0.1

Nursing homes/home care (VVT) intramural

0.2

E-health home automation/robotics

0.1

Nursing homes/home care (VVT) extramural

0.2

Neurology

0.1

Total

4.7

Endoscopy

0.1

Contraception (birth control)

0.0

Other

0.2

Total

4.7

© 2017 KPMG Advisory N.V., registered with the trade register in the Netherlands under number 33263682, a member firm of the KPMG network of
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5

Contents

Introduction and methodology

7

The MedTech market in the Netherlands

19

Dutch MedTech companies

30

Margins in the Dutch MedTech sector

33

Trends impacting the Dutch MedTech market

35

Appendix

51

© 2017 KPMG Advisory N.V., registered with the trade register in the Netherlands under number 33263682, a member firm of the KPMG network of
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6

Introduction
and
methodology

Introduction
Scope

The scope of this study (page 9)
The scope of this study encompasses
the entire medical technology market in
the Netherlands. This includes both
intra- and extramural medical technology
and medical technology which is covered
by basic health insurance (ZVW), the
long-term care act (WLZ), municipality
financed care (WMO) and privately
financed care.
This study includes an overview of
relevant actors and estimates of the size
of the market as well as identifying
trends that are impacting the medical
technology market

Definition

Methodology

Sources

MedTech definition used
throughout this report (page 10)

Method used in defining the
market size (pages 11-17)

Primary and secondary sources
used in this report (page 18)

The definition of MedTech used in this
report is based on the EU Regulation on
Medical Devices and includes all medical
technology that is aimed at improving
quality of care for patients (please refer
to page 10 for more details).

The therapeutic area – care provider
matrix served as the basis for defining
the size of the MedTech market in this
report. The primary and secondary
research conducted focused on
determining the size of the MedTech
market, its relevant actors and trends:

Primary sources used in this report
consist of sector organisations, insurers,
hospitals, private clinics and
manufacturers/wholesalers.

The market values presented are based
on the purchasing costs of the MedTech
products that are incurred by the paying
end-user, based on the sales prices of
the manufacturer or wholesaler.

― In the first stage of the analysis, desk
research was conducted to construct
the therapeutic area – care provider
matrix. In this analysis, existing
sources were triangulated and
assumptions were made in order to
come to an initial set of insights on
the market;

Secondary sources used in this report
comprise industry reports, analyst
reports and other relevant reports in the
medical technology sector.

― In the second stage of the analysis,
the findings of the first stage were
tested and further analysed in an
extensive interview programme
among buyers, producers and
representatives of industry
associations;
― In the third stage of the analysis,
findings were tested by the expert
panel which comprised industry
associations and experts.

© 2017 KPMG Advisory N.V., registered with the trade register in the Netherlands under number 33263682, a member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (‘KPMG International’), a Swiss entity. All rights reserved.

8

Scope

Definition

Methodology

Sources

Introduction and methodology
This report is designed to provide an independent view on the current size, structure and dynamics of the Dutch MedTech market

The questions which this report aims to answer as given by the ministry of VWS
Scope item
1

Which are the relevant actors in the Dutch MedTech market?

2

What is the value of the Dutch market for medical technology, both intra- and extramural, and both inside and outside the insured package?

3

What is the market share of the Dutch industry versus the European/global market?

4

What is the relationship between import and export of medical technology in the Netherlands?

5

What is the market share of SMEs versus big industry? Is there market dominance/are there economies of scale?

6

What are the profit margins for medical device manufacturers?

7

What developments have there been in both intra- and extramural medical technology? What is the explanation for the decrease/increase over recent years?

8

What is the relationship between medical technology used by care providers to treat patients, and used by patients themselves?

Trends
1

What shifts and trends are observed in the care landscape?
What role do care institutions, market players and patients play in this?

2

Are there trends towards a shift in in MedTech spending from intra- to extramural?

3

What trends can be observed in, for example, sales by a manufacturer directly to the patient, or by a manufacturer to a healthcare provider or by a provider to a healthcare
institution?

4

Trends in an international context.

© 2017 KPMG Advisory N.V., registered with the trade register in the Netherlands under number 33263682, a member firm of the KPMG network of
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9

Scope

Definition

Methodology

Sources

Introduction and methodology
The definition of MedTech is based on the definition in the EU Medical Devices Regulation

What is medical technology?

Demarcation of the market

Medical technology can be considered as any technology that is used to save and
improve the quality of lives.

To address the limits of this research, there are some elements that require specific
denotation. Within the scope of this research falls:

― The medical technology category ranges from everyday objects such as sticking
plasters, syringes and wheelchairs to hip and knee replacement joints and
advanced medical systems such as total body scanners(1).

― Medical technology that is used throughout the healthcare system. This includes
care covered by basic health insurance (ZVW), the law on long-term care (WLZ),
municipality financed care (WMO) and privately financed MedTech;

― The added value of medical technology is that it has a beneficial effect on the
patient’s quality of life. Advancements in medical technology have a positive effect
of prolonging human life.

― Maintenance costs without the human factor of maintenance, e.g. spare parts for
devices are included, whereas salaries for maintenance technicians are not;

― There are currently over 500,000 different types of medical devices.

― Medical technology used for research purposes including IVDs;

Definition of medical technology used in this report

― E-health/home automation, as long as it falls within the definition of a medical
device provided on the bottom left, e.g. prevention and monitoring software.

The definition of medical technology used in this report is based on the EU Regulation
on Medical Devices, which defines a medical device as follows:

Among other items, the following fall outside the scope of this research:

“‘medical device’ means any instrument, apparatus, appliance, software, implant, reagent, material or
other article intended by the manufacturer to be used, alone or in combination, for human beings for one
or more of the following specific medical purposes:
― diagnosis, prevention, monitoring, prediction, prognosis, treatment or alleviation of disease,
― diagnosis, monitoring, treatment, alleviation of, or compensation for, an injury or disability,
― investigation, replacement or modification of the anatomy or of a physiological or pathological
process or state,
― providing information by means of in vitro examination of specimens derived from the human
body, including organ, blood and tissue donations,
and which does not achieve its principal intended action by pharmacological, immunological or
metabolic means, in or on the human body, but which may be assisted in its function by such means.”

Source:

(1)

― Costs incurred for hospital automation, e.g. electronic patient records (EPD),
planning costs, workflow and other ICT costs;
― Staff costs for the operation and supervision of medical technology devices;
― Costs incurred for adjusting/modifying medical devices in hospitals;
― Maintenance costs with a human factor, e.g. maintenance contracts, third-party
services and maintenance costs.
The market will be quantified based on the purchasing costs of the MedTech products
that are incurred by the paying end-user, based on the sales prices of the
manufacturer or wholesaler.

Eucomed, MedTech Europe.

Global Medical Devices Nomenclature (GMDN) Agency. European Parliament.

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10

Scope

Definition

Methodology

Sources

Introduction and methodology
This study in the context of other studies on MedTech in the Dutch market

This study compared to other studies
concerning the Dutch MedTech market
The complex and broad nature of the medical
technology market and the varying interpretations of the
definition of MedTech make it difficult to identify an
overall market value for the Dutch market. Data
availability is scarce and secondary research often
differs in terms of the scope and definition used.
There have been a number of studies/publications
aimed at determining the value of the Dutch MedTech
market, all of which had different scopes and
methodologies (Ecorys 2011(1), ING 2012(2), Gupta
2017(3), Ecorys 2017(4)). However only a few studies
attempted to value both the intramural and extramural
market (MedTech Europe, 2015(5) in terms of
manufacturing prices).
Ecorys (2011) and ING (2012) both attempted to
document the intramural medical technology market
along the axes of medical equipment, medical
disposables, prostheses and implants, and medical
instruments. The data in these reports was gathered
through interviews and reported healthcare costs
(Ecorys) and using GlobalData (ING). These studies
both valued the intramural market at roughly €2.4bn
(2016 prices).
The scope and definition used in the MedTech Europe
report (2015) comprised both the intramural and

extramural medical technology market in terms of
manufacturing prices. Therefore the scope of that study
is closest to the scope used in this report. The market
size (roughly €4.4bn in 2016 prices) was estimated
based on available sources and interviews with industry
associations.

medical technology are limited. Therefore, this report
estimates the market along the detailed therapeutic
areas – care category matrix (see next pages for more
details), which is based on secondary research and
verified through an extensive interview programme (35+
interviews) and expert panel meetings.

The most recent publications by Gupta (2017) and
Ecorys (2017) both focused on the intramural market.
Gupta valued the market in 2016 primarily based on
purchasing costs of hospitals (using data obtained from
annual reports) and an assumption of the MedTech
percentage in the categories of diagnostics, implants,
medical disposables and medical technology. This
report valued the intramural market at €2.7bn in 2016.
In its latest report, Ecorys used a similar method to
determine the market size as the one used in 2011, and
valued the intramural market at €3.2bn in 2016.

Limitations of the method used in this
report

Method used in this report
In this study, both the intramural and extramural market
are valued based on a combination of primary and
secondary sources. This report does not use any single
approach (for example a percentage of healthcare costs
as used by Ecorys), but uses multiple verification
stages and research sources to determine the market
value of MedTech in the Netherlands (see page 18 for
sources used). This approach has been applied as
detailed secondary research and data sources around

© 2017 KPMG Advisory N.V., registered with the trade register in the Netherlands under number 33263682, a member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (‘KPMG International’), a Swiss entity. All rights reserved.

There are a number of limitations to the method that
was used in this report. Firstly, the available secondary
data was often only available on a highly aggregated
level, which meant that certain assumptions were
needed in order to estimate MedTech spending.
Secondly, although controlled for, the usage of various
data sources could potentially lead to a slight overlap of
costs in some buckets. Thirdly, because they tend to
lack conclusive data, industry associations,
producers/wholesalers, insurers and hospitals were
only able to provide a detailed view on the market value
of their respective segments to a limited extent.

Source:

(1)
(2)
(3)
(4)
(5)

Ecorys, 2011, ‘Sectorstudie medische hulpmiddelen.
ING, 2012, ‘Sectorstudie Medische Apparatuur’.
Gupta Strategists, 2017, ‘Waardegedreven inkoop’.
Ecorys, 2017 ‘De waarde van zorgtechnologie’.
MedTech Europe, 2015, ‘The European Medical Technology industry’.

11

Scope

Definition

Methodology

Sources

Introduction and methodology
The size of the Dutch medical technology industry is estimated along the therapeutic area – care category matrix

Therapeutic area – care category matrix
A

Dutch MedTech
market

Totals

B

Therapeutic areas

Patient care categories

Total
MedTech
market in the
Netherlands

Totals

The therapeutic area – care category matrix served as
the basis for evaluating the size of the MedTech market
in this report. The primary and secondary research that
was conducted focused on these categories to analyse
the size of the MedTech markets, its relevant actors
and trends.
A. Patient care categories (pages 13-16)
The patient care categories are designed in a way that
reflects the largest care categories in the Dutch
healthcare system. The broad categories are;
preventive care, primary care, secondary care, tertiary
care and long-term care

These broad ranges are subdivided into smaller
categories that aim to reflect the way in which medical
technology reaches the end user, which could be either
a patient or care institution.

Data from prior reports, the Central Bureau for Statistics
(CBS), industry data/research and annual reports of
institutions were analysed and plotted along the patient
care categories and therapeutic area axes.

B. Therapeutic areas (page 17)

Second stage – interview phase

The therapeutic areas aim to reflect the areas in which
medical technology is present within the patient care
categories, both intramural and extramural.

In the second stage, an extensive interview programme
was conducted consisting of more than 35 interviews.
These interviews served to validate and test the market
size and trend hypotheses of the first phase. The
interview programme was focused on the size and
trends in the individual markets across both the patient
care categories and the therapeutic areas.

The therapeutic areas reflect treatment categories in
which MedTech is used by either a care provider (i.e.
an institution) or a patient.

Determining the market size
In determining the size of the medical technology
market in the Netherlands, a combination of primary
and secondary sources is used.
First stage – desk research
In the first stage of the analysis, desk research was
conducted to construct the therapeutic area – care
provider matrix. In this analysis, existing sources were
triangulated and assumptions were made in order to
come to an initial set of insights about the market.
An estimate of the market size is made for the patient
care categories and the therapeutic areas in order to
test these assumptions separately.

