Objectives: This article explores lessons to be learned from three different healthcare systems and the possible implications for the management of healthcare real estate, in particular in connection to the Dutch system. It discusses similarities and differences among the different systems, in search of possible consequences on cost, financing, and design innovation. Background: To keep healthcare affordable in the future, the Dutch government is currently in the process of changing legislation to move from a centrally directed system to a socalled regulated market system. The deregulation of real estate investment that accompanies the new healthcare delivery system offers healthcare organizations new opportunities, but also more responsibility and greater risk in return on investment. Consequently, healthcare organizations must find new methods of financing. Private investment is one of the options. Methods: Three healthcare systems were analyzed on the basis of a literature review and document analysis, then schematized to show similarities and dissimilarities with regard to private investment in hospitals. Observations are based on a selection of recently published articles on privatesector financing and its implications for healthcare real estate decision making in the Netherlands, the United Kingdom, and Germany. Results: The strengths and weaknesses of three healthcare systems with differing proportions of private and public investment in hospitals were explored. Research revealed a gap between intended effects and actual effects with regard to quality and cost. Costly private finance does not necessarily lead to “value for money.” Transferring real estate decisions to private investors decreases the influence of the healthcare organization on future costs and quality. Conclusions: The three healthcare systems show substantial differences between public and private responsibilities. Less governmental involvement affords both opportunities and risks for hospitals. Private investment may lead to innovation, improved efficiency, and cost reduction, provided that the costs and benefits of decisions are not separated between different stakeholders. A missing link between infrastructure provision and healthcare delivery may impede design innovation and optimal adaptation to work processes and could lead to an inefficient allocation of risks and benefits. @en

Since 2008, after 35 years of a publicly supported healthcare real estate budget system, Dutch healthcare organisations have become financially responsible for the profits and risks of their real estate investment. Furthermore the Dutch healthcare system is in transition towards a regulated market system with growing competition between healthcare providers. Both developments will probably change the way healthcare organisations manage their real estate, the location choices they make and the building typology they choose. Real estate will become an increasingly strategic source of profitability and overall performance, similar to capital, human resources, information / knowledge and technology. In the literature on Corporate Real Estate Management (CREM) different models have been developed to link real estate strategy to business strategy (Jonge et al., 2008). In this paper we explore whether these models can be applied to support hospital organisations in their decision-making about real estate. These models are used to build an analytical framework that will be used in a PhD research study called Better healthcare for lower costs, real estate strategies in a changing context. The main issues of this PhD research are the changing context and scope of Corporate Real Estate Management for hospitals and its impact on real estate decisions in relation to general corporate management.@en

Dit artikel verkent een aantal overwegingen ten aanzien van de positie die ziekenhuisorganisaties (willen) innemen in de stad. Wat is beter: een locatie midden in de stad met alle voorzieningen dicht in de buurt, of een locatie buiten het centrum met meer uitbreidingsmogelijkheden en goed bereikbaar vanaf de snelweg? Blijven zorgfuncties geconcentreerd op grote ziekenhuisterreinen of exploderen ziekenhuiscomplexen in kleinschalige zorgcentra op verschillende locaties? Hoe kunnen de kwaliteiten van de locatie(s) zichtbaar worden gemaakt?@en

Subject/Research problem Healthcare is both important and expensive, and is likely to become even more expensive in the future. To keep healthcare affordable in the future, the Dutch government is currently in the process of changing legislation in order to move from a centrally directed system into a so-called regulated market system. Although Dutch healthcare providers have always been private organisations, until recently there was tight central governmental control on quality and investment cost of health care real estate. Once the brief and design had been approved by the Netherlands Board for Health Care Institutions, the government guaranteed the financing of the capital costs. The deregulation of real estate investment that comes with the new healthcare delivery system gives healthcare organisations new opportunities, but at the same time also more responsibility and a higher risk on investments. As a consequence, healthcare organisations have to find new ways of financing. Private capital investment is one of the options. Probably this will require a review of both corporate strategies and corporate real estate strategies. Research Question What are the experiences and lessons from private investment in hospitals in different countries and what might be the implications for healthcare organisations’ real estate strategies? Approach Based on a literature review and analysis of documents the healthcare systems in the Netherlands, UK and Germany have been studied in relation to different approaches of private investment in hospitals. Result The analysis of three health care systems with a different proportion between private and public investment in hospitals has been used to explore strengths and weaknesses of different care systems and possible implications for real estate strategies of healthcare organisations. Application This paper provides a better understanding of the opportunities and risks of private investment in healthcare real estate and consequences for real estate strategies. The paper is part of a PhD research project that investigates the scope, context, theories and tools of Corporate Real Estate Management in hospitals.@en