Ramsay Health Care, the nation’s largest private hospital operator, said full-year earnings came in at the lower end of analysts’ forecasts as it tipped a higher than expected writedown on its underperforming European and UK businesses.

In the company’s second trading update in a fortnight, it also said capital expenditure at its core Australian hospitals was lower than expected. Private hospitals are struggling with higher costs and are pressuring insurers to contribute more to stop facilities from closing.