Private Equity in Health Care

April 29, 2026

Key Findings

More than half of panelists believed that private equity (PE) acquisitions of hospitals substantially worsen quality of care (58%) and increase health care spending (53%). Forty-three percent said that PE acquisitions of hospitals worsen patients’ access to care. Nearly one in five indicated that they did not know what the effects of PE acquisitions were on these outcomes, and several noted there was not enough rigorous research on the topic.
Experts were mixed on whether PE acquisitions improve the financial stability of distressed hospitals: 22% agreed, 40% disagreed or strongly disagreed, and 32% were uncertain. Several panelists commented that short-term financial gains may come at the cost of long-term instability through practices such as loading debt on acquired hospitals.
Fifty-five percent of panelists disagreed or strongly disagreed that prohibiting Medicare payments to PE-owned hospitals would measurably improve patient health outcomes. Some experts characterized such a policy as blunt and as having potential unknown or unintended consequences.
A number of respondents emphasized that the overall impact of PE acquisitions likely depends on the alternatives available to hospitals, including whether hospitals could receive investment from other sources.

Read the full Health Affairs Forefront summary of results here

Survey Questions

Please note: our surveys will consistently use two modifiers to describe the size of an effect: “Substantial”: when an effect is large enough to meaningfully influence policy decisions, program implementation, or outcomes of interest “Measurable”: when the direction of an effect is clear, but the effect may not be sufficiently large to make much of a difference for a given policy, program, or outcome. Weighting by confidence level removes responses of “don’t know” (weight equals 0). Unweighted responses with responses of “don’t know” removed were qualitatively similar to weighted responses. Unweighted results including “don’t know” responses are presented in the exhibits below.

Response rate of 95% (60 out of 63 panelists responded)

In recent years, private equity (PE) firms have increasingly acquired health care organizations. Proponents have argued that PE-owned health care organizations experience greater financial stability and efficiency, but some policymakers have raised concerns that PE ownership may adversely impact healthcare quality and spending. This year, federal lawmakers introduced a bill that would prohibit Medicare payments to hospitals owned or controlled by PE firms.

Question 1: PE acquisitions of hospitals substantially…(select all that apply):

a. Worsen quality of care
b. Worsen patients’ access to care
c. Increase health care spending
d. None of the above
e. Don’t know

Question 2: PE acquisition of financially distressed hospitals measurably improves the financial stability of those hospitals.

a. Strongly agree
b. Agree
c. Uncertain
d. Disagree
e. Strongly disagree
f. Don’t know

Question 3: Prohibiting Medicare payments to PE-owned hospitals would measurably improve patient health outcomes.

a. Strongly agree
b. Agree
c. Uncertain
d. Disagree
e. Strongly disagree
f. Don’t know

Individual Survey Responses

Question One

PE acquisitions of hospitals substantially…(select all that apply)

