*Doubling of Dutch Healthcare Real Estate Investments in 2022 Compared to 2016 DOI: http://dx.doi.org/10.5772/intechopen.112326*

structure was relatively risk-free for healthcare institutions. Since 2012, healthcare institutions become responsible for their own healthcare (real estate) costs. Instead of being reimbursed for the costs, they receive a fee per actual care production delivered, the so-called performance funding. This has ensured that care institutions bear the full economic risks of the real estate whether or not rented or other use. These system changes have also shifted the risks for maintenance, occupancy and the final value of the real estate to the healthcare institution. The transition between the former and the current funding structure of healthcare real estate takes place gradually until 2018.

## *1.2.5 Real estate references*

Unlike the office, (social) housing or retail market, in the healthcare sector there are still not really publicly available real estate references. Many transactions that have taken place between housing corporations and healthcare institutions have not been public and/or are based on a social return that cannot always be expressed in euros. In addition, much real estate is also owned by the healthcare institutions themselves, so its valuation is not public. For several years now, a few parties have been mapping transactions and the first transparency is emerging within the sector. Incidentally, due to diverse functions, these properties are not always easy to compare.
