The COVID-19 pandemic highlighted vulnerabilities in global healthcare systems, emphasizing the need for innovation to enhance resilience, particularly in response to outbreaks and demographic changes like an ageing population. Many of these innovations originate from university research and are brought to market by health-tech spin-offs, creating significant societal value. In the Netherlands, academic entrepreneurial ecosystems play a crucial role in supporting these spin-offs, particularly in their early stages, through various facilitators. However, challenges unique to health-tech spin-offs, such as clinical regulations, often hinder their growth. Despite current efforts, facilitators lack comprehensive knowledge about the effectiveness of their support, leading to gaps that need addressing. Many publications exist about academic entrepreneurial frameworks however there remains a lack of knowledge about their applicability to Dutch academic entrepreneurial ecosystems. This study investigates how the three Dutch academic entrepreneurial ecosystems (Delft University of Technology, Leiden University Medical Centre and Erasmus Medical Centre) can design their academic entrepreneurial support systems to aid health-tech spin-offs effectively. Through a combination of literature analysis and interviews with facilitators and founders, the study identifies mismatches in support, including the need for tailored health-tech programs, clinical validation support, and efficient networking. It also explores the specialized support areas within Dutch ecosystems, such as TU Delft's focus on high-tech inventions, EMC's emphasis on medical devices, and LUMC's concentration on pharmaceutical spin-offs. The findings suggest that while each ecosystem has its strengths, there is a need for more targeted and effective support structures to meet the specific needs of health-tech spin-offs. The study offers practical implications for both facilitators and founders, providing a clearer understanding of how to optimize support within these ecosystems. Additionally, it contributes to the academic literature by offering insights into the unique challenges faced by health-tech spin-offs and the role of academic entrepreneurial ecosystems in addressing these challenges. Future research is recommended to further explore the effectiveness of tailored support solutions and the role of national policies in fostering the growth of health-tech spin-offs.