Recommended Free Tools
Private equity (PE) ownership is associated in published research with higher costs to patients or payers and with mixed-to-harmful effects on care quality. Some studies also associate it with lower nurse staffing or a shift toward less highly trained nursing staff. These are patterns across studies, not guaranteed outcomes at every PE-owned provider: results vary by setting, and observational research cannot establish one cause that applies to every acquisition.
What the overall research finds
A 2023 systematic review in The BMJ examined 55 empirical studies across eight countries; 47 studied US operators. Nursing homes were the most frequently studied setting, with 17 studies, followed by hospitals and dermatology, with nine each. The review found the clearest overall association in costs to patients or payers. Quality findings ranged from beneficial to harmful, but harmful or mixed findings were more common than beneficial ones. Some studies reported reduced staffing per patient or a shift toward lower nursing skill mix. The review did not find consistently beneficial impacts.
As an Amazon Associate I earn from qualifying purchases.
This was a synthesis of studies, not a single experiment or pooled estimate showing how much PE ownership changes costs or quality on average. The authors also cautioned that risk of bias and the US-heavy evidence base limit how broadly the results can be applied.
What studies report in different care settings
| Setting | Evidence and reported findings | How to interpret it |
|---|---|---|
| Nursing homes | A 2021 JAMA Health Forum cohort study of long-stay residents in 302 PE-acquired US nursing homes reported increases in certain emergency visits, hospitalizations, and Medicare costs compared with residents in other for-profit homes. | The estimates apply to the study population and 2012–2018 period, not every home or transaction. Several other measured outcomes were not significantly associated with acquisition. |
| Physician practices | A 2025 US Government Accountability Office (GAO) report found limited research on PE effects and some evidence of higher commercial prices. | GAO identified no rigorous studies in its review on PE effects on physician-practice quality or access, so those effects remain uncertain. |
| Hospitals, specialties, and other services | The BMJ review included hospitals, dermatology, ophthalmology, physician groups, and other services. It found heterogeneous quality results and some reports of reduced staffing or lower-cost skill mix. | Findings from one specialty or outcome should not be treated as a result for every provider or type of care. |
The nursing-home cohort in detail
The 2021 study compared 9,632 residents in PE-acquired homes with 249,771 residents in 9,562 other for-profit homes. Using a difference-in-differences cohort analysis of 2012–2018 data, it reported 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). Quarterly Medicare costs increased by 3.9%, or $270.37 in the study estimate—equivalent to $1,081 per resident annually. These are study-specific estimates for long-stay residents, not a forecast of what an individual home will charge or what an individual family will pay.
#1 Best Overall
The same study found no significant association with acquisition for some other measured outcomes, including antipsychotic use, severe pain, and pressure ulcers. The differing results illustrate why “quality of care” should not be treated as one measure.
Physician practices: prices, quality, and access
GAO reported that PE ownership or investment involved about 6.5% of US physicians in 2024, with shares varying by specialty and geographic market. That is a physician-level estimate, not the share of all practices or facilities owned by PE firms. GAO found some evidence of higher commercial prices but said the rigorous evidence it reviewed did not establish effects on quality or access.
The same GAO report found that at least 47% of physicians were employed by or affiliated with hospital systems in 2024, up from less than 30% in 2012. That statistic describes hospital-system consolidation, not PE ownership. Evidence about consolidation more broadly should not be presented as evidence about PE specifically.
Crashes, No Sound, or Screen Glitches?
Random freezes, missing sound and display glitches usually trace back to one bad driver. Find and replace yours safely.Free scan · under a minutePC Slower Than It Used to Be?
A free scan shows the junk files, broken settings and background clutter dragging Windows down - then fixes them in one click.Free scan · Windows 10 & 11How ownership could affect bills, staffing, and care
Researchers and the nursing-home study discuss several possible pathways, but no single pathway is established as the explanation for every reported outcome. Possible influences include operating decisions, staffing levels and skill mix, negotiated payment rates, debt, and arrangements that separate the operating company from management or property entities.
- Staffing and skill mix: Reducing staff hours or relying more on lower-cost roles could reduce operator expenses, but may also affect the time and expertise available to patients. Some studies report reduced staffing or lower nursing skill mix; the evidence does not show that every PE-owned provider makes these changes.
- Prices and payment: Negotiated rates can affect what commercial insurers or other payers spend. Those amounts are not the same as an operator’s expenses or a patient’s out-of-pocket bill.
- Investment and operations: Financial pressure or resource constraints could put care at risk. Conversely, better management, technology, or compliance could potentially improve operations. These are competing explanations discussed in the literature, not a settled finding that one effect is universal.
For households, a rise in payer spending does not automatically mean an identical increase in a particular patient’s bill. What a patient pays depends on the service, coverage, and plan terms; the studies summarized here do not provide a universal estimate of out-of-pocket changes.
What patients and families can take from the evidence
Ownership can be one useful context when comparing providers, but it cannot tell a patient by itself whether care is good, accessible, or affordable. For a decision about a particular facility or practice, focus on the relevant service and the measures that matter to that decision.
Rank #4
- For a nursing home, consider staffing information and care outcomes alongside ownership; the nursing-home study measured several outcomes and did not find significant associations for all of them.
- For a physician practice, distinguish commercial prices from quality and access. GAO found some price evidence, but not rigorous studies establishing PE effects on quality or access.
- When comparing costs, identify who bears the expense: the patient, an insurer or public payer, or the provider itself. A finding about one cost measure does not establish changes in the others.
- Treat ownership as one factor among several, rather than a stand-alone prediction of the care or bill a particular person will experience.
Why ownership figures are difficult to pin down
GAO estimated that 5% of Medicare-enrolled nursing homes had PE owners in 2022. It cautioned that CMS data did not list all owners in some cases and did not readily identify PE firms; GAO supplemented those data with other sources to develop its estimate. Ownership figures therefore depend partly on how relationships are identified and classified.
The Tool Desk
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 →In November 2023, the Centers for Medicare & Medicaid Services (CMS) described a final rule requiring 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 described the rule and its purpose; it does not by itself 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 figures count ownership changes across facilities; they are not counts of PE acquisitions.
Quick Recap
Product prices and availability are accurate as of the date/time indicated and are subject to change. Any price and availability information displayed on Amazon at the time of purchase will apply.