© 2017 KPMG Advisory N.V., registered with the trade register in the Netherlands under number 33263682, a member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (‘KPMG International’), a Swiss entity. All rights reserved.

The assumptions for the sub-categories were tested
with care institutions, insurance companies, market
experts and industry associations.
Third stage – feedback phase
The main findings of the first two phases were
consolidated and further analysed in order to reach a
concluding report of draft findings that was shared
among the members of the expert panel comprising
representatives from industry associations.
Based on these discussions, the matrix and identified
trends were investigated further and adjusted where
necessary before finalisation.

12

Scope

Definition

A
Methodology

Sources

Introduction and methodology
Distinct specialised care providers operate in different patient care categories

Patient care categories
Self-care/preventive care

Primary care

Secondary care

Tertiary care

Long-term care

Preventive care is aimed at
preventing diseases and
increasing the general health
of the population.
In order to reduce costs in the
healthcare sector and improve
the quality of life, preventive
care is attracting increasing
attention.

Primary care refers to all care
that is accessible for all
patients without restrictions.
The general practitioner (GP)
generally has a central role as
primary care provider. The GP
determines care needs and
may refer patients on for
specialist care i.e.
secondary/tertiary care if
necessary.
Other primary care providers
include dentists, opticians,
audiologists as discussed on
the following page.

This comprises all care
needing a GP referral.
Generally these referrals are
to specialists in hospitals or
clinics.
Rehabilitation and mental
healthcare are also included
here. In general, a patient can
not get treatment in this
category without a referral.

Tertiary care includes experts
in an academic hospital and
specialised laboratories. This
type of care includes medical
specialties that support
secondary healthcare
providers.

Long-term care refers to
nursing homes, home care
and other types of care that
happen outside the hospital
and tend to have a longer
duration, it is sub-divided into
intra- and extramural care.

© 2017 KPMG Advisory N.V., registered with the trade register in the Netherlands under number 33263682, a member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (‘KPMG International’), a Swiss entity. All rights reserved.

13

Scope

Definition

A
Methodology

Sources

Introduction and methodology
MedTech has a distinct role in the activities of each care provider in the patient care categories (1)

Patient care categories
Category
Self-care/preventive
care

Role
This category emphasises
disease prevention. Preventive
care includes healthcare
education, hygiene in food
preparation and compliance with
safety regulations for disease
prevention.

Care provider types
The most important care providers in self-care/preventive care using MedTech are:
— Family carers (caregiving): Caregiving could be provided by family members or other close relatives.
They provide daily assistance to ensure that the activities of daily living are possible;
— Health agencies (e.g. the Dutch municipal or common health service (GGD)): Health agencies
provide healthcare and hygiene education in the Netherlands. They try to create awareness around
healthcare, e.g. sexually transmitted diseases, dangers of obesity;
— Private purchasers: Medical technology can also be purchased prior to consulting a formal institution
(municipality/hospital or other).

Primary care

Primary care includes GPs,
pharmacists, dentists and others.
GPs play a central role in the
healthcare system in the
Netherlands and act as
‘gatekeepers’ in that they
examine patients and determine
whether specialist care is
necessary.

The most important care provider segments using MedTech in primary care are:
— GPs: General practitioners are the first point of contact for healthcare in the Netherlands and can
provide referrals to all medical specialists;
— Dentists: Dental care includes dental prostheses, braces and other dental care;
— Pharmacy/medical specialty stores: Pharmacies/specialty stores distribute medical products and
medicines that are not always prescribed/recommended by the care provider;
— Opticians: An optician is a practitioner who designs, fits and dispenses corrective lenses for the
correction of a person's vision. Opticians determine the specifications of various ophthalmic
appliances to correct a person's eyesight;
— Audiologists: An audiologist is a healthcare professional specialising in identifying, diagnosing,
treating and monitoring disorders of the auditory and vestibular systems in the ear;
— Gynaecology and obstetrics care providers: This field concentrates on pregnancy, childbirth and the
postpartum period;
— Paramedic care providers: Paramedic care is aimed at reducing the functional consequences of a
disease or condition. A GP can refer patients for paramedic care such as occupational therapy,
physiotherapy and speech therapy.

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independent member firms affiliated with KPMG International Cooperative (‘KPMG International’), a Swiss entity. All rights reserved.

14

Scope

Definition

A
Methodology

Sources

Introduction and methodology
MedTech has a distinct role in the activities of each care provider in the patient care categories (2)

Patient care categories
Category
Secondary care

Role
A patient who has been provided
with primary care may be
referred to a secondary care
professional. Secondary care
includes acute care: necessary
treatment for a short period of
time for a brief but serious
illness, injury or other health
condition, such as in a hospital
emergency department. These
are consultant-led services
which include psychology,
psychiatry and orthopaedics.
Secondary care is usually but
not always delivered in a
hospital/clinic with the initial
referral being made by the
primary care professional.

Care provider types
The most important care providers in secondary care using MedTech are:
— General hospitals: A hospital is a healthcare institution providing patient treatment with medical
equipment and specialised medical and nursing staff;
— Top clinical hospital: A hospital that distinguishes itself from general hospitals by always choosing
the forefront position with patient-oriented scientific research, top-level care and education. It often
has a specific medical specialty area;
— Academic hospitals also offer less complex care, however in order to exclude double counting, in
this study academic hospitals are accounted for in tertiary care;
— Independent treatment centres are private clinics. They perform common elective i.e. nonemergency, surgery as well as diagnostic procedures and tests. Common treatments at an
independent treatment centre include hip replacements, cataract operations or MRI scans rather
than more complex operations like neurosurgery;
— Mental healthcare: Mental healthcare providers offer counselling, treatment and support to people
with different mental health problems or psychiatric disorders such as anxiety disorders, depression,
addiction, aggression or schizophrenia;
— Rehabilitation care: Rehabilitation care is a treatment designed to facilitate the process of recovery
from injury, illness or disease to as normal a condition as possible. The purpose of rehabilitation is to
restore some or all of the patient's physical, sensory and mental capabilities that were lost owing to
injury, illness, or disease.

© 2017 KPMG Advisory N.V., registered with the trade register in the Netherlands under number 33263682, a member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (‘KPMG International’), a Swiss entity. All rights reserved.

15

Scope

Definition

A
Methodology

Sources

Introduction and methodology
MedTech has a distinct role in the activities of each care provider in the patient care categories (3)

Patient care categories
Category

Role

Tertiary care

Once a patient is hospitalised,
they may require highly
specialised treatment and care
within the hospital. Tertiary care
requires professionals, usually
surgeons with specific expertise
in a given field, to carry out
investigation and treatment for
the patient.

The most important care providers in tertiary care using MedTech are:

Long-term care includes nursing
homes, care at home and other
types of care that happen
outside the hospital and tend to
be more long-term.

The most important care providers in long-term care using MedTech are:

Long-term care

Care provider types

— Academic hospitals: Academic hospitals can provide highly specialised treatments. Examples of
tertiary care services are cancer management, neurosurgery, cardiac surgery, plastic surgery,
treatment for severe burns, and other complex medical or surgical interventions;
— Top clinical hospitals also offer complex care, however in order to exclude double counting, in this
study top clinical hospitals are accounted for in secondary care.

— Intramural and extramural VVT care providers: Intramural refers to nursing homes, which are a type
of residential care that provides around-the-clock nursing care for elderly people and other persons
in need of long-term care. Extramural refers to home care, which is care given at the homes of
elderly people or people who need special care e.g. after intramural treatment.

© 2017 KPMG Advisory N.V., registered with the trade register in the Netherlands under number 33263682, a member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (‘KPMG International’), a Swiss entity. All rights reserved.

16

Scope

Definition

B
Methodology

Sources

Introduction and methodology
Usage of MedTech has been divided into 17 defined therapeutic areas

Therapeutic areas identified

The Dutch medical technology market

Therapeutic area

Description

The MedTech market can be categorised into two main streams –
medical devices and in vitro diagnostics.

1

Care products

Medical products incl. stoma, incontinence materials and wound management materials

Medical device market (2-4, 6-17)

2

Diagnostics and imaging

Diagnostics, imaging systems including patient monitoring

3

Ophthalmic

Visual aids including lens implants and glasses

4

Cardiology

Medical technology related to cardiology procedures incl. prostheses and implants

5

In vitro diagnostics

In vitro diagnostics are tests that can detect diseases, conditions, or infections

6

Orthopaedics

Orthopaedic-related MedTech such as implants, prostheses and orthopaedic shoes

7

General hospital and plastic surgery

General hospital and plastic surgery medical equipment including tools, disposables

8

Ear, nose and throat

ENT MedTech including hearing implants, hearing aids and ear irrigation equipment

9

Diabetic care

Includes disposables (test-strips) and equipment e.g. insulin pumps, injection equipment

10

Drug delivery

MedTech used for transporting pharmaceutical compounds into the body incl. dialysis

11

Respiratory equipment

MedTech equipment such as oxygen machines and CPAP equipment

— Investigation, replacement or modification of the anatomy or of
a physiological process;

12

Home altering elements

Home altering elements needed to assist people with a disability in their everyday lives

— Control of conception.

13

E-health/home automation/robotics

E-health/home automation/robotics equipment classified solely as MedTech

14

Dental

MedTech used in dental procedures, including disposables, prostheses and implants

In this report, we identified 17 therapeutic areas (and a category
‘other’).

15

Neurology

Medical technology used in neurology diagnosis and analysis

In vitro diagnostics (5)

16

Medical aids

MedTech that supports daily functioning of the patient including communication,
signalling, food delivery, mobility aids, and arm-hand-finger function

17

Endoscopy

Equipment used to look inside the body

Other

Other MedTech which is not specified in the above categories

The in vitro diagnostics market is characterised by any medical
device which is a reagent, reagent product, calibrator, control
material, kit, instrument, apparatus, equipment or system, intended
by the manufacturer to be used for the examination of specimens,
including blood and tissue donations, derived from the human
body, solely or principally for the purpose of providing information.

Source:

KPMG analysis, GIP Peilingen, GlobalData (medical equipment).

© 2017 KPMG Advisory N.V., registered with the trade register in the Netherlands under number 33263682, a member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (‘KPMG International’), a Swiss entity. All rights reserved.

The medical device market denotes any instrument, apparatus,
appliance, software, material or other article, whether used alone
or in combination, including the software intended by its
manufacturer to be used specifically for diagnostic and/or
therapeutic purposes. This includes:
— Prevention, diagnosis, monitoring, treatment or alleviation of
disease;
— Diagnosis, monitoring, treatment, alleviation of or
compensation for an injury or handicap;

17

Scope

Definition

Methodology

Sources

Introduction and methodology
Data presented in this report is based on an extensive interview programme, secondary research and expert panel meetings

Sources used in this report
Primary sources (interviews)

Health insurers

Sector organisations

— CZ
— VGZ

— Gupta, 2017 'Waardegedreven
inkoop'

— Capital IQ

— Actiz
— Dekra

Hospitals

— Zorgcijfer databank

— Company websites

— Diagned

— General hospital (1)

— Germany Trade & invest

— DVN

— General hospital (2)

— ING, 2012 'Sectorstudie medische
apparatuur'

— Ergotherapie NL

— General hospital (3)

— Farmacotherapeutischkompas

— PharmaField

— NVVC

— Top clinical hospital (1)

— GlobalData (Medical Equipment)

— Intrakoop

— FHI

— Top clinical hospital (2)

— GIP Peilingen

— Firevaned

— Top clinical hospital (3)

— EvaluateMedTech

Expert panel

— Academic hospital (1)

— Euromed

— Dekra

— Academic hospital (2)

— EY 'Pulse of the Industry, 2017'

— Diagned

— Academic hospital (3)

— MedTech Europe

— FHI

— Neprofarm

Producers/wholesalers

— Zorginstituut Nederland

— Firevaned

— NFU

— Draeger

— FME

— Nuvo

— Medux/Hartigbank

— KPMG Nieuwe bekostiging
eerstelijnsdiagnostiek

— NVAB (kindhoren)

— Orthopaedic manufacturer

— Nefemed

— NVMBR

— Sensara

— KPMG Lifesciences and healthcare
briefing

— Revalidatiezorg NL

— Siemens Healthcare

— Global Medical Devices
Nomenclature Agency

— Patiënten federatie

— TNO

Secondary sources

— ZKN

— VGN

— NVZ Ziekenhuizen

— Ecorys, reports on MedTech 2011,
2017

— LHV
— Nefemed
— Nefrovisie

— TFHS

— Rabobank 'Sector rapport medische

technology'

— Emergo Group, EHCI, 2016
— Annual reports

— MedTechEngine

— FMS
— NVZ
— VWS

— CBS

© 2017 KPMG Advisory N.V., registered with the trade register in the Netherlands under number 33263682, a member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (‘KPMG International’), a Swiss entity. All rights reserved.

