Transcript The e - ERES

"The Effect of Further
Liberalisation in the
Healthcare Industry on
the(Healthcare) Real Estate
in the Netherlands”
Ivonne Lim
Index
•Background
•Research questions
•Theoretical insights
•Methodology
•Results
•Conclusions
07/07/2015
Pagina 2
Background
Via Beeld | Koptekst
en voettekst
wijzigen
07/07/2015
Pagina 3
Total health care expenditure
2010, % GDP
15.00
10.00
5.00
0.00
4.00
3.50
3.00
2.50
2.00
1.50
1.00
0.50
0.00
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Pagina 4
Health Care expenditure of the Netherlands
Central forecasting bureau of the Netherlands, 2012
% GDP
Health care expenditure, constant as % GDP
Idem, plus demographical factors
Total health care expenditure, realisation
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Pagina 5
Political decissions on long term care
Decreasing public finance and increasing private finance
Before 2008: Health
care institutions
received
reimbursements for
capital costs and
nursing costs
2008: capital costs
reimbursement
(healthcare
institutions) were
discarded. Patients
received
livingcosts and
nursing costs
contribution
instead.
2013-2016:
patients with light
care needs receive
no longer
contribution for
their living costs
07/07/2015
2016- …: patients
with intensive
care needs will
no longer receive
contribution for
their living costs
Pagina 6
Research main question
• If the Dutch government further liberalizes the healthcare industry and
seniors have more freedom to choose their own living, how will the
Dutch health care real estate structure be on that moment and which
real estate are attractive to investors?
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Pagina 7
Theoretical insight
•CFt : Cash Flow at year t
•n : Number of exploitation years
•IRR : Internal Rate of Reaturn
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Pagina 8
Theoretical insight
• By removing the living contribution, patients has more freedom to
choose their own home/neighbourhood. Traditional nursinghouses
will be less attractive and most seniors will live much longer in their
own home (Economical Institute for Real Estate, december 2012)
•There will be a transition, from institutional living complexes to
senior residences (ABF Real Estate monitor, 2013).
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Pagina 9
Methodology
Literature:
Data-bank and forecasting
Interviews:
Economists, Real Estate
professionals, Researchers,
Scientific advisor etc
Survey:
Living preferences of
seniors
Analysis:
The hot´s and not´s
Results:
Winners and bleeders
Conclusion
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Pagina 10
Increasing number of seniors
CBS (National Bureau of Statistics of the Netherlands, 2012)
30%
5.0x 1 mln
27%
4.5
24%
4.0
21%
3.5
18%
3.0
15%
2.5
12%
2.0
9%
6%
3%
0%
1.5
1.0
0.5
1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020 2025 2030 2035 2040 2045 2050 2055 2060
number of 65+
number of 80+
% 65+
% 80+
12 x 1 mln
11
10
9
8
7
6
5
4
3
2
1
-
48%
44%
40%
36%
32%
28%
24%
20%
16%
12%
8%
4%
0%
1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020 2025 2030 2035 2040 2045 2050 2055 2060
number of 65+
working population
% 65+
07/07/2015
65+/working population
Pagina 11
Forecasting
ABF Research Fortuna 2012
Under- and uppersupply of care housing (2013-2040)
160,000
Undersupply independent senior
living (adjusted to senior needs, care
institution arround)
140,000
120,000
Undersupply of intramural places long term intensive care
100,000
80,000
60,000
Undersupply of intramural places short stay
40,000
20,000
0
-20,000
2013
2025
2030
2040
Undersupply of sheltered living (for
long term light care)
-40,000
-60,000
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Pagina 12
Forecasting
Interviews with real estate professionals, economists, investors and advisors
•´A real market will exist among the seniors, hereby the
preferences of each client get much more important´.
•´To get more stable cash flow you have to offer a flexible real
estate that is suitable to several target groups´.
•´Considering the invidual culture of the Netherlands, even if
seniors get more and more independent, they still prefer the
health care institution instead of their children to take care of
them´.
•´Considering the efficiency in time and costs, seniors will be
(willingly of pushed) living together in a cluster/complex´.
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Pagina 13
Survey
Living preferences of seniors of (mostly) 55 years and older
AGE
Civil Status
6%2% 11%
10%
18%
12%
55%
30%
22%
33%
Younger than 50 yrs
50-54 years
Married
Single
55-59 years
60-64 years
Divorced
Living together
65-69 years
Older than 70 years
Financial status
20%
23%
4%
1%
10%
42%
Employee
Enterpreneur
Employer
Jobless
Retired
Other
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Pagina 14
Survey
Living preferences of seniors of (mostly) 55 years and older
Owner or tenant
Prefered monthly
livingcost
7%3%
33%
22%
67%
68%
Wants to own house
Wants to rent a house
Prefered location
Less than € 650 p.m.
€650 - €800 p.m.
€800 - €1.000 p.m.
€1.000 -€1.500 p.m.
Prefered living
19%
20%
Prefered neighbours
17%
25%
39%
7%
5%
1%
60%
20%
4% 11%
27%
58%
In the same neighbourhood
Closer to the children
Closer to the city
Closer to the facilities
In a village
On the country side
Family house
Appartment
Nursing complex
Others
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Young(er) families
Mostly 55+
Students
Others
Pagina 15
Survey
Living preferences of seniors of (mostly) 55 years and older
Prefered outdoor space
Prefered parkingplace
15% 2%
14%
59%
42%
17%
41%
27%
23%
(Shared) garden
Rooftop garden
Balcony
Loggia
None
Own garage
In the neighbourhood
Indoor garage
No
Prefered facilities
Prefered number of bedrooms
23%
31%
2% 6%
87%
28%
59%
7%
16%
64%
64%
Shoppingmalls/-centre
Nature
Sport facilities
Public transport
Horeca
Culture
One bedroom
Two bedrooms
Three bedrooms
Four bedrooms
An area to let the dog out
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Pagina 16
Conlusion
•When the care sector is further liberalized, real estate investors should
offer a various kinds of senior living,due to the preferences of each client.
•Most of seniors will live in complexes that exist of various kind of
appartments. This concept could offer the most stable cashflow because
of her flexibility.
•The living complexes will mostly be located near by facilities such as a
healthcare institution, shopping centre, green area and public transport.
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Pagina 17