Around one in five Dutch hospitals is not in good financial health, according to a report published on Wednesday by accountants group BDO Branchegroep Zorg.

Small hospitals in particular are more likely to have financial problems and this is likely to be made worse by allowing health insurers to refuse to pay for treatment at hospitals with which they don’t have contracts, BDO said.

In addition, family doctors are now carrying out more small operations, which is also having an impact.

Mergers to create bigger hospital groups are not always the answer, BDO said. For example, merged hospital group Pasana recently went bankrupt.

The hospitals in best financial shape are the Laurentius hospital in Roermond, the BovenIJ hospital in Amsterdam and the Slingeland hospital in Doetinchem.