Why Portuguese hospitals do not need focused clinics, but do need focus
When I moved to Portugal, the private healthcare market surprised me. In the Netherlands, focused clinics specialised in cardiology, ophthalmology or orthopaedics grow year after year, around 7.5% annually according to Gupta Strategists. In Portugal the phenomenon barely exists. The private sector is built around broad hospitals that do everything under one roof, yet with even more impressive growth of 10 to 15%.
I spent years working for a focused clinic. So naturally I asked whether Portugal could benefit from the same model. But as the saying goes: if all you have is a hammer, everything looks like a nail. That trap applies here too.
The focused clinic is a Dutch answer to a specifically Dutch problem, made possible by a specifically Dutch insurance market. The real question for Portuguese healthcare leaders is not "should we build focused clinics?" It is sharper: how do we deliver more value to the patient inside the broad hospital we already have?
Why focus could emerge in the Netherlands and it did not happen in Portugal
The 2006 Health Insurance Act gave independent clinics the right to bill within the basic insurance package. Insurers began negotiating hard on price and on outcome per care pathway. A door opened, and specialised, high-volume players walked through it, offering shorter waits and lower costs for planned care, often built on the one-stop-shop principle. This was not a superior management philosophy. It was a market structure that created an opening.
Portugal's structure is different. The patient, not an insurer, is often the one choosing and paying. And the private insurer and the private hospital frequently sit inside the same group. When the company that insures the patient also owns the hospital that treats them, the system steers patients internally. That can be efficient. It also means no outside player applies the competitive pressure that, in the Netherlands, pushed care out into focused clinics.
So the focused clinic does not scale here. Not because the idea is weaker, but because the market is built differently. This is not a stagnant market; it grows fast. It simply grows broader, not more focused.
What focus actually delivers
In 1974 Wickham Skinner described the focused factory: a plant that does a limited set of things and, precisely for that reason, outperforms the complex one. Simplicity, repetition and experience breed competence. A factory cannot excel at everything; the ones that try excel at nothing.
Michael Porter brought the same logic into healthcare with the Integrated Practice Unit: a team organised around a patient's condition rather than around a specialty. The focused clinic is an IPU avant la lettre. The data shows the mechanism working: clinics in the Netherlands treat around 18% of patients with only 3 to 4% of the medical-specialist workforce. Higher throughput, lower cost, better outcomes, because the team does the same thing often enough to get genuinely good at it. But the real winner is the patient: a shorter wait, fewer visits, faster answers.
Choose by patient value…
A broad hospital cannot leave everything else out the way a focused clinic does. And it does not need to. What it can do is bring the logic of the one-stop-shop principle inside.
The trap of the broad hospital is the belief that every care pathway can be optimised at once. It cannot. Attention, capital and capacity are finite. So leaders have to choose where to start, and the right lens is patient value. The logic of the BCG matrix helps: which pathways combine real potential with a position you can win. But growth and market share are not enough in healthcare. The decisive question is where the patient is served worst today.
I saw what that can mean. In a hospital where I worked, we built a wound expertise centre. Complex wounds pull in several disciplines at once: wound-care nurses, (vascular) surgery, dermatology, sonography and the lab. Normally a patient bounces between them over weeks. That delay is not an inconvenience; walk too long with a complex wound and the outcome can be amputation. By organising the disciplines around the patient, and reserving lab slots so results came back within the same visit, we turned it into a genuine one-stop shop. The patient left in a single visit with a treatmentplan, and in time it drew patients from well beyond the region.
… But allocate by strategy
Here is the part most implementations lack. You choose where to start by patient value, but that is not the only decision. Resources still have to be allocated wisely. A one-stop-shop pathway runs through shared, scarce resources, the CT scanner, the MRI, the lab, which are often already a bottleneck in the process. So as you build, you protect first claim on that scarce capacity for the pathway that matters most strategically. Choose where to start by patient value; allocate capacity with your strategy in hand. They are not the same decision.
That is what Portugal can take from the Netherlands. Not the focused clinic itself, but the discipline underneath it. Where do you see the greatest need for focus?
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Gupta Strategists. (2022). De kracht van focus. ZKN
Porter, M. E., & Teisberg, E. O. (2006). Redefining health care: Creating value-based competition on results. Harvard Business School Press.
Skinner, W. (1974). The focused factory. Harvard Business Review, 52(3), 113–121.
