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    Reference: 20220224
    Release date: 24 May 2023

    Promoter – Financial Intermediary




    The project entails the strategic investment plans of the Elisabeth-Twee Steden Hospital (ETZ) in Tilburg, aimed at optimising its healthcare infrastructure, service delivery and energy efficiency.

    Additionality and Impact

    The project supports the InvestEU objective of social investments, in particular by creating infrastructure for basic, complex and acute hospital care.

    The project covers the first two phases of the three-phased long-term strategic investment plan of ETZ, a top-clinical hospital in Tilburg, the Netherlands. By concentrating acute and complex care at the main location ETZ-Elisabeth, the Hospital aims to optimise the quality, cost-effectiveness, and sustainability of its healthcare activities. Its other two locations, ETZ-Waalwijk and ETZ-TweeSteden, will be renewed as well, and retain a role in diagnostics, elective and plannable care, ensuring hospital services remain available in patients' direct proximity.

    The project will renew and improve care infrastructure and help ETZ to cope with the increasing demand for healthcare from a growing and ageing population. In addition, the project will improve the energy efficiency of the Hospital's infrastructure and improve its carbon footprint.

    The project supports EIB's health policy objective and aims to provide high quality and accessible healthcare services. The project addresses a sub-optimal investment situation in the healthcare market in general, and in the hospital care segment in particular, as socio-economic returns are expected to exceed financial returns significantly.

    The Bank can provide sizeable and long-term financings, aligning maturities to the economic life of the investment, while providing flexible drawdown modalities during the construction phase. In parallel, the EIB adds to the depth of available financing options available to the Promoter, at attractive economic terms, and thereby facilitates and accelerates the necessary investments into hospital infrastructure.


    ETZ plans a phased but comprehensive renewal of its main hospital location ETZ Elisabeth, into a sustainable healthcare campus, where all acute, complex and clinical care will be concentrated. Upon completion of the investment plan, ETZ will be able to operate in a more agile and efficient way, within an optimally designed hospital. That will help the hospital to meet the increasing healthcare needs in its catchment area and maintain its positions as top-clinical hospital, and trauma centre for the province of North Brabant. In a first phase (until 2026), a new hospital building will be constructed at the ETZ Elisabeth location, to accommodate the emergency department, operation theatres and intensive care, cardiocare unit, intervention centre, nursing wards and a general practitioners centre. In the second phase (2027-2031), the building will be expanded with radiology units, more operating theatres, nursing wards and a parking garage. In parallel, the sites ETZ Waalwijk and ETZ TweeSteden will maintain their role for outpatient activities, day treatment and diagnostics.


    • Health - Human health and social work activities

    Proposed EIB finance (Approximate amount)

    EUR 200 million

    Total cost (Approximate amount)

    EUR 450 million

    Environmental aspects

    Hospitals are not explicitly mentioned in the Environmental Impact Assessment (EIA) Directive 2011/92/EU as amended by 2014/52/EU, though the project is covered by Annex II of the Directive concerning urban development. The compliance with requirements of the EIA Directive 2011/92/EU as amended by 2014/52/EU on Environmental Impact Assessment (EIA) and Habitats Directive will be verified during appraisal. It is expected that the project will bear more comprehensive benefits to the community as healthcare is an element of social cohesion and economic development.


    The promoter has been assessed by the EIB as being a private company not being subject to EU rules on public procurement or concessions. However, if at the project appraisal, the EIB were to conclude that the Promoter is subject to the EU public procurement legislation then the European Commission will be duly informed and the promoter will have to apply those rules.


    Signed - 14/12/2023

    Under appraisal
    17 November 2023
    14 December 2023


    Before financing approval by the Board of Directors, and before loan signature, projects are under appraisal and negotiation. The information and data provided on this page are therefore indicative.
    They are provided for transparency purposes only and cannot be considered to represent official EIB policy (see also the Explanatory notes).

    Related tags

    The Netherlands Health