18

The MedTech
market in the
Netherlands

The MedTech market in the Netherlands
The Dutch MedTech market is estimated at >1% of the global market value and about 4%-5% of the EU value, estimated at €4.7bn in 2016

World market

Medical technology market, 2016 (in €bn)
385

4.7

110

Other
40
Russia
Brazil
Canada
China
Japan

Europe

4

Other
7

23

2

31

Switzerland

4

The European MedTech market is estimated at €110bn(1) in 2016, with the largest
European producer being Siemens (€15bn) in Germany, followed by Philips (€13bn)
in the Netherlands.

2
3

Netherlands

5

Spain

7

Italy

11

110

European healthcare systems are largely financed through payroll taxes or general
taxation, making it a highly regulated market in terms of prices and quality. Demand in
the region is strong, as Europe’s population is aging faster than the world average.

The Netherlands
Medical
devices

France

16

Germany

30

162

GLOBAL

EUROPE

Eucomed, EvaluateMedTech, KPMG analysis.

The Dutch MedTech market is estimated at €4.7bn in 2016, based on manufacturing
and wholesale prices. The Dutch healthcare system is considered to be one of the
best in Europe3 and the Netherlands is a major hub in the European MedTech market.
The MedTech market in the Netherlands makes up a relatively small portion
(approximately 4%) of the European market and 1% of the global market. However
the Dutch MedTech market is among the more advanced markets in Europe, and
Dutch manufacturers compete with European and global players in both the national
and international markets.

In vitro
diagnostics

Source:

4.4

14

UK

USA

Europe

16

Austria
Sweden
Belgium

8

The world MedTech market is estimated at €385bn(1) in 2016 and the largest market is
the US, followed by Europe and Japan. The largest company in the MedTech industry
is Medtronic, with sales of €25bn(2) in 2016.

0.3

NETHERLANDS

The Dutch MedTech market is expected to grow going forward as a result of, among
other factors, 1) wider adoption of medical technology in everyday lives, 2)
advancements in technology that enable us to detect diseases at an early stage, 3)
substitution of labour with technology.

Source:

(1)

EvaluateMedTech.

(2)

Eucomed.

(3)

EHCI.

© 2017 KPMG Advisory N.V., registered with the trade register in the Netherlands under number 33263682, a member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (‘KPMG International’), a Swiss entity. All rights reserved.

20

The MedTech market in the Netherlands
MedTech and medicines spending in the Netherlands are both estimated at roughly 5% of the total healthcare spending in 2016

Medical technology and medicines as a proportion of total
healthcare spending in the Netherlands, 2016

Therapeutic areas as a percentage of total healthcare
spending
Care products

0.6%

Diagnostics and imaging

0.5%

Ophthalmic

MedTech
5% Medicines
5%

Total
healthcare
costs
€96.1bn

0.4%

Orthopaedics

0.4%

In vitro diagnostics

0.3%

General hospital and plastic surgery

0.3%

Medical and mobility aids

0.3%

Dental

0.3%

Ear, nose and throat

Other healthcare
costs
90%

CBS, Medicijnmonitor, 2017, KPMG analysis.

0.2%

Diabetic care

0.2%

Drug delivery

0.2%

Respiratory equipment

0.1%

Home adaptation equipment

0.1%

E-health, home automation, robotics

0.1%

Neurology

0.1%

Endoscopy

0.1%

Other

Source:

0.5%

Cardiology

Source:

0.2%

CBS, KPMG analysis.

© 2017 KPMG Advisory N.V., registered with the trade register in the Netherlands under number 33263682, a member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (‘KPMG International’), a Swiss entity. All rights reserved.

21

The MedTech market in the Netherlands
The value chain of the Dutch MedTech system comprises many actors

The value chain of the Dutch MedTech system

MedTech
developers

Notified
bodies

Agents/
importers

(2)

MedTech
producers

Payment through basic health insurance, municipalities
(WMO), government (WLZ), private insurance and noninsured payments

Distribution

Patient care A
categories

Wholesalers

Preventive care

Distributors

Primary care

Specialty stores

Secondary care

Therapeutic B
areas

Patient
All MedTech that
ends up being used
by patients flows
through the patient
care categories and
the therapeutic
areas

(500-700)

Tertiary care
long-term care

Total
market
value
€4.7bn

1
2
3

Market split,
please refer
to pages 2729

Can both be
end users

Note:

There are two notified bodies for certification: DEKRA certification and DARE!! Medical certifications.

Key:

A

Patient care category

B Therapeutic areas

1

Intra/extramural MedTech

2

(x)

Number of actors active

Insured/non-insured MedTech

3 Used by care provider/patient

© 2017 KPMG Advisory N.V., registered with the trade register in the Netherlands under number 33263682, a member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (‘KPMG International’), a Swiss entity. All rights reserved.

22

The MedTech market in the Netherlands
The largest share of the Dutch healthcare budget is spent on secondary care technology

The Dutch MedTech market along the
patient care category axis
Long-term care
Tertiary care

A

The Dutch MedTech market along the therapeutic
areas axis

B

Care
products

Preventive
care

8% 1%

13%
Other

10%

Primary
care

37%

11%

37%

€4.7bn

€4.7bn

Diagnostics,
imaging and
monitoring

10%
Ophthalmic
8%

43%

6%
7%
General
hospital and
plastic surgery

Secondary
care

In vitro
diagnostics

7%

Cardiology

Orthopaedics

Note:

Please see page 24 for more details on the patient care categories.

Note:

Please see pages 25-26 for more details on the patient care categories.

Source:

KPMG analysis.

Source:

KPMG analysis.

Further market split estimates
1

Intramural MedTech

50%

2

Insured MedTech

85%

15% Non-insured MedTech

3

Used by care provider

80%

20%

Source:

Extramural MedTech

50%

Used by patient

KPMG analysis, interview feedback.

© 2017 KPMG Advisory N.V., registered with the trade register in the Netherlands under number 33263682, a member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (‘KPMG International’), a Swiss entity. All rights reserved.

23

A

The MedTech market in the Netherlands
MedTech spending tends to increase in line with the complexity or duration of illnesses

The Dutch MedTech market along the patient care category
axis (in €bn)
Preventive care/self-care

0.06

General practitioner

0.07

1

1. Preventive care: MedTech in preventive care is currently at an early stage.
Companies like Google, Apple and also start-ups facilitate and create apps that are
specifically designed to detect potential medical issues through algorithms in phones
and wearables. Also 'smart homes' for elderly and disabled people are used for
preventive purposes.

2

2. Primary care: In primary care, MedTech can be found in for example care products,
including stoma and wound management, and diabetic care essentials and other care
products distributed through pharmacies and medical specialty stores. In addition, a
large portion of MedTech spending is within the visual aids category that is distributed
through opticians and includes glasses and lenses, as well as hearing aids and
MedTech used in paramedical care.

0.29

Dentist

0.53

Pharmacy/medical specialty store

0.43

Optician
0.22

Audiologist

Comments

Gynaecology 0.01
0.19

Paramedical care
Independent treatment centre (ZBC)

0.09

Mental healthcare (GGZ)

0.03

Rehabilitation care

0.26

3
0.94

General hospital
0.72

Top clinical hospital
0.47

Academic hospital
Nursing homes/home care (VVT) intramural

0.23

Nursing homes/home care (VVT) extramural

0.16

Key:
Source:

Included in the intramural medical technology market.

4
5

3. Secondary care: In secondary care, hospitals are the most prominent MedTech
users, with capital-intensive medical technology that is used for diagnostics and
imaging, including lab diagnostics and patient monitoring, as well as other MedTech
such as disposables and cardiology equipment including prostheses and implants.
MedTech in secondary care also includes all medical aids used in rehabilitation care
and other treatment centres.
4. Tertiary care: Academic hospitals tend to acquire the most high-end medical
technology and usually cooperate with large suppliers to develop and improve the
medical technology used in capital-intensive devices. Academic hospitals tend to use
the latest diagnostic and imaging equipment, including lab diagnostics and patient
monitoring, as well as high-end disposable equipment and technologies.
5.Long-term care: In long-term care, medical technology includes respiratory
equipment, home automation, home altering elements and medical aids, such as for
communication or mobility. Home automation is expected to play a larger role in the
future as the Dutch population is ageing.

KPMG analysis.

© 2017 KPMG Advisory N.V., registered with the trade register in the Netherlands under number 33263682, a member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (‘KPMG International’), a Swiss entity. All rights reserved.

24

B

The MedTech market in the Netherlands
The Dutch MedTech market along the therapeutic treatment area axis (1)

The Dutch MedTech market along the therapeutic
area axis (in €bn)
Care products (general disposables)

1

0.58

Diagnostics and imaging

2

Ophthalmic

3

Cardiology

4

Orthopaedics

5

0.34

In vitro diagnostics

6

0.34

General hospital and plastic surgery

7

0.29

Medical and mobility aids

8

0.27

Dental

9

0.27

0.50
0.44
0.37

Ear, nose and throat 10

0.24

Drug delivery 11

0.19

Diabetic care 12

0.12

Respiratory equipment 13

0.12

Home adaptation equipment 14

0.12

E-health/home automation/robotics 15

0.11

Neurology 16

Source:

1. The care products segment is broad and mostly includes disposable items such as
stoma care supplies, incontinence materials, catheters and wound management
materials.
2. Approximately 70% of the diagnostics and imaging therapeutic area comprises
apparatus for diagnostic and imaging purposes; other categories within this
segment include patient monitoring equipment. Imaging equipment is also used in
other therapeutic areas such as cardiology.
3. Ophthalmic includes specialty glasses for the visually impaired as well as regular
glasses and lenses. This is measured using manufacturers’ prices and excludes
costs for aesthetics, consulting and other costs related to the sale of visual aids.
Implants and prostheses are also included in this category.
4. MedTech in cardiology includes implants and prostheses used in cardiologyrelated procedures as well as diagnostic apparatus and disposables that are
specifically utilised in cardiology-related procedures.
5. The orthopaedics category includes orthopaedic-related medical technology such
as implants and prostheses as well as orthopaedic shoes.
6. The market for in vitro diagnostics consists of all the lab equipment and
disposables needed to perform tests for the purpose of detecting diseases,
conditions or infections. Also included is self-measuring equipment for blood
clotting times.

0.06

7. General and plastic surgery medical equipment includes tools, disposables and
implants used in general and plastic surgery procedures.

Endoscopy 17 0.05
Other

Comments

0.22

8. Medical aids include aids for communication, signalling, food delivery, mobility
(e.g. wheelchairs and automatic wheelchairs) and arm-hand-finger functions.

KPMG analysis.

© 2017 KPMG Advisory N.V., registered with the trade register in the Netherlands under number 33263682, a member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (‘KPMG International’), a Swiss entity. All rights reserved.

