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Outbyte Driver Updater FREEScan for outdated or missing drivers - takes under a minuteDriver Scan →Outbyte PC Repair FREERepair Windows errors before they cause bigger problemsFix Now →Private equity ownership is most consistently associated in published research with higher costs to patients or payers; findings on quality are mixed to harmful, and some studies link ownership to lower nursing levels or a less highly skilled staff mix. These are associations, not guaranteed outcomes for every provider. The evidence varies by care setting, and the broadest review was predominantly based on U.S. operators.
What the broadest research review found
A 2023 systematic review in The BMJ examined 55 empirical studies across eight countries. Forty-seven studies analyzed U.S. operators. Nursing homes were the most commonly studied setting, with 17 studies; hospitals and dermatology had nine each. The review found the clearest overall association between private equity ownership and increased costs to patients or payers. Quality findings ranged from harmful to beneficial, mixed, or neutral, with harmful or mixed results more common than beneficial ones.
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The review did not produce one pooled estimate that applies across providers. Its authors noted risks of bias and the U.S.-heavy evidence base, and found too few studies to draw firm conclusions about health outcomes or costs to operators. It found no consistently beneficial impacts, but its results do not establish that every private-equity-owned provider raises prices or delivers worse care.
How costs may change—and who bears them
“Cost” can mean different things: a negotiated price paid by an insurer, spending by a public payer such as Medicare, a patient’s out-of-pocket bill, or the provider’s own operating expense. The review’s clearest overall finding concerned costs to patients or payers; it does not mean that every provider’s operating costs rise, nor that patients directly pay every increase.
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A 2021 JAMA Health Forum cohort study gives a more specific example. It compared long-stay residents of 302 U.S. nursing homes acquired by private equity during 2012–2018 with residents of 9,562 other for-profit homes. In that study population, the acquisition group had a 3.9% increase in quarterly Medicare costs—an estimated $270.37 per resident per quarter, or $1,081 annually—relative to the comparison group. The acquisition group included 9,632 residents and the comparison group 249,771. These are study-specific estimates, not a forecast for other homes or transactions.
Physician-practice evidence is thinner. In its 2025 report, the U.S. Government Accountability Office (GAO) found some evidence of higher commercial prices associated with private equity in physician practices. GAO also emphasized that research on effects in these practices is limited, so the price evidence does not establish a uniform effect across specialties or markets.
What is known about staffing and patient care
Nursing homes
In the 2012–2018 nursing-home cohort, private-equity acquisition was associated with relative increases in ambulatory-care-sensitive emergency department visits of 11.1% (1.7 percentage points) and hospitalizations of 8.7% (1.0 percentage point) among long-stay residents, compared with residents in other for-profit homes. The study did not find significant associations for some other measured outcomes, including antipsychotic use, severe pain, and pressure ulcers. The results describe that study’s population and period; they should not be read as a guarantee that a particular acquisition will produce the same changes.
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Other care settings
Across the broader literature, some studies associate private equity ownership with reduced staffing per patient or a shift toward a lower nursing skill mix. Staffing was not comprehensively measured in every setting, and the findings do not establish that staffing falls at every acquired provider. The review also covered hospitals, dermatology, ophthalmology, physician groups, and other specialties, where evidence and quality measures differ.
For physician practices, GAO’s 2025 review did not identify rigorous studies of private equity’s effects on quality or access. That is an evidence gap, not proof that quality and access are unaffected. GAO estimated that about 6.5% of U.S. physicians had private equity ownership or investment in 2024, with shares varying by specialty and geographic market.
Why ownership type does not tell the whole story
Private equity ownership can involve operating changes, staffing and skill-mix decisions, negotiated payment rates, debt, or separate operating, management, and property entities. These are possible mechanisms or organizational arrangements discussed in the literature, not one proven explanation for all observed outcomes. The nursing-home study describes competing possibilities: financial pressure or constrained resources could harm care, while management, technology, or compliance improvements could potentially help.
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Consolidation statistics also need to be kept distinct. GAO reported that at least 47% of physicians were employed by or affiliated with hospital systems in 2024, up from less than 30% in 2012. That figure concerns hospital-system affiliation, not private equity. Findings about hospital-physician consolidation should not automatically be attributed to private equity ownership.
Why ownership data can be hard to interpret
Ownership records may not make the controlling investor easy to identify. GAO estimated that 5% of Medicare-enrolled nursing homes had private equity owners in 2022, but it found that CMS data did not list all owners in some cases and did not readily identify private equity firms. GAO supplemented CMS data with other sources to produce its estimate. Ownership prevalence figures therefore depend in part on how data are assembled and classified.
In November 2023, the Centers for Medicare & Medicaid Services (CMS) said a final rule would require Medicare- or Medicaid-enrolled nursing homes to disclose additional information about owners, operators, management, financial-control entities, and certain property lessors. CMS said the additional information would be made public to help families, researchers, and regulators understand ownership relationships. The announcement describes the rule and its intended transparency; it does not establish how completely the requirements have since been implemented.
CMS also reported that 348 hospitals and 3,000 nursing homes changed ownership between 2016 and 2021. Those are counts of ownership changes across facilities, not counts of private equity purchases.
Quick Recap
How to read a claim about private equity and care
- Check the setting: a nursing-home result may not apply to a physician practice, hospital, or specialty clinic.
- Check what “cost” means: payer spending, negotiated prices, patient bills, and provider operating expenses are different measures.
- Check the outcome and comparison: staffing levels, staff skill mix, hospital use, and access answer different questions; study designs and comparison groups matter.
- Check the ownership data: incomplete or hard-to-classify records can affect which providers are counted as private-equity-owned.
- Read association carefully: observational findings can identify patterns without proving one causal pathway or predicting an individual provider’s results.
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