Sector guide
Healthcare & medical practice M&A in the Benelux
Healthcare SMEs in the Benelux include private medical practices (dental, dermatology, physiotherapy), specialised clinics, medical-device distribution, and care-home operators. Geographic spread is even because demand follows population, but transaction concentration sits in Brussels, Antwerp, Ghent, Amsterdam, and Utrecht. Typical revenue ranges €500k for solo practices to €25m for multi-site care groups. Regulatory complexity is the sector's defining feature: Belgian RIZIV/INAMI structures and Dutch healthcare regulator approvals shape both operations and valuation.
Sector multiples
EV/EBITDA bands from the Upswitch Multiples Index (Q1 2026 snapshot), per country.
| Country | p25 | Median | p75 |
|---|---|---|---|
| Belgium | 4.5x | 5.5x | 6.6x |
| Netherlands | 4.7x | 5.8x | 7.0x |
Deal dynamics in 2026
Healthcare M&A in the Benelux is the highest-multiple sector at 4.5-6.6x EBITDA in Belgium, slightly higher in the Netherlands. PE roll-ups dominate (~50% of deals), particularly in dental chains, dermatology, ophthalmology, and care homes. The sector is structurally consolidating as solo practices retire and chains acquire. Earn-outs feature in 40-50% of deals: buyers want assurance that patient lists transfer with the practice and that key practitioners stay through a transition. Cross-border PE activity is high: French (Eurazeo Capital), Dutch (Waterland) and UK PE all actively pursue Benelux dental and ophthalmology platforms.
Valuation quirks specific to this sector
Three quirks dominate healthcare valuations. First: practitioner-dependency. In solo or duo practices, the owner-practitioner generates 60-90% of revenue; without a transition plan, multiples compress sharply. Two-year earn-outs tied to patient retention are standard. Second: regulatory transfer risk. RIZIV/INAMI numbers in Belgium and AGB-codes in the Netherlands are personal, not corporate: buyers need an explicit transfer plan and sometimes regulatory pre-approval. Third: government-funded revenue stability. Healthcare revenue is partially government-funded (RIZIV reimbursements, AOK), which gives revenue stability but caps growth: multiples reflect this with high floors but compressed ceilings.
Typical buyers
Three buyer archetypes acquire Benelux healthcare in 2026: (1) PE-backed roll-up platforms in dental, dermatology, ophthalmology, and care homes: these are the most active, typically paying 5-7x EBITDA on platforms and 4-5x on tuck-ins; (2) larger Benelux healthcare groups making strategic acquisitions, typically at 4-5.5x; (3) practitioner-driven succession buyouts where younger doctors or dentists take over from retiring colleagues, often at 4-5x SDE for sub-€2m revenue practices with vendor financing.
Frequently asked
- What multiple should I expect for my Belgian healthcare practice?
- 5.5x EV/EBITDA median in Belgium for 2026, with a 4.5x to 6.6x range. Dental and dermatology chains clear the upper band (PE-driven demand); solo medical practices clear lower because of practitioner dependency. The Netherlands runs 0.3-0.5x higher across all sub-sectors.
- How do I structure the RIZIV/INAMI transfer for a buyer?
- The RIZIV/INAMI number is personal and doesn't transfer with the practice. The buying practitioner must apply for their own number, which takes 3-6 months. Practical SPA mechanic: the seller continues to practise under their own number during the transition (typically 6-12 months), with patient files transferred progressively. A clear transition plan is the single biggest DD requirement in this sector.
- Are PE roll-ups still active in Benelux dental in 2026?
- Yes, very. The Benelux dental roll-up cycle started ~2019 with French and UK PE entering; in 2026 the consolidation is still ~40% complete. Premium urban dental practices (Brussels, Antwerp, Amsterdam centre) routinely receive unsolicited PE approaches. Multiples are 5.5-7x EBITDA for established practices with multi-practitioner operations.
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