The Dutch health system is financed predominantly by commercial bank loans, especially after the market-oriented reform in 2006, when government investment guarantees were abandoned. Commercial capital markets were envisaged to improve efficient capital allocation and management. We analyzed the effects of commercial bank loans on interest rates, investments and allocative efficiency in the Dutch healthcare sector. We aimed to explain variation in interest rates by financial performance of healthcare providers, hypothesizing that the reform reduced interest rates for financially well-performing providers. Using financial data from publicly available annual reports, we explored the effect of financial performance on long-term loan interest rates through pooled linear regressions. Our data showed that financial reserves have steadily increased, although profitability margins have declined since 2011–2013 (depending on the sector). While nominal interest rates have generally declined since 2006, the risk surplus on healthcare loans has steadily increased. Furthermore, we observed no significant relation between the financial performance of healthcare providers and interest rates on capital loans. Maintaining additional financial reserves provided no apparent benefit to capital costs. This suggests that healthcare providers may consider whether financial reserves should be maintained at current levels or can better be used for direct investments. Moreover, healthcare policymakers should evaluate whether the increase in risk surplus combined with an apparent lack of reward for financial scrutiny is a desired outcome of the reform.

荷兰卫生系统的资金主要来自商业银行贷款，特别是在 2006 年市场化改革之后，政府投资担保被放弃。商业资本市场旨在提高资本配置和管理的效率。我们分析了商业银行贷款对荷兰医疗保健行业利率、投资和配置效率的影响。我们的目的是解释利率随医疗保健提供者的财务表现而变化，假设改革降低了财务状况良好的提供者的利率。使用公开年度报告中的财务数据，我们通过汇总线性回归探讨了财务绩效对长期贷款利率的影响。我们的数据显示，尽管自 2011 年至 2013 年以来利润率有所下降（取决于行业），但财务储备稳步增加。尽管名义利率自 2006 年以来普遍下降，但医疗贷款的风险盈余却稳步上升。此外，我们观察到医疗保健提供者的财务业绩与资本贷款利率之间没有显着关系。维持额外的财务储备对资本成本没有明显的好处。这表明医疗保健提供者可能会考虑财务储备是否应维持在当前水平，或者是否可以更好地用于直接投资。此外，医疗保健政策制定者应评估风险盈余的增加以及财务审查明显缺乏奖励是否是改革的预期结果。