3D Investing in Practice GelijkGezond: Investing in better health by tackling problems at their source

People with a lower socioeconomic status have a shorter life expectancy on average, experience poorer health and rely more heavily on healthcare and social support services. In many cases, the root causes of these challenges lie not in healthcare itself, but in a combination of social issues such as debt, unemployment and a lack of social support. This is precisely where GelijkGezond focuses its efforts. The initiative improves health outcomes, reduces pressure on the healthcare system and, at the same time, delivers an appropriate financial return.

A different approach to a persistent challenge
Many people repeatedly visit their GP or other healthcare professionals, even though their needs extend far beyond medical care. GelijkGezond brings together healthcare and social care professionals to address these underlying issues. Rather than focusing on a person's condition, the starting point is understanding what they need to improve their health and overall wellbeing.

The initiative specifically supports people on low incomes with complex support needs. They receive guidance from dedicated professionals with the time and flexibility to identify the underlying causes of their problems and actively help them access the right support, whether related to health, debt, housing or employment. This approach builds on existing local services, prevents fragmented care and tackles the root causes of poor health. As a result, people can enjoy healthier lives and become less dependent on healthcare and social support over time.

GelijkGezond closely aligns with NLHealth's ambition and our Organising Care Differently investment strategy: reducing pressure on the healthcare system by organising care more effectively and placing greater emphasis on prevention and wellbeing.

Balancing the three dimensions: return, risk and sustainability
This investment clearly demonstrates how the three dimensions of 3D investing interact and reinforce one another in practice. 

Sustainability is reflected in the initiative's social impact. Its aim is to help people live healthier lives, improve their wellbeing and reduce unnecessary use of healthcare services. In doing so, GelijkGezond not only delivers better outcomes for vulnerable groups but also contributes to a more sustainable and resilient health and social care system.

The financial return is generated by that same impact. As participants become healthier and require less care, the initiative creates both social and financial value. Municipalities reimburse GelijkGezond based on the savings achieved. Health insurers, meanwhile, reimburse the organisation based on the number of completed support programmes. An outcomes-based reimbursement model would have made contractual arrangements with health insurers too complex at the outset, delaying the launch of the initiative. Instead, insurers evaluate afterwards what impact the programme has had on healthcare utilisation. The combined income from municipalities and health insurers enables GelijkGezond to deliver the programme and repay its investors.

The main risk lies in execution. Although the approach has already been tested successfully in several pilot projects across the Netherlands, this is the first time it has been implemented at scale using a shared outcomes-based payment model involving both municipalities and health insurers. Success depends on reaching the target group, delivering the intended outcomes and ensuring effective collaboration between municipalities, health insurers and delivery partners. To manage these risks, clear agreements have been put in place covering monitoring, reporting, phased financing and governance.

Impact and financial return go hand in hand
One of the key lessons from this case is that social impact and financial return can reinforce one another. When the intervention succeeds, all parties benefit. Residents receive the support they need, healthcare professionals have more time to focus on the work they are trained to do, municipalities and health insurers experience less pressure on the health and social care system, and PGGM earns the agreed financial return.

Because all stakeholders share an interest in achieving the same outcome, the initiative creates a strong foundation for collaboration. Financial incentives are aligned with delivering meaningful social outcomes, rather than maximising the volume of care provided.

Investing in what does not yet exist
For PGGM, the challenge was not recognising the social importance of the issue, but finding a way to make the initiative investable. At the time, there was no standard outcomes-based payment model through which municipalities and health insurers could pay GelijkGezond for achieving agreed results. Nor was there an established investment model for providing the working capital needed to finance such an initiative upfront.

Developing a suitable financing structure required close collaboration between GelijkGezond, PGGM and its co-investors. There was no ready-made investment opportunity; together, the parties designed a financing model capable of attracting institutional capital. Investors were therefore involved from an early stage to help shape an investable proposition.

This was achieved through a Dutch coalition of investors and funders comprising PGGM, Invest-NL and Noaber Foundation, with Rabobank supporting the foundation as a donor. PGGM provided a €1.5 million loan, while investors collectively contributed €3.2 million in financing. In addition, the foundation received several donations, including €1 million from Rabobank.

For GelijkGezond, investing involved more than assessing an existing business case. Sometimes it also means working together to develop a promising initiative into an investment proposition suitable for institutional investors.

What this case demonstrates about 3D investing
GelijkGezond illustrates how 3D investing works in practice. Rather than weighing return, risk and sustainability separately, the approach seeks solutions in which these three dimensions reinforce one another. The investment contributes to better health outcomes, reduces pressure on the healthcare system and delivers a financial return that reflects the level of risk PGGM has taken. In doing so, GelijkGezond demonstrates how PGGM, through its Organising Care Differently investment strategy, is helping build a more sustainable and future-proof health and social care system.