25

B

The MedTech market in the Netherlands
The Dutch MedTech market along the therapeutic treatment area axis (2)

The Dutch MedTech market along the therapeutic
area axis (in €bn)
Care products (general disposables)

1

0.58

Diagnostics and imaging

2

Ophthalmic

3

Cardiology

4

Orthopaedics

5

0.34

In vitro diagnostics

6

0.34

General hospital and plastic surgery

7

0.29

Medical and mobility aids

8

0.27

Dental

9

0.27

0.50
0.44
0.37

0.24

Ear, nose and throat 10
Drug delivery 11

0.19

Diabetic care 12

0.12

Respiratory equipment 13

0.12

Home adaptation equipment 14

0.12

E-health/home automation/robotics 15

0.11

Neurology 16

Source:

9. Dental MedTech includes the medical technology needed in dental procedures
such as disposables, prostheses and implants.
10. Ear, nose and throat mostly consists of hearing implants, hearing aids and ear
irrigation equipment.
11. Drug delivery equipment includes all systems used for transporting pharmaceutical
compounds into the body, including dialysis and resources related to treatment
where drug delivery is needed.
12. Diabetic care medical equipment mostly consists of disposables and equipment
such as insulin pumps and injection equipment.
13. Respiratory equipment includes medical equipment such as oxygen machines and
continuous positive airway pressure (CPAP) equipment.
14. Home-altering elements include medical technology that is needed for caring for
bedridden patients as well as medical technology that is needed to assist people
with a disability in their everyday lives.
15. E-health/home automation/robotics are mostly used in preventive care, mental
healthcare and long-term care/home care. This segment is still relatively small but
is increasing rapidly.
16. Neurology includes medical applications and technologies related to the treatment
of neurological procedures and diagnosis.

0.06

17. Endoscopy medical equipment is used to look inside the body and perform surgery
without making large incisions.

Endoscopy 17 0.05
Other

Comments

0.22

KPMG analysis.

© 2017 KPMG Advisory N.V., registered with the trade register in the Netherlands under number 33263682, a member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (‘KPMG International’), a Swiss entity. All rights reserved.

26

1

The MedTech market in the Netherlands
The intramural market seems to be as large as the extramural market

2016 2012

Classification of MedTech into intra- and extramural care (2012, 2016)

50%

Source:

Intramural MedTech

50%

Total
MedTech
market
€4.7bn

Extramural MedTech

Interview feedback, KPMG analysis.

MedTech in intramural care

MedTech in extramural care

Most capital-intensive medical technology spending occurs intramurally in hospitals or
nursing homes. This is due to the complexity of intramural treatments and
corresponding MedTech requirements, as well as the quality of the technology that is
invested in.

With the help of new medical technology and by organising care more efficiently,
many types of treatments and care can be organised outside the hospital setting.

— Large complex MedTech systems such as PET and MRI scanners are often very
expensive and need to be operated by trained staff in a hospital environment.
Therefore, most large complex medical technological systems are present in
academic and general hospitals in contrast with elderly care institutions where it is
mainly low-tech medical technology that is used. Additionally, hospitals also invest
more in higher quality non-durable and disposable MedTech, which can increase
the quality of treatment, but also the cost.

Trends and
shifts

— Current technology allows a large amount of MedTech to be used outside of the
hospital setting and without specialist knowledge. This trend is expected to
continue: software advancements improving the ease of use increasingly limit the
need for direct specialist knowledge. By investing in digital care closer to the
patient, care becomes more personalised for the individual resulting in higherquality care.
— MedTech in extramural care also includes MedTech used in nursing homes
(VVT), dental care, hearing care, visual aids, dentistry, general practice and
independent treatment centres.

With a gradual shift in recent years (2012-2016) from intramural to extramural care, public health, nurses, nursing homes and rehabilitation centres are using much
more technical care as treatments increasingly require the use of medical technology. In addition, patients are increasingly treated in the home environment for which
new medical technology is being developed.
Advancements in medical technology make extramural care less complex with the help of integrated solutions. These solutions help extramural care providers such as
GPs and caretakers in nursing homes to use MedTech that otherwise would require specialist knowledge.
In addition, a patient receiving long-term medical care can increasingly count on advancements in medical technologies and requires less intervention by intramural
care providers.

Source:

Interview feedback, KPMG analysis.

© 2017 KPMG Advisory N.V., registered with the trade register in the Netherlands under number 33263682, a member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (‘KPMG International’), a Swiss entity. All rights reserved.

27

2

The MedTech market in the Netherlands
The largest part of MedTech spending in the Netherlands is covered by government institutions and health insurance
Total
MedTech
market
€4.7bn

Classification of MedTech into insured and non-insured care (2012, 2016)

85%
Source:

Insured MedTech

15%

Non-insured
MedTech

Interview feedback, KPMG expert, KPMG analysis.

Insured MedTech

Non-insured MedTech

Health insurance is compulsory for all people who live or work in the Netherlands.
Consequently, most MedTech used in intramural and extramural care, whether used
by patients or hospitals, is covered by the Dutch basic health insurance system.

Care without a medical need, for example cosmetic surgery or sterilisation, is not
reimbursed by basic health insurance and consumers need to pay for these
treatments themselves.

— Hospitals and treatment clinics typically get reimbursed for a specific treatment
package, which is known as a DBC. The reimbursement fee includes an amount
to cover depreciation of capital-intensive MedTech and the use of disposable
MedTech.

— Hospitals sometimes choose to invest in medical technology that is not covered
by insurance, when the technology is considered to add value to a specific
treatment. However, this only affects a very small portion of the care provided.

— Most medical technology is covered by the Dutch basic health insurance system.
The rest is covered by the relevant municipality (WMO), the long-term care act
(WLZ), the law on special healthcare needs (AWBZ) and private health insurance.

Trends and
shifts

— Some low-end MedTech that is sold and distributed through pharmacies and
drugstores is not insured, such as pregnancy tests and wound management
items. Additionally, certain types of preventive and long-term-care-related medical
technology are also not insured, as well as certain visual/hearing aids such as
glasses and lenses.

In total, the percentage of total MedTech which is reimbursed is expected to grow slightly. This could be fuelled by a gradual shift from labour to technology.
Additionally, there might be a slight shift towards more non-insured MedTech as the preventive market is growing and not yet (fully) reimbursed currently.
Health insurers employ cost-effectiveness analyses that determine whether the addition of a certain type of medical technology is cost efficient and contributes to the
treatment before it is included in the basic health insurance cover.

Source:

Interview feedback, CPB, KPMG analysis.

© 2017 KPMG Advisory N.V., registered with the trade register in the Netherlands under number 33263682, a member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (‘KPMG International’), a Swiss entity. All rights reserved.

28

3

The MedTech market in the Netherlands
MedTech is still largely used by care providers owing to its complexity, but using smart tools to help patients interpret data may
change this
Total
MedTech
market
€4.7bn

Classification of MedTech into care provider use and patient/self-care use

60%
Source:

Care provider use

40%

Patient/self-care use

Interview feedback, KPMG expert, KPMG analysis.

Care provider use

Patient use

Most MedTech is used by care providers in the Dutch market for the treatment of
patients. Care providers use a wide range of medical technology from low to high
tech.

Self-care seems to be used less in the Netherlands than in other countries in Europe
because patients can be checked/tested by a general practitioner at relatively low
cost. However, owing to factors including the 'own risk' contribution (i.e. patient excess
or deductible) self-care is gradually increasing.

In the case of intramural care in top clinical and academic hospitals, almost all
MedTech is used by the care provider. Capital-intensive MedTech is mostly meant to
be used by multiple patients, therefore it is the care provider that uses the MedTech to
treat the patients.
Additionally, a portion of the extramural care is used by care providers, such as (parts
of) dental and ophthalmic care products and home automation.

Trends and
shifts

MedTech used by patients can be low-tech, such as mobility aids, home-altering
products, care products, contraception etc., or high-tech, for example diabetic care
instruments, home automation and e-health/e-monitoring applications.
This includes ophthalmic equipment, disposables, hearing aids and orthopaedics.
Additionally, a small portion of intramural MedTech is intended for use by the patients
themselves (rather than by healthcare providers), for example diabetic care
instruments.

The consumer (patient) is increasingly using MedTech for health monitoring, self diagnostics and preventive purposes. Please see also trends on patient-data-sharing
technologies (p.42) for more information about wearables.
A second trend is that medical technology is shared with patients to increase self-monitoring under the supervision of a healthcare provider. If diverging data is
detected, the monitoring device can either signal the healthcare provider directly or tell the patient to go and see the care provider, for example in diabetic care.

Source:

KPMG expert, interview feedback.

© 2017 KPMG Advisory N.V., registered with the trade register in the Netherlands under number 33263682, a member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (‘KPMG International’), a Swiss entity. All rights reserved.

29

Dutch
MedTech
companies

Dutch MedTech companies
An estimated 500-700 companies are active in the Dutch MedTech market, 95%-97% of which are SMEs

3%-5%

Most companies operating in the Dutch
market are either small or medium-sized
enterprises, or subsidiaries of large
multinationals

500-700
companies

There are some leading Dutch companies that
are active on the international market in the field
of diagnostic imaging.

Dutch MedTech landscape(a)
Large companies

— Other larger companies located in the
Netherlands are mainly subsidiaries (roughly
ten) of large multinationals.

95%-97%
SMEs
Note:

(a)

SME: <250 employees; large companies: >250 employees.

Source:

Capital IQ, interview feedback, KPMG analysis.

MedTech landscape segmentation(a)
Other

Care products
Diagnostics, imaging and
monitoring

Medical
instruments

Ophthalmics
Cardiology
In vitro
Gynaecology
Medical aids
(mobility)
Endoscopy
Neurology
Dental

Orthopaedics
General hospital
ENT
Diabetic care
Drug delivery
ICT
solutions

Respiratory equipment

Note:

(a)

Source:

Capital IQ, interview feedback, KPMG analysis.

Sector estimate based on available information (n=300) and main activity.

The Dutch sector is characterised by a
high level of cooperation that is enabled
by the system’s structure

that a product with the CE mark will be
immediately accepted in most international
markets.
However, SMEs are increasingly looking outside
the Dutch borders to grow their businesses.
— The regulatory system and the ability to get
new medical technology ‘insured’ is a timeconsuming and difficult process, which often
causes Dutch companies to look across
borders for growth opportunities.
— The Dutch government invests substantial
amounts in start-ups. However, investments
in SMEs in the ‘growth stage’ seem to be
limited.

SMEs are often motivated to work closely with
care providers and academic institutions as
innovation partners to develop new MedTech.
— A large portion of these SMEs are
developing new innovative medical
technology in e-health, patient monitoring
and medical instruments.
— An example of incentivisation is the WBSO
law, which is designed to keep personnel
costs low in order to stimulate innovation.
Also, in the Netherlands, the European
standards for product design apply, meaning

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31

Dutch MedTech companies
Supplier power seems to differ significantly among the five largest MedTech sectors

Supplier power in the Dutch MedTech market
Low

The ophthalmic market has a relatively large number of lens and glasses
producers and also a relatively large number of opticians. Market power therefore
seems to be relatively low.

4.

A small number of large corporates dominate the cardiology market (three US
companies have a 90% share of the global market).

5.

There are a large number of producers of orthopaedic shoes/aids in the
Netherlands. These consist of a small number of larger chains and smaller familyowned stores. This market seems to be very local, therefore supplier power still
exists within the smaller market.

High

Care products 1
Diagnostics and
2
imaging
Ophthalmic 3
Cardiology 4

Orthopaedics 5

Source:

3.

Purchasing power of hospitals
Large academic hospitals seem to prefer large suppliers or wholesalers that operate
internationally as their main suppliers because of their track records on quality and
ability to deliver.

Intrakoop, 2017, interview feedback, Capital IQ, Intrakoop, KPMG analysis.

Comments
Supplier power seems to differ greatly among the different sectors. High-tech sectors
such as diagnostics and imaging and cardiology tend to be led by large players
because of the complexity and scale requirements.

Hospitals (or purchasing cooperatives) tend to choose a small number of
wholesalers/producers as their main suppliers, often because of purchasing
advantages and price reductions for volume buying.
However, cooperation between hospitals seems to be lacking in an international
context (compared to Germany for example). The power to negotiate better prices in
order to generate cost savings is mostly dependent on the level of supplier
concentration within specific therapeutic or technological areas.(1)

1. The market for care products is broadly defined and a number of players are
active on the market. The goods are typically low-tech and homogeneous. Market
competitiveness is expected to be relatively high and market strength relatively
low.
2. Supplier power in diagnostics and imaging seems high. Due to complex
technology and scale requirements only a few large players are active in the Dutch
market.

