Physical therapy in 2026: low rates, health insurers and what you can do

The situation in the Dutch physiotherapy sector does not look rosy in 2026. Practice owners are considering quitting en masse, young therapists are dropping out after a few years, and patients are finding that their physical therapy is becoming increasingly expensive. The cause? A perfect storm of low rates, shrinking health care benefits and rising costs. If you're working as a physiotherapist in the Netherlands or starting your career, it's time to think carefully about your strategy.

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The numbers don't lie. In 2024, no less than considered 54% of practitioners to quit. 17% are even actively selling their practice. These are not incidents, but symptoms of a sector that is under great pressure. But before we complain, let's first understand how we ended up here.

How health insurers set the rules

Health insurers are in a difficult position. Premiums should not rise too fast, because then politics will run out of control. At the same time, they must keep their insured persons happy. The solution? Physical therapy is moving from basic insurance to additional packages, where they have more freedom to cancel.

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In 2026, things will change again. Physical therapy after corona disappears from the basic package. For most people, this means that you need additional insurance. And that's where the problem lies: those additional packages are getting thinner every year. Where many insurers used to reimburse you for unlimited physical therapy, the current packages are limited to 6, 9, 12 or a maximum of 27 treatments. And of course, they cost an extra premium.

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The result? 13% of people who need physical therapy opt out for financial reasons. So those people keep walking around with their complaints, which ultimately leads to more expensive care. But that is a problem for later.

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What does this mean for patients and practices?

For patients, the bill is simple. Physical treatment costs between €43 and €50 per half hour. Do you have an injury or chronic complaint? Then you quickly need 10 to 20 treatments. Without additional insurance, you pay for it yourself. If you do have an additional package, you may be up to your maximum and have to pay for the rest out of pocket.

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For practices, the story is even more frustrating. That €43 per treatment? That includes the rent, the energy costs, the administration, and, of course, the therapist's salary. Health insurers often charge rates that are €10 below the recommended rates. And those rates haven't risen for years, while all other costs are rising.

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The result is that practices have less and less space. 40% of practices face staff shortages, compared to 16% in other sectors. Young physios are leaving en masse for better-paying sectors. Those who work in a hospital or rehabilitation center under a collective labor agreement sometimes earn up to €1,000 more per month. It makes sense that they're leaving.

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The economic pressure is getting too great

The Dutch physiotherapy sector is on the verge of consolidation. Practitioners have fewer and fewer margins to invest in staff, training or new equipment. Many practices only survive through scaling up or cooperation. Some entrepreneurial physios buy multiple practices in their region to work more efficiently. Others are simply considering quitting.

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22% of all BIG-registered physiotherapists are over 55, and a large part will retire within a few years. Normally that would not be a problem, but the new generation is not moving on. In four years, the number of new students fell by 15%. And of those who do graduate, stops 45% inside five years.

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The administrative burden also plays a role. Physical therapists spend a lot of time reporting and accounting to health insurers. Time they'd rather put into patients. Practices that outsource their administration do survive, but that costs extra money that actually isn't there.

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What can you do as a professional?

Okay, enough wailing. The situation is what it is. The question is: what do you do with it? This is where it comes down to your phase in your career.

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If you've just graduated

Take a good look at where you will be working. Choose a place where you can learn a lot and are valued. That does not necessarily have to be in primary care. Hospitals and rehabilitation centers often offer better working conditions. Or are you going to specialize in something that is in demand: sports physiotherapy, geriatrics, pelvic physiotherapy. The more specialized, the higher the rates and the better your position.

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Also, consider your options abroad. Working in Switzerland not only offers higher salaries, but also better employment conditions, more development opportunities and a different perspective on your profession. What do you earn net? Easily double what you get in the Netherlands, while you can work with the same diplomas.

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If you've been around a bit longer

Then it is time for financial planning. How much do you earn now? What do you want to earn in 5 or 10 years? If you stay in primary care, realize that the margins are only getting smaller. Maybe it's time to broaden your portfolio. Occupational physiotherapy for companies, for example, is growing. Or, you can partner with other practices to share costs.

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Emigrate to Switzerland is also an option later in life. Many experienced physios take the step and find a second youth in their careers there. Appreciation for your work is different, salaries are better and you can still build up a solid buffer for your pension. Our complete checklist helps you get off to a well-prepared start.

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As a practice holder

You are facing difficult choices. Are you going to keep going, selling or working together? If you keep going, you have to do business smartly. That means: outsourcing administration, collaborating with other practices, specializing in a niche, or expanding your practice to include fitness or occupational physiotherapy to be less dependent on insurers.

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Selling can also be an option. There are entrepreneurial physios who buy up multiple practices and create economies of scale. If you're approaching 55 and don't have a successor, start talking now. A transfer of practice takes longer than you think.

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What politics should do

The House of Representatives wants an emergency plan for physical therapy. The KNGF has been calling for minimum rates for some time. That would help, but it's not enough. Here are five concrete proposals from our side:

1. Introduction of minimum rates - The NZa is now investigating this. Make sure they arrive quickly and that they are realistic. No symbolic policy, but rates that you can use to run a practice.
2. More physical therapy in the basic package - Stop shifting to additional packages. Preventive physical therapy is cheaper than subsequent hospital care. Everyone knows that, so act accordingly.
3. A collective agreement for primary physical therapy - Practice owners say they can't afford it now. That's true, but if the rates become fair, it's possible. A CLA provides clarity about employment conditions and makes the profession more attractive.
4. Reduction of administrative burdens - Physical therapists are not administrators. Simplify reporting requirements and invest in digitization that really works.
5. Stimulating cooperation and scaling - Give practices that work together tax benefits. Help them share knowledge and support them with back office solutions.

Alternative routes for those who want to continue

If you don't wait for politics, there are other ways. Specializing is one. Geriatric physiotherapy, pelvic physiotherapy, sports physiotherapy: all areas where you can charge higher rates and are in demand. You do have to invest time and money into it, but it pays off in the long run.

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In addition, there is foreign countries. At takeoff, we'll guide you through your move to Switzerland: you'll get help with paperwork, help with your move, and you'll be part of a community of physios who have taken the same step. The salary is better, the valuation is higher and your lifestyle is improving.

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Another option is to set up a cooperative with other physical therapists. Together, you negotiate better with insurers, share costs and offer more different treatments. It does require cooperation and trust, but it works.

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The hard truth

Change in the physiotherapy sector does not happen overnight. Minimum rates are being investigated, a collective agreement is being discussed, and there are various initiatives to strengthen the sector. At the same time, many practices and therapists are already under pressure.

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What does help is to keep your options open. You can actively contribute ideas about improving the sector through professional organizations. And at the same time, you can see what your personal situation requires. Some therapists opt for specialization, others opt for collaboration with colleagues. Still others find their solution in another sector or abroad.

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