Nearly half of hospitals are in poor financial health, putting reforms to care for the ageing population and replace outdated buildings into doubt.

The latest annual review by accountancy firm BDO gave 35 of the 60 general hospitals a “satisfactory” rating for their financial performance, down from 55 a year ago.

The firm also warned that half of hospitals made a return of less than 1% in 2023, leaving them without the resources to invest in personnel, equipment and infrastructure.

The warning comes a week after the government outlined plans to cut €252 million from the health ministry’s annual budget, though much of the savings will come from cutting subsidies for sports clubs and access to healthcare for non-residents.

Health minister Fleur Agema has also been under fire for her handling of the situation at the Zuyderland hospital in Heerlen, Limburg, which wants to abolish its emergency department because of a shortage of personnel.

BDO warned that the tight margins hospitals are operating on left them with no scope to carry out the plans set out in the integral healthcare agreement drawn up two years ago by the previous government.

Keeping healthcare affordable

The agreement aims to keep healthcare affordable by reforming care for elderly people, with an emphasis on prevention and arranging more care through family doctors and relatives, leaving hospitals to deal with acute situations.

BDO said the funding model currently discourages hospitals from promoting preventive measures because they are paid for every operation and medical procedure they carry out, whereas the reforms are aimed at reducing demand.

“As hospitals become better at delivering personalised care, it eats deeper into their financial results,” the agency said in its report.

The hospitals’ association NVZ also said the way insurers finance the healthcare system needed to be reviewed. It argued that hospitals’ funding should be based on what facilities they provide, such as the number of beds, rather than how many operations they carry out.

Chairman Ad Melkert said: “It is important that hospitals have a financial perspective again and know what the future holds.

“What we need are fixed budgets for acute healthcare, contracts for multiple years and more collective purchasing by insurers.”