Source:

(1)

Intrakoop, 2017.

Interview feedback, Capital IQ, Intrakoop, KPMG analysis.

© 2017 KPMG Advisory N.V., registered with the trade register in the Netherlands under number 33263682, a member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (‘KPMG International’), a Swiss entity. All rights reserved.

32

Margins in the
Dutch
MedTech
sector

Margins in the Dutch MedTech sector
Profit margins of MedTech companies in the Dutch market were estimated at around 10% in 2015 and seem to have decreased slightly

EBIT margins in the Dutch MedTech sector, 2011-2015
0%

4%

8%

12%

16%

20%

2011

2012

2013

2014

Limited data availability has resulted in a purely indicative estimate of
MedTech profit margins
Limited data was available on profit margins of companies operating in the Dutch
medical technology space as only few national and international MedTech producers
publish profit data. Additionally, a large number of international players operating in
the Dutch market do not publish margin data specifically for their Dutch
divisions/subsidiaries. As a result, the analysis on the left is conducted based on a
minimum of 24 annual reports for each year, and no distinction between subsectors
could be made.
This approach differs from the approach used by Gupta (2017)(1) which resulted in a
higher margin percentage (15%-20%). Gupta based its analysis on the average profit
margins (EBIT) of five large suppliers of medical devices and/or equipment(1).

Profit margins for Dutch medical technology producers seem to have
decreased slightly in the period 2011-2015
There are several potential reasons for a decreasing EBIT margin trend:

2015
Average margin
in 2011-2015
Note:

Based on available profit margin (EBIT) information of companies operating in the Netherlands.
n>24 companies per year.

— Budget constraints: Budget constraints of hospitals can potentially lead to a
decrease in MedTech purchasing. Some hospitals opt to postpone capital
investments or downgrade the quality of purchases in order to comply with budget
constraints;
— Competitive pressure: There is more competitive pressure in the market meaning
that the negotiating position of purchasers is stronger.

Margin data points for 2016 were insufficient to reach a conclusion.
Source:

Capital IQ, annual reports, KPMG analysis.

— Pressure from health insurers: Health insurers exert pressure in terms of the
pricing of new MedTech or decline to cover advancements in current medical
technologies that offer the same sort of treatment but are often more expensive.
.
Source:

(1)

© 2017 KPMG Advisory N.V., registered with the trade register in the Netherlands under number 33263682, a member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (‘KPMG International’), a Swiss entity. All rights reserved.

Gupta, 2017 ‘Ezeltje strekje’.

34

Trends
impacting the
Dutch MedTech
market

Trends impacting the Dutch MedTech market

Dutch dynamics

MedTech supports the (expected)
shifts in Dutch healthcare e.g. from
intramural to the home environment,
or from treatment to prevention

Major treatment area
trends

Innovations in MedTech will increase
precision, speed, personalisation, and
automation of medicine, improving the
outcomes for patients

E-health trends

E-health technologies enable
seamless delivery of care, continuous
access to patient data, and improved
clinical decision-making

Business model trends

Manufacturing and supply
chain trends

MedTech suppliers are gradually
moving towards customer-centric
business and service models such as
value-based healthcare (VBHC) and
managed equipment services

The traditional supply chain models
are expected to be disrupted by the
Internet of Things (IoT), direct-toconsumer supply and customer
inventory management systems

© 2017 KPMG Advisory N.V., registered with the trade register in the Netherlands under number 33263682, a member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (‘KPMG International’), a Swiss entity. All rights reserved.

36

Dutch dynamics

Major treatment

E-health

Business model

Supply chain

Trends impacting the Dutch MedTech market
In the Netherlands, medical technology supports the treatment trend to move towards individual care that requires less surgery and
focuses on prevention
Dutch healthcare trends
From

To

General
healthcare

Individual
healthcare

Description

Shift in patient category
From

Healthcare is becoming more tailored to the specific needs of patients. Owing to
advancements in technology, patients are receiving healthcare which better suits their
needs.

To

Primary, secondary
and tertiary care

Technology is an important driver in making healthcare more closely tailored to the
specific care needs of patients at an affordable price.
The reimbursement system needs to deal with the increase in individual healthcare.
Intramural

Home environment

Extramural care could be more cost efficient and less expensive than intramural care.
Technology could be an important driver in increasing the extramural care component
in the Dutch healthcare landscape.

Secondary and
tertiary care

Long-term care

Therapy

Prevention

The goal of preventive care is to help people to stay healthy. Additionally, the idea of
preventive care is to prevent diseases before they require hospital care. It also keeps
people productive and enables them to be economically productive in their senior
years.

Primary and
secondary care

Prevention

Large tech companies such as Apple and Google are expected to be enablers of this
trend through e-health solutions.
Large equipment

Small equipment

Small diagnostic machines are increasingly substitutes for larger devices and include
innovative features and software.

Secondary and
tertiary care

Point-of-care testing is more commonly used by care providers. It enables care
providers to do laboratory tests at the patient’s bedside.
Invasive

Less invasive

In surgery, a gradual shift has been observed from invasive to less invasive procedures
owing to advancements in medical instruments.

Secondary and
tertiary care

Less invasive surgery could also lead to lower care costs as patients are expected to
spend less time in hospital after a treatment/surgery.

© 2017 KPMG Advisory N.V., registered with the trade register in the Netherlands under number 33263682, a member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (‘KPMG International’), a Swiss entity. All rights reserved.

37

Dutch dynamics

Major treatment

E-health

Business model

Supply chain

Trends impacting the Dutch MedTech market
Together with Germany and the UK, the Netherlands is quick to adopt innovative surgical tools

Trends in major treatment areas
Category
Autonomous
surgical robots

Description
Since the introduction of Intuitive Surgical’s Da Vinci system, a number of robotic surgeries
have been performed. However, medical device manufacturers are now developing
autonomous surgical robots that no longer need to be controlled/assisted through human
intervention.

Implications
— Increase precision and enhance
surgical outcomes
— Minimise prolonged surgical time

These robots will be used in complex, minimally invasive (MI) and soft tissue-related
procedures to perform repetitive tasks or automate certain parts of a procedure such as steps
needed during orthopaedic surgeries.
3D printed surgical
planning models
and instruments

3D printed models will be used for planning complex surgeries including cardiovascular
procedures to treat septal defects and replacement of heart valves, as well as neurological
procedures.

— Enhance pre-operative planning
— Improve surgical precision and
success rate

3D printed surgical instruments are being developed with customised designs and shapes for
surgeons to achieve better outcomes and minimise risks during surgeries.
Augmented reality
assisted surgeries

i

Source:

Research is ongoing to use augmented reality to perform complex and minimally invasive
surgeries.

— Offer precise and real-time motion
tracking

Augmented reality surgical navigation technology is being tested to perform spine and brain
surgeries.

— Improve the success rate of MI
brain/spine surgeries

The technology aims to enhance the success rate of image-guided surgeries offering x-ray
imaging and optical imaging in an augmented reality view.
The surgical tools that are being deployed to assist in procedures in general, academic, and rehab hospitals have been designed and focused on microsurgery, surgery assistance, precision surgery, and minimally invasive
surgeries, including examples such as the SOFIE surgical robot (from the Eindhoven University of Technology), the TELEflex advanced endoscope (University of Twente), and Intuitive Surgical’s Da Vinci system, all of which
were developed since the 2000s. More advanced recent examples in the use of augmented reality include Philips’ deployment of its augmented reality surgical navigation technology for image-guided spine, cranial, and trauma
surgery at Karolinska University Hospital (2017). Greater use of image-guided therapy will significantly impact the ORs of academic/tertiary centres as the multi-purpose nature of these procedures requires reconfigurations and
better technical layout, integration, and interfaces.

Philips is bringing augmented reality to surgery: Here’s how, Medical device outsourcing; Why an Autonomous robot won’t replace your surgeon anytime soon, Wired; RoboNED; KPMG analysis.

© 2017 KPMG Advisory N.V., registered with the trade register in the Netherlands under number 33263682, a member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (‘KPMG International’), a Swiss entity. All rights reserved.

38

Dutch dynamics

Major treatment

E-health

Business model

Supply chain

Trends impacting the Dutch MedTech market
Innovative start-ups work together with hospitals and large Dutch imaging companies to develop big-data-driven systems and diagnostic
devices
Trends in major treatment areas
Category
Artificial intelligence
systems

Description
Artificial intelligence (AI) systems are capable of crunching big data and identifying patterns that
humans fail to interpret.
MedTech companies are looking at AI solutions that will be used to make diagnoses and
imaging of various conditions more accurate and predictive.

Thread-based
diagnostic device

Implications
— Faster, accurate diagnosis
— Provide clinical decision support

More profound research and development is planned in the MedTech area for the diagnosis of
cancer, cardiac disorders and neurological conditions.

— Innovations in MedTech will increase
precision, speed, personalisation, and
automation of medicine, leading to
better outcomes

Scientists have developed a new type of surgical thread made from cotton or synthetics with
the ability to collect diagnostic data and communicate it wirelessly in real time.

— Develop low-cost implantable and
wearable diagnostic tools

These thread-based devices could potentially be used as smart bandages to monitor wound
healing or smart sutures for surgical implants, or integrated with textile or fabric to be used as
personalised health monitors and point-of-care diabetes tests.

i
Source:

While AI technologies such as IBM Watson continue in their proof of concept in oncology (e.g. with Memorial Sloan-Kettering), many European providers have waited to see the outcome as the pioneer organisations prove the
effectiveness of its automated image interpretation. However, AI appears to be more palatable and more immediately realisable based upon conversations with pharmaceutical providers who are deploying AI (e.g. Novartis,
Sanofi’s partnership with IBM Watson) in non-clinical decision support, such as in R&D improvement and clinical trials where it is used to identify matching opportunities.

Medtronic, Samsung partner to develop neuromodulation implant apps for smart devices, FierceBiotech. Google DeepMind Wants to Save Eyesight with Artificial Intelligence, Medical Device\and Diagnostic Industry. KPMG analysis.

© 2017 KPMG Advisory N.V., registered with the trade register in the Netherlands under number 33263682, a member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (‘KPMG International’), a Swiss entity. All rights reserved.

39

Dutch dynamics

Major treatment

E-health

Business model

Supply chain

Trends impacting the Dutch MedTech market
Technology start-ups in the US and Europe are focusing increasingly on assistive care and therapy devices that reduce drug
dependency
Trends in major treatment areas
Category
Leadless
pacemakers

Description

Implications

Leadless pacemakers have been developed for patients in need of permanent and singlechamber pacing therapy.

— No visible surgical scar after incision
of pacemaker

These pacemakers do not require the use of wired leads to provide an electrical connection
between the pulse-generating device and the heart.

— Reduce risk of infections

The less invasive and shorter implantation procedure for leadless pacemakers reduces
recovery time and eliminates complications related to the transvenous leads.
Neuroprosthetics

Neuroprosthetics are devices implanted in the patient’s head that try to replicate the way brain
cells communicate with one another. These devices can boost the capacity of the brain and
improve recall functions in the future.

— Reduce dependency on drugs for
neurological disorders

Whenever an individual communicates, the brain fires a specific code that is unique to each
person and is similar to a software command.
Ultrasound therapy

Research is being undertaken by scientists to develop non-invasive ultrasound therapy to treat
patients with Alzheimer's.

— Reduce dependency on drugs for
Alzheimer’s patients

The ultrasound waves are able to cross the blood brain barrier, which is a layer that protects
the brain against bacteria, to stimulate microglial cells.

i
Source:

These cells clear the brain of neurotoxic amyloid plaques – structures that are responsible for
memory loss and a decline in cognitive function in Alzheimer’s patients.

The use of ultrasound therapy has been led globally by UMC Utrecht – which has married the high-intensity focused ultrasound with MRI to create image-guided therapies. Its application has already been deployed in treating
uterine fibroids, bone metastases, and breast cancer (since 2010). Future applications are being researched for liver, kidney, and pancreatic cancers. This approach will continue to be developed as the technology needs to be
further proven, while in the Netherlands there is no comparative provider with these capabilities to-date.

