Working in healthcare through an intermediary: what you need to know

Over 30% of zzp’ers in healthcare (in Dutch) work through an intermediary agency. This is very convenient as the intermediary deals with the clients. As a self-employed person, you take on work at times that suit you best and at an hourly rate that you determine yourself. 

On the other hand, as a zzp’er, you often work alone and at a different workplace each time. And as with any self-employed person, your income may vary from month to month. You will have to provide for an income in case of illness yourself and you will not build up a supplementary pension.

If you decide to start as a self-employed professional in the care sector through an intermediary agency, pay attention to the following points.

Check your agreement

Check your working relationship to see if you are working with the right type of contract. Your clients and you are both responsible for choosing the right working relationship. Make sure you avoid false self-employment and comply with the DBA Act (Employment Relationships Deregulation Act). 

As director of the sector organisation, Van Erp regularly sees mediation agencies working with a non-solicitation clause. “This is a kind of competition clause that states, for example, that you are not allowed to take clients with you. Or that you are not allowed to work for a client through another agency. As a self-employed person, you probably prefer the freedom to also take on clients outside the intermediary. Therefore, an agreement without a non-solicitation clause is more favourable. Is that not possible? Then you can refuse the agreement and look for an agency that does not have a non-solicitation clause."

Check the quality

The quality of mediation agencies for zzp’ers in healthcare varies. To choose a good agency, it is important to check several things:

• Matching. How well does the agency match you with suitable assignments?
• Guidance. Do you get support in preparing contracts and invoices?
• Communication. Is communication with the agency clear? Do they contact you of their own accord?
• Rates. Does the agency charge rates that match your desired hourly rate?
• Customer satisfaction. What do other zzp’ers say about their experiences with the agency?

Ask the agency about their working methods and check online reviews and experiences of other freelancers. 

Determine your hourly rate

As a zzp’er, you decide what your hourly rate is, even if you work through an intermediary agency. Calculate your hourly rate with this tool. Take into account your experience, specialism, your target group, and the net income you want to earn. You can find information online about average rates in the healthcare sector. 

Keep in mind that the intermediary agency offers assignments at different rates. The level of your rate may therefore affect the type of assignments you can or cannot get. Ask the agency about this.

Do you have to declare VAT?

Two weeks after your registration at KVK, you will receive a letter from the Belastingdienst, the Netherlands Tax Administration. It will state whether you have to submit a quarterly VAT return or whether you are exempt from VAT. It is your responsibility to check whether this is correct. Call the Tax Administration if you are not sure. 

Please note, although many care services are exempt from VAT, you may be liable for VAT if you work through an intermediary agency. You must then charge VAT to your client and file a VAT return. 

• Did you receive the assignment from a healthcare institution (your client) via an intermediary agency? And do you send the invoice for your care services directly to the care institution and not to the intermediary agency? If so, this is exempt from  VAT.
• Do you carry out the assignment at a care institution with an assignment contract and send the invoice to your intermediary agency? Then VAT liability does apply. 

More information 

There is a lot involved in working as a zzp’er in the care sector. Check this guide to starting as a healthcare professional.  Each care sector profession has its own laws and regulations. Check out these step-by-step guides for detailed information about some of the different sectors:

• Starting as a self-employed home care professional
• Starting as a zzp nurse or VIG
• Starting as a self-employed social worker
• Starting as a dental hygienist
• Starting a childcare centre
• Starting a childminding agency