Bergman Clinics is a multinational European clinic chain that focuses on elective medical specialist (secondary) care done in an outpatient setting. In a conversation with HBI Jeroen Cammeraat, CEO, explained how being focused on high volume elective procedures that can be done in an outpatient setting makes it possible to build an efficient and scalable multinational healthcare operator.
The company was founded as a cosmetic surgery clinic in the Netherlands in 1988 by a plastic surgeon named Dr Robert Bergman. It was subsequently bought in 1994 by a Dutch family (the Malenstein family), who expanded it into a multi-clinic and multi-specialty chain in the Netherlands. This was helped by a 2006 Dutch healthcare reform which allowed private ownership in outpatient clinics. Then in 2019 the group expanded northwards into Scandinavia (Sweden, Denmark and Norway) and eastwards into Germany. In 2021, Triton Partners acquired a majority stake to further expand the platform.
In 2025 the company achieved €700 million revenue, more than double the 2019 figure (€300 million). Its EBITDA was around €100 million.
In the Netherlands the company does a broad range of specialties: orthopaedics, ophthalmology, dermatology, women’s care, GI and ENT. In Scandinavia they focus mostly on refractive and aesthetic surgery for self paying clients. In Germany, they do both dermatology and ophthalmology.
But in all three regions Bergman Clinics is focused on elective care done in an outpatient setting. Germany is the only country in which they have hospital beds, because the licensing requires this in order to be able to operate outpatient facilities.
When asked whether the big opportunity which the business is seeking to capitalise on is the fact that healthcare is increasingly taking place in an outpatient setting, Cammeraat says yes. He emphasises the need to offer accessibility, given the increase in demand and shortage of supply of care services, and outpatient settings are the best way to do so efficiently.
Jeroen Cammeraat, CEO, Bergman Clinics
“Some markets are ahead of others in this trend, such as the Netherlands (if you compare it to Germany, for instance, there’s still a long way to go, although the German hospital reform may accelerate the trend there). Overall the trend is very favourable to us, and that’s why we decided to build out our platform, initially in the Netherlands, and then expand into other European markets,” Cammeraat says.
Being focused on high-volume elective care and having the scale of 150 clinics and 750,000 patients per year means they can standardise and optimise pathways in a way that most providers can’t. “There’s a lot of research showing that medical quality is ultimately very much volume-driven. We have more than 50 different unique care pathways for the different specialty areas we cover, and in some of those we perform particular surgical procedures on more than 25,000 patients per year.”
Focusing on “plannable” elective care means that everything can be scheduled in advance and executed according to protocol, almost like a factory. Rigorously collecting data helps them to benchmark and “constantly improve performance across all dimensions”. This includes tracking adverse medical events, patient satisfaction, operational efficiencies, and financial efficiencies, across Bergman’s 150 clinics.
“It’s very different compared to a more hospital-based inpatient operator offering a wide range of services. A hospital offering a wide variety of services as well as acute care will never be able to achieve the level of optimisation and standardisation that we can.”
Digitising processes is important for the accessibility piece as well as helping with standardising and optimising of pathways. AI is increasingly being used to automate processes as part of this. “We have predictive modelling capabilities. So we know exactly how long a procedure will take, what the risk profiles are of every patient, what the expected outcome is going to be, and how to drive the best possible outcome.”
Another advantage of focusing on high-volume, standardisable procedures is that it makes it easier to know what technology to invest in:
“We want to be at the bleeding edge of technology innovation. Once a product is brought to market and has proven itself in terms of efficacy and efficiency, we are typically one of the most attractive launching platforms for the vendors to test it at a large scale. With cataract surgery we can run comparisons on different intraocular lens implants, for example. We typically are the first to have access to those innovations to test them, validate them and then roll them out across all clinics. We run large registry studies. This means we can also compare different vendors, and we can do that with speed and at a volume that is incomparable to local players.”
Bergman Clinics is one of only a limited number of multi-specialty healthcare operators that has managed to achieve international scale, although there are many single-specialty multinational chains in areas such as ophthalmology, dentistry, and veterinary.
Being an outpatient operator does offer an advantage over inpatient groups trying to achieve international scale. Pan-European hospital group Vivalto Santé, which is present in seven European countries, has found that the main benefit of this is “diversification” in the face of potential tariff cuts and other forms of regulatory risk.
Cammeraat says to reap the benefits of international scale requires being an “integrator”, rather than just a consolidator. “You can only do this if you make your model truly platform-based and transferable. And again, this requires optimising your care pathways to really drive best practices.”
This doesn’t mean that Bergman isn’t constrained by reimbursement systems and the way healthcare is set up in different countries. “Reimbursement systems do drive some of the decision-making. We perform the majority of the orthopaedic surgeries without an overnight stay, for example. But in Germany that is unthinkable, at least as things are currently. There has to be an overnight stay in Germany for a hip or a knee surgery, which is often not the case in the Netherlands. Although, we foresee that this will change rapidly, allowing us to enter the German market with our orthopaedic offering. This will become a very attractive portfolio expansion to our focus on ophthalmology and dermatology in Germany.”
But outpatient operators can do a lot more “integration” than multi-country inpatient groups, who are able to share knowledge and best practices between doctors cross-nationally but can’t optimise pathways in the same way because they’re dealing with low volume and high complexity care and therefore many more protocols, which in many cases differ by country. “Cataract surgery is essentially the same regardless of whether you’re doing it in Sweden, the Netherlands, Taiwan or the US; irrespective of the healthcare system and the reimbursement, the way it’s performed is what drives the best outcomes,” Cammeraat says.
In terms of plans for future expansion, Cammeraat doesn’t rule out entering new countries, but says this is not on the cards in the very near term. “In Germany there is plenty of room to expand, given the size of the market and that it’s quite fragmented,” he says.
When thinking about new markets to enter, he says that those which are attractive in terms of the supply-demand imbalance and which have fragmented provision will be the targets. The reimbursement system is less of a consideration — “Bergman Clinics is successfully operating in public reimbursement, statutory insurance, PMI and out of pocket payment markets.”
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