Belgium becomes a global player in healthcare real estate

Update : 30-03-2026

Aedifica and Cofinimmo are aiming to become a €12 billion giant in healthcare real estate through their merger. In a sector where scale is becoming crucial, they are creating a group capable of competing with international giants. Aedifica’s exchange offer for Cofinimmo has now succeeded: almost 80% of Cofinimmo shareholders tendered their shares.

The backdrop to this merger is international consolidation pressure. According to data from the European Public Real Estate Association (EPRA), European real estate companies are relatively small. All 450 players combined account for barely 13% of the world’s listed real estate. This makes them vulnerable to takeovers by well-funded foreign players. In recent years, it has been the American giants in particular that have been snapping up companies. And in Brussels, two players already disappeared from the stock market tables in 2024: office specialist Befimmo and Intervest Offices & Warehouses.

Attractive time for acquisitions

Although interest rates have stabilised, many European real estate companies are trading at large discounts to their intrinsic value, making them attractive to acquirers with deep pockets. In other words, if you don’t want to be swallowed up (by American firms), you have to merge and increase your scale. “It’s not every day that you get the chance to buy your neighbour’s house at a hefty discount”, Trends chief economist Daan Killemaes also remarked on the timing of the merger plans. The acquisition will see the group become the fourth-largest player on the global stage, after three American giants.

The demographic context must also be considered. The ageing of the population in Europe is gathering speed, as the first baby boomers are now turning eighty. That means it's better to join forces today than in ten years' time.

1 + 1 = 3

Synergy and economies of scale lie at the heart of Aedifica’s logic. Both companies focus on healthcare real estate for the elderly, which results in a significant overlap and therefore enables costs to be allocated more efficiently. That said, Cofinimmo is still sitting on its inheritance from the past and still has offices in its portfolio and cafés that are leased to AB InBev. The exchange offer ran until early March 2026. Aedifica needed at least 50% plus one share to acquire control of Cofinimmo, and it succeeded by a wide margin. Almost 80% of Cofinimmo shareholders tendered their shares (source). Both companies must now have the merger approved at an extraordinary general meeting. The merger will result in the delisting of the Cofinimmo share from the stock market.

The road was not without bumps. The Belgian Competition Authority initially raised critical questions about the combination of the two largest Belgian players in healthcare real estate, causing the process to be delayed by several months (source). After negotiations, the watchdog nevertheless gave the green light, on condition that Aedifica sells €300 million worth of Belgian healthcare properties over the next four years.

Through this merger, the group may be included in more international real estate indices, and its credit rating could also rise, which would be beneficial for financing costs. Finally, a larger firm is also more resilient – a diversified portfolio spanning several countries spreads risks more effectively. Aedifica is active in Northern Europe – where Cofinimmo barely has a presence – while Cofinimmo would give Aedifica access to markets in Southern Europe. In other words: geographically and operationally, the two complement each other perfectly.

What is an RREC?

Aedifica and Cofinimmo are both regulated real estate companies (RRECs). An RREC is a listed real estate company that meets specific legal requirements. The RREC status was created to allow private investors to invest in real estate on the stock markets, with attractive tax conditions. Belgium has around fifteen RRECs in total.

The RREC status offers investors a range of advantages. Firstly, they enjoy a high dividend yield, as at least 80% of the profits must be distributed each year. As RRECs distribute the majority of their profits and pay (little or) no income tax themselves, they generally pay out higher dividends than traditional companies. In addition, the withholding tax (dividend tax) on some RREC dividends has been reduced from 30% to 15%. This favourable rate applies to RRECs that invest at least 80% in residential care real estate in the European Economic Area (now only applicable to Care Property Invest).

Secondly, you can invest in large-scale property projects with small amounts of money. With a single share, you gain exposure to an entire portfolio of offices, warehouses, care homes and/or shopping centres. This means you do not need to buy a property yourself in order to collect rental income. In addition, a listed real estate company is much more liquid than direct real estate: you can buy or sell your shares on any trading day, which isn’t the case with bricks and mortar. Finally, the legal framework (mandatory valuations each quarter, debt limits and so on) provides a degree of protection and transparency.

Belgian real estate shares: who's who?

Belgium has a wide range of listed real estate companies, both large and small. Since March 2025, four RRECs have been included in the BEL 20 Index, which indicates the prominence of the sector on the Brussels stock exchange. In addition to logistics group WDP (portfolio of €8.6 billion as at 31 December 2025), Cofinimmo (portfolio of €6 billion as at 31 December 2025) and Aedifica (€6.3 billion as at 31 December 2025), Montea (logistics real estate) also entered the BEL 20. Montea itself specialises in logistics warehouses and distribution centres, with a portfolio of €3.2 billion as at 31 December 2025. The medium-sized players also include Xior (student housing - €3.6 billion as at 31 December 2025) and Retail Estates (€2.1 billion as at 31 March 2025).

Smaller Belgian players include Care Property Invest (healthcare), Vastned (retail), Wereldhave Belgium (retail), Home Invest Belgium (residential), Ascencio (retail), Inclusio (residential), Warehouses Estates Belgium (retail, logistics, offices), QRF (retail) and Immo Moury (offices, residential, retail).

What makes listed real estate attractive for investors?

Real estate is known as a tangible investment. Listed real estate combines this advantage with the liquidity of a share.

As RRECs are required to distribute the bulk of their profits, dividend yields are often higher than in many other sectors.

In addition, real estate companies often offer predictable cash flows. Their income often stems from long-term leases (according to Aedifica and Cofinimmo’s annual reports, their weighted average lease term is nineteen and thirteen years, respectively).

Moreover, rental agreements are often linked to inflation, causing rental income to rise in line with the cost of living. For investors, this acts as a partial inflation hedge as the fair value of rental income is maintained.

Diversification is another advantage. Listed property does not always perform in line with traditional shares. Particularly specialised segments (such as healthcare real estate or residential) can follow their own dynamics. Moreover, most RRECs spread their portfolio over hundreds of properties and dozens of tenants to reduce the individual risk. This wide range of possibilities makes real estate a sector that has something for everyone. Many investors include property funds in their portfolios for diversification and as a defensive cornerstone providing a steady income.

The real estate is also managed by teams with expertise in real estate management, development and financing. They also have access to transactions and markets that are out of reach for individual investors.

Finally, some companies can be attractive takeovertargets. This is particularly true in a climate where the share prices of real estate players lag behind their intrinsic value.

There are risks associated with investing in listed real estate, however, as the value of real estate shares can fluctuate significantly due to changes in interest rates, economic slowdowns or changes in regulations.

How can you invest in listed real estate?

Investing in real estate shares can take place in various different ways. The most direct approach is to buy individual shares in RRECs. A range of real estate funds and ETFs are available for anyone looking for greater diversification. These offer access to dozens of real estate companies and spread your risk across multiple countries and real estate segments in one fell swoop.

Before investing, be sure to read up on the main characteristics and risks of financial instruments.

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