‘Intelligence is landlocked’: Silicon Valley start-up wants to supercharge the brain with a computer chip, National Post. Ultrasound Therapy for Preventing Brain Aging and Alzheimer’s, World Health. https://www.umcutrecht.nl/en/Research/Researchcenters/UMC-Utrecht-Center-for-Image-Sciences/Research-programs/Image-guided therapeutic-ultrasound. KPMG analysis.

© 2017 KPMG Advisory N.V., registered with the trade register in the Netherlands under number 33263682, a member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (‘KPMG International’), a Swiss entity. All rights reserved.

40

Dutch dynamics

Major treatment

E-health

Business model

Supply chain

Trends impacting the Dutch MedTech market
Use of robotics in delicate surgical areas such as eye care is increasing in the Netherlands, which is in line with the global trend

Trends in major treatment areas
Category
Robotic eye surgery

Description
Robotic eye surgeries will open up new avenues in eye operations which have been limited
traditionally due to the physiological limits of the human hand.
These technologies are likely to be used in ocular surgeries, such as vitreoretinal surgery – a
highly delicate and precise operation.

Miniature retinal
scanners

i
Source:

Implications
— Higher degree of precision and
control specifically for delicate
operations

Photonic integrated circuits could be used to reduce the size of optical coherence tomography
(OCT) systems that are used for retinal imaging.

— Enable self-diagnosis of retinal
diseases

The reduction in size could lead to benefits such as cost effectiveness, accessibility and
instantaneous sharing of scans via smartphones.

— Enhance portability of OCT devices

The first development of robotic eye surgery technology in the Netherlands was announced in 2011 out of Eindhoven Technical University; it enabled better accuracy in sensitive procedures such as retina restoration or securing
a detached retina. Engineers at the university subsequently formed Preceyes BV, a medical robotics firm that partnered with the University of Oxford in clinical trials to perform the first robotic eye surgery in 2016.

The future of refractive surgery: Nonsurgical?, Eyeworld. New Refractive Corneal Collagen Cross Linking Procedure Approved in Europe, Shapiro Laser Eye Centre. Avedro Raises $32 Million for Commercialisation of Cross-linking Technology, Market
Scope. Coin-sized retina scanner targets improved diagnosis, Modern Retina. http://www.ox.ac.uk/news/2016-09-12-world-first-robot-eye-operation. KPMG analysis.

© 2017 KPMG Advisory N.V., registered with the trade register in the Netherlands under number 33263682, a member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (‘KPMG International’), a Swiss entity. All rights reserved.

41

Dutch dynamics

Major treatment

E-health

Business model

Supply chain

Trends impacting the Dutch MedTech market
Patient-data-sharing technologies such as wearables and IoT enable seamless delivery of care in both remote and clinical/hospital
settings
E-health trends
Category
Wearables

Internet of Things
(IoT)

Description

Implications

Wearable technology is being leveraged for various medical purposes.

— Enable enhanced self-care practices

Going forward, it will be used to prevent the onset of, to diagnose, and to delay the progression
of diseases. For instance, wearables could be able to detect cardiac arrhythmia or motor
fluctuations in Parkinson’s patients. They would also help to retain memories in patients with
Alzheimer’s and diagnose diseases such as diabetes and cystic fibrosis.

— Provide preventive solutions

IoT technologies enable real-time monitoring and analysis of various medical devices and
systems on a continuous basis, irrespective of whether the patient is in a hospital, at home or in
a remote location.

— Reduce cost of chronic medical care
by lowering hospital readmissions

With this technology, patients and healthcare professionals have improved access to patient
data and make better health decisions, thereby offering preventive healthcare solutions.
Cloud-based big
data analytics

Cloud-based big data analytics are being leveraged to get insights from large volumes of data
collected from laboratory tests, electronic medical records (EMR) and real-time monitoring of
patient data in hospitals.

— Improve patient outcomes
— Reduce cost of healthcare

Medical device companies are partnering with technology players to help enhance care delivery
using big data analytics in clinical and remote settings.

i
Source:

Philips’ HealthSuite digital services, which include its platform and cloud-based infrastructure, aspire to enable the analysis, sharing, hosting, and connection of data between various healthcare providers, connected devices,
apps, and patients. Widespread adoption of such a platform has not yet been observed, external stakeholders often ascribe this delay to challenges in data governance, privacy, and trust issues between the multiple stakeholders
and siloed datasets between providers in the continuum. In the Netherlands at the time of writing, Radboud UMC is prototyping a solution for continuous monitoring of COPD patients via sensors, apps, and providers.

How the IoT Is Enabling the Next Generation of Medical Devices, Medical design Briefs. 10 Medical-Device Wearables To Improve Patients' Lives, Information week Website. https://www.philips.nl/healthcare/innovatie/healthsuite-digitalplatform/casestudies. KPMG analysis.

© 2017 KPMG Advisory N.V., registered with the trade register in the Netherlands under number 33263682, a member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (‘KPMG International’), a Swiss entity. All rights reserved.

42

Dutch dynamics

Major treatment

E-health

Business model

Supply chain

Trends impacting the Dutch MedTech market
Smart apps integrated with medical devices provide real-time access to patient data and support improved clinical decision-making

E-health trends
Category
Smart apps

Description
Medical device manufacturers are integrating smart apps with their devices.
These smart apps are capable of tracking data not only from medical devices but from other
information sources such as GPS and wearable activity trackers.
They will provide patients and doctors with real-time insight into the impact on patients of
particular diseases such as diabetes, cancer and neurological disorders.

Blockchain
technology

i
Source:

Implications
— Enhance physician-patient
engagement
— Support improved clinical decisionmaking

Blockchain technology works by storing blocks of unchangeable digitally recorded data. Each
block is stored in a cryptographically hashed and linked linear chain.

— Allow real-time access to patient data
from anywhere

The potential use of the technology in healthcare is to integrate patient health data from
wearables, sensors, mobile apps, medical devices and other IoT devices with no risk of cyber
threats.

— Improve diagnosis and care outcomes

While healthcare apps have been offered by pharma and medical device companies as complements to their products (for education or manual data input), more recent partnerships have connected technologies with providers,
EPDs, and patients. Radboud UMC built one of the Netherlands’ first connected digital health prototypes for diabetes patients in 2015, with an app and online community connected to EPDs, devices (e.g. wireless glucose
meters, and activity monitors), and patient reported data. These models are being explored further across other chronic diseases – both in the broader connecting of devices, data, and stakeholders, but also in unlocking the
value of data (e.g. from a clinical registry) and from a clinical decision-support perspective (e.g. development of algorithms).

Medtronic, Samsung partner to develop neuromodulation implant apps for smart devices. Blockchain Healthcare start-ups, IntelligentHQ. KPMG analysis.

© 2017 KPMG Advisory N.V., registered with the trade register in the Netherlands under number 33263682, a member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (‘KPMG International’), a Swiss entity. All rights reserved.

43

Dutch dynamics

Major treatment

E-health

Business model

Supply chain

Trends impacting the Dutch MedTech market
Large MedTech suppliers in the Netherlands are gradually moving towards customer-centric business and service models

Move from a traditional business model
towards customer-centric models
Shift away from the traditional one-way
business model
For MedTech companies, the blurring lines between the
physical, digital and biological spheres require changes
to their business model as decision-making power shifts
away from manufacturers to other healthcare
stakeholders.
In order to remain competitive when both the supply
and demand sides of their businesses are being
disrupted, device makers are gradually progressing
from being product-centric to offering customer-centric,
platform-based MedTech products and services.

Platform-based business model
The platform-based business model approach is
designed to support an entire ecosystem of
interconnected patients, partners and providers. This
will not only help in improving the quality and cost of
patient care but will also provide new avenues for
growth and represents an integrated approach that may
lead to higher margins.

hospital and suppliers through continuous innovation
and feedback loops, and ensures that the hospital uses
up-to-date technology for patients.

Managed equipment services
Product

Platform-based business model
Manufacturer
Care providers

Platform

Continuous collaboration and improvement loops
on equipment

Ecosystem

Value creation is a continuous two-way process

Source:

Connected Care and Health Informatics, Philips Healthcare.
Company website/annual report. KPMG analysis. Interview feedback.

Traditional value chain business model

Managed equipment services
Production

Distribution

Marketing

Customers

Value creation is linear and one way

Managed equipment services mean that the hospital
that purchases the equipment is provided with a service
agreement under which all updates and improvements
are installed on the equipment for a 15/20-year period.
This model stimulates collaboration between the

© 2017 KPMG Advisory N.V., registered with the trade register in the Netherlands under number 33263682, a member firm of the KPMG network of
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44

Dutch dynamics

Major treatment

E-health

Business model

Supply chain

Trends impacting the Dutch MedTech market
Customer- and patient-centric (value-based) business models already applied by large companies in the Dutch MedTech market

Examples of customer- and patientcentric models in the Dutch market
Platform-based business model – Philips
Healthcare example
Philips Healthcare is looking to leverage a platformbased business model to gain market share and value
across the continuum of healthcare needs.
The platform-based business model approach is
designed to support an entire ecosystem of
interconnected patients, partners and providers. This
will not only help Philips in its aim to improve the quality
and cost of patient care but will also provide the firm
with new avenues for growth and represents an
integrated approach that has the potential to lead to
higher margins.

Managed equipment services – Siemens
Healthcare example
Siemens Healthcare employs a business model in
which it also offers products in managed equipment
service arrangements. By working closely together with
the healthcare provider, Siemens is able to improve its
medical technology and implement changes directly
with those institutions that have a managed equipment
contract. These ‘innovation labs’ that Siemens employs
also stimulate collaboration within certain specialist
fields in hospitals.

Moving into healthcare – Medtronic example
Medtronic is another example of a company that is
exploring new business models. With its integrated
Health Solutions division, Medtronic supports hospitals
to reduce the cost of care and improve quality and
efficiency. But Medtronic has moved further into the
delivery of healthcare, for example in 2015 by
partnering with Diabeter, a clinic that focuses on the
treatment of type-one diabetes. In the partnership, the
client-friendly concept of Diabeter can be brought to a
higher level, and to more patients in more countries.
The collaboration accelerates the availability of new
technologies to the patients and focuses on valuebased healthcare (VBHC). Furthermore, Medtronic is
playing a role in further advancing health-related IT and
communications systems, broadening the access to
and potential applications of remote control for patients,
and thus making the healthcare it provides more
patient-friendly.

Source:

Wie doet het met wie – nieuwe allianties, KPMG, 2016.
https://diabeter.nl/en/about-diabeter/organisation/.
Connected Care and Health Informatics, Philips Healthcare.
Company website/annual report. KPMG analysis. Interview feedback.

© 2017 KPMG Advisory N.V., registered with the trade register in the Netherlands under number 33263682, a member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (‘KPMG International’), a Swiss entity. All rights reserved.

45

Dutch dynamics

Major treatment

E-health

Business model

Supply chain

Trends impacting the Dutch MedTech market
Traditional supply chain for MedTech is expected to be disrupted by VMI systems, IoT and direct sales by medical device manufacturers

Inventory management disruptions

Substituting the distributor’s role

Vendor-managed inventory (VMI) programmes

Medical device manufacturers are expected to eliminate
distributors from the traditional supply chain.
Distributors and other group purchasing organisations
act as intermediaries between device manufacturers
and users – they buy equipment in bulk and take
discounts from manufacturers, selling on the products
to hospitals.

Medical device manufacturers are utilising VMI
programmes in their manufacturing and supply chains
to streamline operations and drive efficiencies.
The VMI programmes benefit medical device
manufacturers through increased end-to-end supply
chain visibility including track and trace, and
management of the condition of devices. They also
reduce on-hand inventory levels and generate cost
savings.
To enhance the efficiency of VMI programmes/systems
further, medical device manufacturers are collaborating
with radio frequency identification (RFID) and smart
sensor manufacturing firms.

