Ramsay Health Care (ASX:RHC) investors have faced a 43% loss over the past five years, with the share price dropping 47% and 28% in the last year alone. Despite significant insider buying recently, the company's earnings per share (EPS) fell by 16% annually, indicating ongoing challenges. The total shareholder return (TSR) over five years was -43%, primarily due to dividend payments, highlighting a stark contrast to the broader market's 23% gain last year.