Productivity increased significantly and profit grew dramatically by more than 100 million euros. More importantly, nearly all hospitals were doing better: 74 of 90 had improved their productivity and 85 out of 90 hospitals had achieved positive results for 2004. Gupta Strategists concludes that in 2004 a form of market forces were already at work. In some regions, such as Rotterdam for example, there was a correlation between costs, market performance and financial performance. In competitive areas, the fruit of market forces already began to show even before the opening of healthcare markets.