How to work as a healthcare zzp in the Netherlands: expat guide for 2026

Can an expat work as a healthcare zzp in the Netherlands?

Yes, an expat can work as a healthcare zzp’er in the Netherlands, but the route depends on nationality and profession. EU, EEA and Swiss nationals can usually start without a Dutch residence permit. Non-EU nationals who stay longer than 90 days generally need a residence permit, and regulated healthcare roles can require diploma recognition before work starts.

Healthcare work adds a second filter on top of normal freelancing rules: professional access. Browse the [Knowledge Hub](/knowledge-hub) for more freelancer accounting guides. If the role is a regulated profession, such as nursing, the foreign diploma must be recognised through the Dutch system before the professional title can be used lawfully in the Netherlands.

Registration as a zzp’er does not by itself create the right to practise medicine or reserved healthcare acts. A healthcare professional may need both business registration and professional recognition. This distinction matters because tax registration, work permission and patient-care authority are checked by different public bodies and each step can block the next one.

• EU, EEA and Swiss nationals can usually stay and work without a Dutch residence permit.
• Non-EU nationals who stay more than 90 days usually need a residence permit.
• Non-EU self-employed workers generally need the residence permit 'Arbeid als zelfstandige'.
• Regulated professions require diploma recognition before the title can be used.
• Healthcare freelancing involves both entrepreneurship rules and profession-specific rules.

Which registrations do you need before you see patients?

Most healthcare zzp’ers need at least a KVK registration, the correct SBI activity code, and a business administration from day 1. If the profession is BIG-regulated, BIG registration or recognition of a foreign diploma is critical. If the work falls under new-care-provider rules, the provider may also need a CIBG notification using eHerkenning before taking assignments.

For protected healthcare titles and reserved acts, business registration is not enough. The Dutch system separates entrepreneur status from professional authority. A nurse, doctor or other regulated professional can only rely on the professional title after the underlying qualification route is completed under the Dutch recognition system.

When care is delivered as a new care provider, the public-law onboarding can extend beyond KVK. Rijksoverheid states that a zzp care provider giving pgb-funded care must notify CIBG, use eHerkenning for that step, and register with an SBI code that matches the activity. That makes the startup checklist longer than a normal freelance setup.

• Register the business with KVK and check that the SBI code matches the healthcare activity.
• Confirm whether the profession is BIG-regulated before marketing services.
• Arrange BIG registration or foreign diploma recognition when the profession is regulated.
• Apply for eHerkenning if the care-provider portal requires it.
• Check whether the activity triggers a CIBG notification as a new care provider.
• Keep business and patient-care permissions as separate compliance tracks.

Do healthcare zzp’ers charge VAT, and can they use the KOR in 2026?

Many healthcare zzp’ers do not charge VAT on qualifying medical services. Belastingdienst states that medical acts aimed at the personal health care of a human are exempt from VAT. The 2026 KOR can only be used when the delivered goods or services are taxable and turnover stays at or below EUR 20,000 per calendar year, so VAT-exempt care usually does not fit the KOR logic.

The practical question is not whether the freelancer works in healthcare, but whether the exact service qualifies for the healthcare VAT exemption. If the service is exempt, the freelancer does not charge VAT to the client and should not treat the activity like normal taxable turnover. If the activity is taxable, the freelancer follows normal VAT rules and should review the [VAT return guide](/knowledge-hub/vat-returns-netherlands-expat-freelancer-guide).

Healthcare professionals should be especially careful with mixed activities. A practitioner may deliver exempt care on one invoice line and taxable work on another, for example staffing, advisory or other non-exempt services. That split determines whether quarterly VAT returns are required and whether the EUR 20,000 KOR threshold is even relevant.

• Qualifying medical treatment aimed at personal healthcare is VAT-exempt.
• VAT-exempt care usually means no VAT is charged on the invoice.
• If the activity is taxable, normal Dutch VAT rules apply.
• The 2026 KOR threshold is EUR 20,000 annual turnover.
• The KOR only applies when the supplied goods or services are taxed with VAT.

Which 2026 tax and record-keeping deadlines matter from day one?

A healthcare zzp’er should track taxes and records from the first invoice, even in a partly VAT-exempt practice. If VAT applies, the 2026 quarterly deadlines are 30 April, 31 July, 31 October and 31 January 2027. Income-tax filing is usually due by 1 May, and core business records must generally be kept for 7 years.

A startup in healthcare often mixes exempt and taxable income, so it is safer to organise the bookkeeping before the first payment arrives. Keep sales invoices, purchase invoices, bank records and ledgers from day 1. The [deductible expenses guide](/knowledge-hub/deductible-expenses-freelancers-netherlands) can help separate business costs from private spending, but the legal retention duty still sits with the entrepreneur.

Belastingdienst also applies entrepreneur-specific income-tax rules in 2026, including a zelfstandigenaftrek of EUR 1,200 if the entrepreneur meets the urencriterium. The tax benefit is calculated at 37.56%, and the startersaftrek is EUR 2,123 when the conditions are met. Those numbers matter only after the entrepreneur first qualifies as an income-tax entrepreneur.

Which healthcare-specific quality rules apply to a zzp care provider?

Healthcare freelancing is not only a tax setup; it is also a quality-law setup. Rijksoverheid states that the Wkkgz applies to all care providers, including zzp’ers. That means the freelancer must think about complaints handling, learning from incidents, and patient information before the first client contact, not after the first complaint arrives.

The Wkkgz requires more than good intentions. A care provider must organise complaint handling and connect to an acknowledged dispute route, and patients must be informed when care errors occur. For a solo healthcare business, these obligations often sit outside the bookkeeping system, so they are easy to miss during startup.

Where the practice uses other professionals, the obligations can expand further. The Wkkgz framework also refers to checking the functioning of new care workers before they start, and to reporting certain serious situations to the Inspectorate. Even a one-person practice should map these rules before accepting clinical work.

• Arrange a complaints process that patients can actually use.
• Have access to a complaints officer that is free for patients.
• Join a recognised disputes body for healthcare complaints.
• Organise a safe internal process for reporting incidents and learning from them.
• Inform patients when something goes wrong in the care provided.
• Review extra duties if other care workers are hired or contracted later.

How do you avoid schijnzelfstandigheid in healthcare in 2026?

A healthcare zzp’er must be able to show real entrepreneurial independence, not only a freelance contract. Rijksoverheid’s choice tool uses 10 questions to test the working relationship, and the Dutch government resumed full enforcement on schijnzelfstandigheid from 1 January 2025. Corrections can reach up to 5 years back, although the government states that retroactive correction only goes back to 1 January 2025.

"Als je echt een ondernemer bent en zelfstandig werkt kun je dat gewoon blijven doen."

Healthcare is a high-risk area because a freelancer can look independent on paper but work like staff in practice. If the client fixes the rota, controls the work method, removes business risk and treats the worker as embedded staff, the arrangement becomes harder to defend as self-employment. Before taking a long-term assignment, check the practical setup together with the opdrachtgever.

Rijksoverheid’s public guidance is useful because it focuses on the real working relationship instead of the document title alone. As Staatssecretaris Idsinga said, 'Als je echt een ondernemer bent en zelfstandig werkt kun je dat gewoon blijven doen.' For a healthcare zzp’er, that means autonomy, commercial risk and a contract that matches day-to-day reality.

• Use the Rijksoverheid choice tool before signing a major assignment.
• Test the real working relationship, not only the written contract.
• Keep control over schedule, method and commercial decisions where possible.
• Make sure the freelancer carries visible entrepreneurial risk.
• Avoid arrangements where the role is indistinguishable from an employee position.