Internet of Things (IoT)
Industry players are leveraging the IoT to manage
inventory which further adds to their operational
efficiency.
IoT sensors embedded in parts/devices will help
medical device manufacturers to achieve inventory
stocking efficiency by implementing RFID and mobile
scanners connected to the cloud.

Medical device
manufacturer

Distributors

End-users i.e.
hospitals/patients

Taking on the role of a distributor, medical device
manufacturers are selling their products directly to
hospitals at discounted prices.
Small/medium-scale medical device companies, in
particular, are expected to benefit from this transition as
they will be able to sell products directly to hospitals.
Moreover, the marketplace is expected to be further
disrupted, with speculation ongoing regarding ecommerce players such as Amazon entering the market
to sell medical devices online.

© 2017 KPMG Advisory N.V., registered with the trade register in the Netherlands under number 33263682, a member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (‘KPMG International’), a Swiss entity. All rights reserved.

Source:

Medical Product Outsourcing; Transforming The European Medical
Device Supply Chain: Adding Value And Reducing Costs, DHL Supply
Chain, How Johnson & Johnson's Supply Chain Made Strides in 2016,
Johnson & Johnson. ‘How Amazon is Poised to Disrupt the MedTech
Industry’, MDDI Online.
KPMG analysis.

46

Levers of MedTech adoption

Regulatory enablement

Regulation or policy within a country
regarding speed and access to
medical technology

Incentives to make it
happen

Necessity as the enabler
of innovation

Financial incentives that explicitly
incentivise use of technology to
enable better care to be delivered
more affordably

Necessity to adopt, aligned along the
triple aim of improving experience/
access, health outcomes, and cost

© 2017 KPMG Advisory N.V., registered with the trade register in the Netherlands under number 33263682, a member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (‘KPMG International’), a Swiss entity. All rights reserved.

47

Regulatory

Incentives

Necessity

Levers of the MedTech adoption
The external environment is an important factor in the wider adoption of MedTech (2)

Role of the external environment
As described on the previous pages, there are multiple
examples, including in the Netherlands, of care
providers adopting new medical technology in providing
healthcare and treating patients. The degree of
adoption largely depends on the drive and enthusiasm
of the healthcare professionals and the leadership of
the care providers. Moreover, having a focus on
technology or on creating partnerships with technology
providers stimulates innovation and broad adoption.
In order to achieve national adoption of medical
technology, the external environment plays a pivotal
role, especially when medical technology transforms
the way healthcare is delivered.
Our analysis of multiple international examples
revealed three key levers in the external environment
that influence the degree of adoption of medical
technology within a given country:
1.

Regulation or policy within a country regarding
speed and access to medical technology;

2.

Financial incentives that explicitly incentivise the
use of technology and enable better care to be
delivered more affordably;

3.

Necessity to adopt, aligned along the ‘Triple Aim’,
i.e. improving experience/ access, health
outcomes, and cost(2).

The next pages discuss these three external levers,
with some illustrative international examples.

Regulation and policy

Approvals and Fast-tracking Access – FDA (US)
The FDA’s policies have provided an accommodating
environment to allow access for medical devices. Much of this
mandate was provided by the 21st Century Cures Act. This Act
created the Breakthrough Devices categorisation which seeks to
approve or deny requests within 60 days, considering other data
sources for approval. Furthermore, it eased definitions of certain
things like Digital Health apps, allowing them to be excluded from
the device definition, for example those which passively collect
information. The Act also defined a classification system which
assesses the level of effort in obtaining approval depending on
the risk of causing injury or death to a patient, Class 1 being low
risk (e.g. floss) versus Class 3 being devices that can potentially
injure or kill a patient (e.g. pacemaker).

Regulation and policy can reduce barriers to access,
affect speed to market, and can promote adoption of
technologies in care delivery. Regulation can affect
both the actual access to technology and the speed of
access. For example, if there is a one-size-fits-all
approach for granting access to all the different types of
medical technology, this may delay the access to
technologies that would otherwise need a less strict
approval protocol, such as digital health apps. The

© 2017 KPMG Advisory N.V., registered with the trade register in the Netherlands under number 33263682, a member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (‘KPMG International’), a Swiss entity. All rights reserved.

speed of the US food and drug administration (FDA)
approval process is relatively slow compared to the EU
because the FDA requires greater evidence before
permitting access. The FDA is currently deploying
different avenues for the approval of different types of
medical technologies, speeding up the process of
approval and access to the market.
In addition, health technology assessment (HTA)
bodies have a certain degree of influence on advising
or deciding about the reimbursement of new medical
technology. If medical technology is being reimbursed
this increases the adoption of the technology. Sweden
for example has a national HTA that has a large degree
of influence on the ultimate reimbursement, whereas
Denmark has regional HTAs that make local decisions,
and there is no regulatory requirement to use a HTA in
policy decision-making and planning. This gives
healthcare providers in Denmark more freedom to
disregard the recommendations] of the HTA, making
sure that patients receive access to the technologies
they need.

48

Regulatory

Incentives

Necessity

Levers of the MedTech adoption
The external environment is an important factor in the wider adoption of MedTech (2)
In addition to regulation, national policy could also
create a policy imperative for the use of new technology
in the delivery of healthcare. For example, the ‘Five
Year Forward View’ of the NHS states that the UK
healthcare system needs to leverage the potential of
technology and innovation, enabling patients to take a
more active role in their own health and care while also
enabling NHS staff and their care colleagues to do their
jobs (see box below).

NHS Five Year Forward View (UK)
The UK NHS’ Five Year Forward View invests in a five-year plan
with a focus on improving the deployment and adoption of
technology and innovation in care delivery, including creating test
bed sites, partnering life sciences with NHS providers, and
investing in models such as the NHS’ own incubator for innovation
and the launch of a library of NHS apps. It has also created the
NHS Innovation and Technology Payment: “creating the conditions
and cultural change necessary for proven innovations to be
adopted faster and more systematically through the NHS, and to
deliver examples into practice for demonstrable patient and
population benefit.” It will do this by identifying innovations where
financial or procurement barriers are preventing widespread
adoption in the NHS despite good evidence that prevalent adoption
would deliver efficiency and improve quality in healthcare.

Source:

https://www.statnews.com/2016/06/28/medical-devices-safety-europe-us/.
IHI. FDA, 2017, retrieved from:
https://www.fda.gov/RegulatoryInformation/
LawsEnforcedbyFDA/SignificantAmendmentstotheFDCAct/21stCenturyC
uresAct/default.htm. Health Technology Assessment in the European
Union – State of Art and Future Scenarios, Icom Innovation, February
2017. Next steps on the NHS Five Year Forward View, NHS, March 2017.

© 2017 KPMG Advisory N.V., registered with the trade register in the Netherlands under number 33263682, a member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (‘KPMG International’), a Swiss entity. All rights reserved.

49

Regulatory

Incentives

Necessity

Levers of the MedTech adoption
Flexibility within funding or dedicated funding increase the adoption of MedTech
Financial incentives to adopt new technology
The way healthcare and medical technology is funded
can greatly influence the adoption of medical
technology in the delivery of care. The adoption of
medical technology can be increased by flexibility in
funding healthcare including a possible return-oninvestment, and by explicit incentives to use medical
technology.
If there is more flexibility in the use of funds, it is easier
to get a return on investment from new technologies. In
Israel, for example, funding based on the health of
specific segments of the population allows the
healthcare provider Clalit to allocate funding into its
infrastructure (see box on the right). In the US, New
York State’s ‘Delivery System Reform Incentive
Payment’ (DSRIP) programme, bundled payments
enable technology investment for things that normally
would not be reimbursed, but can improve patient
outcomes, like air conditioners to reduce exacerbations
for asthma patients. The South African health insurer
Discovery Health was also encouraged by a possible
return-on-investment to invest in wearables and digital
platforms to improve care outcomes (see box on the
right).

Source:

(1) https://www.opengovasia.com/articles/7649-ds-supporting-3bs-objectives-and-principles-of-singapores-health-it-masterplan,retrieved on 1/12/2017.
https://www.nza.nl/publicaties/nieuws/129745/, retrieved on
9/12/2017.

Other ways to stimulate the adoption of medical
technology are to provide funds to purchase new
technology (e.g. subsidies, grants, etc.), or to arrange
reimbursement for the use of medical technology.
Singapore, for example, has been investing in and
providing funding for the implementation of technology
since 2014 in accordance with its Health IT Master
Plan. In the Netherlands, teleconsultations with
dermatologists by GPs have been reimbursed since
2007, enabling the use of this technology in the
diagnosis of dermatological diseases, and therefore
reducing the number of referrals to hospitals.

Incentive Structures Enabling Clalit to Invest (Israel)
The reimbursement and investment structure in Israel has given
both Israel and Clalit flexibility without the specificity of how they
allocate their funding, and enabled them to invest in technology to
find low-cost primary-based solutions. As a result, low-cost primary
care access has created a system which is highly MedTechfocused, including the fact that over 60% of pediatric consultations
in Israel happen over smartphones.
Technology has allowed Clalit to enable lower cost types of care
such as self-management, primary-based preventative care, and
the lower-cost delivery through e-consults.

National investments in technology (Singapore)
Recognising the Return on Investments (ROI) in
Devices – Discovery Health (South Africa)
Discovery Health’s Vitality programme supports its health
insurance product by providing incentives to its members to live a
healthier, more active lifestyle. Discovery Vitality was launched in
South Africa in 1997 and is designed around evidence-based
interventions and behavioural economics to improve health
outcomes. The programme encourages customers to track
essential health indicators (through FitBit data) and set goals for
improved health, then earn points by making progress such as
completing assessments, exercising, purchasing healthy food,
quitting smoking, and losing weight. As customers earn points,
they can redeem various rewards, including cash back and
discounts at retailers.
The programme encourages healthy behaviour, improves health
outcomes and, by extension, reduces medical costs associated
with health plans over the long term. The company's significant
investment in the Vitality programme and brand has led to higher
new business levels, strong performance in terms of loss ratio and
lapse rate and product innovation opportunities that create further
competitive advantage.

© 2017 KPMG Advisory N.V., registered with the trade register in the Netherlands under number 33263682, a member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (‘KPMG International’), a Swiss entity. All rights reserved.

Singapore provides national investments in everything from the
rollout of video consultations, to partnerships with its National
Robotics Programme to use more robotics in care delivery, such
as ‘smart wards’ that will be integrated with smart logistics in
hospitals. This is in line with the shift of care from hospitals to the
community through for example robotics-assisted home care. Data
can enable the identification of cost-effective clinical practices,
reducing costs, without any drop in clinical outcomes.
In addition to looking for opportunities for such value-driven care,
the Ministry of Health in Singapore is exploring predictive
analytics. A group of government-supported researchers has
developed a predictive model for identifying discharged patients
who are at risk of multiple readmissions; it enables proactive early
intervention to be provided to better support these patients. A
‘Hospital to Home’ programme supported by this model is
expected to serve some 19,000 patients in 2017(1).

50

Regulatory

Incentives

Necessity

Levers of the MedTech adoption
An increasing necessity in the Netherlands might require more adoption of MedTech (1)
Necessity as a key lever for adoption
The last external key lever for broad adoption of
medical technology is necessity, where health
technology is leveraged and integrated into care
delivery models to achieve the triple aim: improving
access, quality, and costs of care. If a country has a
need to improve either of these aims, and medical
technology can provide a solution, the adoption of that
technology is more likely to happen.

1.

2.

Incentives make it happen. Providers will typically
behave the way in which they are funded – and
their adoption of medical technology is impacted by
this. The use of explicit levers to enable technology
(e.g. subsidies), or more flexible payment models
which incentivise outcomes over individually paid
treatments can enable better use of technology.

3.

Necessity as the enabler of innovation. Medical
technology has risen to the challenge of helping
healthcare providers to achieve the ‘triple aim’ of
improving cost, quality, and access. Innovation
does not need to reinvent the way care is
delivered, but can augment the situation between
patients and providers to improve access to care,
intervene in a more timely way, and do it more
affordably.

The boxes on the right show several examples of
medical technology improving access, quality and costs
of care.

The environment for MedTech in the
Netherlands
In the Netherlands, quality and access are coming
under pressure while at the same time healthcare
spending is increasing due to the aging population and
the increasing number of people with (sometimes
multiple) chronic diseases. These demographic
developments are creating the need for a focus on
limiting healthcare costs, without reducing access and
quality. This could transform the Netherlands into a
highly MedTech-adopting country, by leveraging the
external levers as discussed on the previous pages.

Regulatory enablement. Regulations in health
technology need to exist to protect patients from
unsafe devices but can also prevent access to
technologies that could save their lives. Regulation
needs to be nimble enough to provide access to
patients for technology, but needs to have the
authority to ensure that technologies help and not
harm patients.

Improving care (Geographic) access with
technology – Ontario Telemedicine Network
(OTN) (Canada)
The Ontario Telemedicine Network is one of the largest
telemedicine networks in the world and plays a key role in
providing access to care in particular in areas such as
rural Ontario, where patients can be significant distances
from providers/have reduced access. OTN delivers video
consults, provides tele home care, and promotes the use
of telemedicine. OTN has curated and established various
solutions and programmes that Ontario’s healthcare
providers and organisations can take advantage of to
deliver patient-centred healthcare that is focused on the
home environment, and improve their practice and
administrative functions.

In conclusion, the three factors that enable nationwide
adoption are:
Source:

© 2017 KPMG Advisory N.V., registered with the trade register in the Netherlands under number 33263682, a member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (‘KPMG International’), a Swiss entity. All rights reserved.

OTN.

51

Regulatory

Incentives

Necessity

Levers of the MedTech adoption
An increasing necessity in the Netherlands might require more adoption of MedTech (2)

Hub and spoken technology models for care
quality, access, and cost savings – Mercy
Virtual (US)
Mercy Virtual is a hospital without a bed. The medical
team can, with the help of technology such as highly
sensitive cameras and real-time vital signs, ‘see’ patients
where they are and diagnose patients and deliver care
remotely. It supports Mercy’s network of hospitals,
primarily through the virtual dashboards that they use to
monitor patients. So far, Mercy Virtual has been able to
generate savings through improving care delivery,
reducing waste of supplies, and reducing intensive care
bed days and travel costs to visit patients. “For example,
Mercy Virtual has helped its parent health system save
$9.2 million annually by using technology from the
software company SAP to standardise communication
and terminology throughout its facilities and reduce waste
of very expensive surgical supplies. Remote patient
monitoring by Mercy Virtual has also helped reduce total
intensive care patient days in the hospital by 90,000 over
a period of a several years, which translated into savings
of $50 million.(2) ”

Source:

(1)

EIU, from: https://www.pwc.in/press-releases/global-mhealth-adoption.htm.

(2)

Mercy Virtual.

Low-resource settings leveraging technology –
m-Health (developing world)
There is a significantly higher uptake of mobile health,
known as mHealth in the developing world than in
developed countries. An EIU(1) analysis shows an uptake
of approximately 59% of emerging market consumers
using an mHealth app compared to 35% in the developed
world. There are various ‘necessity’ reasons why the
developing world is scoring higher in terms of adoption
compared to the developed world. This includes
everything from providing access which is difficult
geographically and/or from the supply-side perspective of
providers (e.g. hospitals might be long distances from the
villages they serve, or there could be a shortage of
specialists in these regional care settings), to improving
the cost of delivery and the quality of care. For example,
in many of the developing countries such as India, the
vast majority of care is paid for out of pocket by patients,
and therefore mHealth is the only way to make care
affordable. From a quality perspective, mHealth can be
used to improve outcomes for patients by providing them
with more information to self-manage, potentially
intervening earlier, or helping them by supporting
decision-making.

OTN.

© 2017 KPMG Advisory N.V., registered with the trade register in the Netherlands under number 33263682, a member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (‘KPMG International’), a Swiss entity. All rights reserved.

52

Appendix

Glossary
AI

Artificial intelligence

OCT

Optical coherence tomography

AWBZ

Dutch law on special healthcare

RFID

Radio frequency identification

CBS

Central Bureau voor de Statistiek (statistics)

ROI

Return on Investment

COPD

Chronic obstructive pulmonary disease

SMEs

Small and medium enterprises (<250 FTEs)

CPAP

Continuous positive airway pressure

TFHC

Task force healthcare

DSRIP

Delivery System Reform Incentive Payment

VBHC

Value-based healthcare

EHCI

European Health Consumer Index

VMI

Vendor-managed inventory

EPD

Dutch healthcare system – electronic patient records

VVT

Dutch nursing homes and home care industry

ENT

Ear, nose and throat

VWS

Dutch Ministry of Health, Welfare and Sports

Extramural care

Care outside the hospital

WLZ

Dutch law on long-term care

FDA

Food and Drug Administration

WMO

Dutch law on social support – Municipality-financed healthcare

GGD

Dutch municipal or common health service

ZVW

Dutch basic health insurance

GGZ

Mental healthcare

GP

General practitioner

HTA

Health technology assessment

ICT

Information and communications technology

Intramural care

Hospital care

IoT

Internet of Things

IT

Information technology

IVD

In vitro diagnostics

IVDR

In vitro diagnostics EU regulation

MDR

Medical devices EU regulation

MedTech

Medical technology

MI

Minimally invasive

© 2017 KPMG Advisory N.V., registered with the trade register in the Netherlands under number 33263682, a member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (‘KPMG International’), a Swiss entity. All rights reserved.

54

Appendix
Matrix

17. Care products (incl. stoma & wound management)
18. Diagnostics and imaging (incl. patient monitoring)
19. Ophthalmic (incl. implant, prostheses and glasses))
20. Cardiology (incl. prostheses and implants)
21. Orthopedics (incl. proheses & orthopedic shoes)
22. in Vitro Diagnostics
23. General hospital & Plastic surgery
24. Medical aids (Incl. communication, signaling, food delivery, mobility, and arm-hand-finger function)
25. Dental
26. Ear, Nose, & Throat (incl. hearing aids)
27. Drug delivery (incl. dialysis)
28. Diabetic care (incl. implants and prostheses)
29. Respiratory Equipment
30. Home adaptation
31. E-Health home automation/ Robotics
32. Neurology
33. Endoscopy
34. Contraception (birth control)
35. Other
Total
0.06
0.07
0.29

0.53

0.43

0.22

0.01

© 2017 KPMG Advisory N.V., registered with the trade register in the Netherlands under number 33263682, a member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (‘KPMG International’), a Swiss entity. All rights reserved.

0.19

0.09

0.03

0.26

0.95

0.72

0.47

0.23

0.16

Total

17. Other

16. VVT Extramural

15. VVT Intramural

14. Academic hospital

13. Top clinical hospital

12. General hospital

11. Rehabilitation care

10. Mental healthcare (GGZ)

9. Independent treatment center (Z

8. Paramedical care

7. Gynaecology

6. Audiologist

5. Optician

4. Pharmacy/medical specialty sto

3. Dentist

2. General practitioner

€Bn

1. Preventive care/ self care

Market size estimate - Medical technology in the Netherlands

-

0.58
0.50
0.44
0.37
0.34
0.34
0.29
0.27
0.27
0.24
0.19
0.13
0.12
0.12
0.11
0.06
0.06
0.00
0.22
4.7

55

Appendix
Matrix – Sources
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35

Interview feedback (e-health preventive care + 30% of other category).
CBS (Total costs for GP * client & bewonersgebonden kosten * MedTech % in P&B gebonden kosten), verified by interview feedback, verified by KPMG expert on percentage of care products, diagnostics and
imaging, in vitro diagnostics, drug delivery).
Based on KPMG research into dental lab spend, verified in interview feedback (medical equipment spend as % of total spend for dentists, extrapolated).
Farmaceutischcompas, assumption MedTech part based on interview feedback, verified by KPMG expert on percentage of other, diabetic, drug delivery, respiratory, orthopaedics, care products).
Based on revenue * COGS of total opthalmics market (based on 2 largest opticians) + specialty glasses from GIP Peilingen * assumption for MedTech part * assumption for part insured by ZVW.
Based on GIP Peilingen * assumption for MedTech part * assumption for part insured by ZVW, verified by interview feedback.
Based on GIP Peilingen * assumption for MedTech part * assumption for part insured by ZVW, verified by zorgcijferdatabank (Total costs * Patient & bewonersgebonden kosten * MedTech % in P&B gebonden
kosten).
Based on GIP Peilingen * assumption for MedTech part * assumption for part insured by ZVW for orthopaedics (*50%), medical aids (*5%) & home adaptation (*60%), % based on KPMG expert, total verified by
interview feedback.
Based on NVZ ziekenhuizen, share ZBC * general and academic total spend, verified by care products (15%) + in vitro (50% of extramural in vitro).
Based on medical aids, home altering equipment, verified by CBS, client en bewonersgebonden kosten* % MedTech, verified by interview feedback.
Based in on parts of care products, orthopaedics, medical aids, drug delivery, based on KPMG expert, interview feedback on orthopaedics.
Based on interview feedback, % of revenue spend on MedTech, extrapolated (disposables & capital equipment) (11%).
Based on interview feedback, % of revenue spend on MedTech, extrapolated (disposables & capital equipment) (9%).
Based on interview feedback, % of revenue spend on MedTech, extrapolated (disposables & capital equipment) (6%).
VVT extramural, based on % in ‘De verpleeg- en verzorgingshuiszorg en thuiszorg in kaart’ --> total based on interview CBS (Total costs * Patient & bewonersgebonden kosten * MedTech % in P&B gebonden
kosten), verified by interview feedback, verified by KPMG expert on percentage drug delivery, respiratory equipment, home adaptation, e-health, care products, medical aids)’
VVT intramural, based on % in ‘De verpleeg- en verzorgingshuiszorg en thuiszorg in kaart’ --> total based on interview CBS (Total costs * Patient & bewonersgebonden kosten * MedTech % in P&B gebonden
kosten), verified by interview feedback, verified by KPMG expert on percentage drug delivery, respiratory equipment, home adaptation, e-health, care products, medical aids).
Based on GIP Peilingen * assumption for MedTech part * assumption for part insured by ZVW and GlobalData Medical Equipment – wound care, verified by wound product % interview feedback (hospitals).
Based on ING Sectorstudy (extrapolated), verified by interview feedback, verified by extrapolation of intramural imaging costs, challenged by OECD data.
Based on revenue * COGS of total opthalmics market (based on 2 largest opticians) + specialty glasses from GIP Peilingen * assumption for MedTech part * assumption for part insured by ZVW.
Based on GlobalData Medical Equipment, verified by interview feedback
Based on GlobalData Medical Equipment + GIP Peilingen * assumption for MedTech part * assumption for part insured by ZVW, verified by interview feedback.
Based on interview feedback, verified by sensecheck from EvaluateMedTech and GlobalData.
Based on GlobalData Medical Equipment.
Based on GIP Peilingen * assumption for MedTech part * assumption for part insured by ZVW, verified by interview feedback (WMO).
Based on KPMG research into dental lab spend, verified in interview feedback (medical equipment spend as % of total spend for dentists, extrapolated).
Based on GIP Peilingen * assumption for MedTech part * assumption for part insured by ZVW, verified by interview feedback.
Based on GlobalData Medical Equipment + GIP Peilingen * assumption for MedTech part * assumption for part insured by ZVW.
Based on GIP Peilingen * assumption for MedTech part * assumption for part insured by ZVW, verified by interview feedback.
Based on GIP Peilingen * assumption for MedTech part * assumption for part insured by ZVW.
Based on GIP Peilingen * assumption for MedTech part * assumption for part insured by ZVW, verified by interview feedback.
E-health monitor, interview feedback.
Based on GlobalData Medical Equipment.
Based on ‘Endoscopy market trends’ * Dutch part of world market, verified by % endoscopy spend of total hospital revenue.
Based on GIP Peilingen * assumption for MedTech part * assumption for part insured by ZVW.
Based on other ratio of other research. We assumed approximately 5% of total in other category.

© 2017 KPMG Advisory N.V., registered with the trade register in the Netherlands under number 33263682, a member firm of the KPMG network of
independent member firms affiliated with KPMG International Cooperative (‘KPMG International’), a Swiss entity. All rights reserved.

56

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