Name	Vote	Confidence	Comments
Margarita Alegria	Increase health care spending, Worsen patients’ access to care, Worsen quality of care	9
David Asch	Increase health care spending, Worsen patients’ access to care	7
John Ayanian	Don’t know	0
Peter Bach	No Response
Laurence Baker	Worsen patients’ access to care, Worsen quality of care	4
David Blumenthal	Increase health care spending, Worsen patients’ access to care, Worsen quality of care	8
Erin Fuse Brown	Increase health care spending, Worsen patients’ access to care, Worsen quality of care	7	I’m not as confident about the magnitude of the effect of PE acquisition on access to care, as compared with the quality or spending effects. However, recent studies have demonstrated increased risk of bankruptcy or closure following PE acquisition, which could disrupt access.
Melinda Buntin	Increase health care spending, Worsen patients’ access to care, Worsen quality of care	7
Michael F. Cannon	No Response
Lawrence Casalino	Increase health care spending, Worsen patients’ access to care, Worsen quality of care	8
Amitabh Chandra	Don’t know	0
Lanhee J. Chen	None of the above	6
Michael Chernew	Increase health care spending	6	I am unsure of quality effects.
Janet Currie	Increase health care spending, Worsen patients’ access to care, Worsen quality of care	7
Lesley Curtis	Worsen patients’ access to care, Worsen quality of care	6
David Cutler	Increase health care spending, Worsen patients’ access to care	7	The literature on price is stronger than on quality.
Julie Donohue	Worsen quality of care	7	PE acquisitions are often associated with reductions in staffing that can lead to reductions in quality of care.
Joseph Doyle	Increase health care spending	9	PE firms tend to generating higher profits by lowering staffing, focusing more on high mark-up services, and increasing prices to commercial payers. Whether quality of care changes depends on the context.
David Dranove	Don’t know	0	Effects are theoretically ambiguous and there are few if any well designed studies to tease them out.
Stacie Dusetzina	Increase health care spending, Worsen quality of care	5
Jose Esarce	No Response
Elliott Fisher	Worsen quality of care	10	Access likely mixed: better access for commercial patients, worse for Medicare and Medicaid.
Richard Frank	Worsen quality of care	6
Craig Garthwaite	Don’t know	0	The literature here is quite in flux, and often struggles to deal with the edogneity of which hospitals are acquired.
Darrell Gaskin	Increase health care spending, Worsen patients’ access to care, Worsen quality of care	10	PE is pure rent seeking.
Martin Gaynor	Don’t know	0	I don’t think there’s sufficient evidence on this to draw an inference.
Sherry Glied	None of the above	6	Relative to what??
David Grabowski	Worsen quality of care	8
Jonathan Gruber	Don’t know	0
Vivian Ho	Worsen patients’ access to care, Worsen quality of care	9	The S. Kannan et al 2023 JAMA paper documents worse outcomes in hospitals after PE acquisition and finds a drop in admission of dually eligible Medicare/Medicaid patients.
Jason Hockenberry	Increase health care spending	7
Haiden Huskamp	Worsen quality of care	9
Benedic Ippolito	Don’t know	0	The answer depends heavily on the counterfactual. E.g., relative to baseline spending likely increases. Relative to a non-PE buyer they may not. Relative to potential closure raises other questions.
Anupam Jena	Don’t know	0
Nancy Keating	Increase health care spending, Worsen patients’ access to care, Worsen quality of care	9
Aaron Kesselheim	Increase health care spending	8
Jonathan Kolstad	Increase health care spending	8
R Tamara Konetzka	Increase health care spending, Worsen patients’ access to care, Worsen quality of care	7	PE acquisition shifts emphasis toward reducing costs and increasing revenues (spending). With some nuance, the research seems to show that PE acquisition can be detrimental to quality. In the long run, financial instability after PE sale is likely to worsen access as well.
Rick Kronick	Increase health care spending	6
Valerie Lewis	Increase health care spending, Worsen patients’ access to care, Worsen quality of care	7	My read of the literature on this (particularly in the last few years and several good studies) is that PE acquisition of hospitals increases mortality and worsens other quality outcomes, and has other effects such as resulting in lower staffing ratios. I believe some studies show neutral effects, but most show negative or mixed (with negative) effects. In addition, my read is PE acquisition is related to higher costs, I blieve through increased prices.
Nicole Maestas	Increase health care spending, Worsen patients’ access to care, Worsen quality of care	10	We now have robust research evidence in support of this.
Tom McGuire	None of the above	8	I think the direction is right ie worsen, but I dont agree with “substantially.”
Ellen Meara	Worsen quality of care	4
Ateev Mehrotra	Increase health care spending, Worsen patients’ access to care, Worsen quality of care	8	While it makes sense that PE could have positive benefits with hospitals, I think the evidence is clear. PE investment in hospitals has been harmful.
David Meltzer	Increase health care spending, Worsen patients’ access to care, Worsen quality of care	7
Joseph Newhouse	Increase health care spending, Worsen quality of care	6
Sean Nicholson	Increase health care spending	7
Steve Parente	None of the above	7
Stephen Patrick	Worsen quality of care	9
Harold Pollack	Don’t know	0	I suspect the answer will vary by service, by patient population, and by payor mix. When market and regulatory incentives and oversight are well-aligned, PE may improve outcome. When these are not well-aligned, PE may be harmful.
Daniel Polsky	Worsen quality of care	3	This work has had a counterfactual problem. What would have happened to the hospital if it was not acquired by PE? Would it be capital starved? Would it have closed? This context is critical to answer the above question. The literature has generally showed pre-post acquisition by PE, things get worse, but the pre-trends were not great.
Ninez Ponce	Don’t know	0
Thomas Rice	Increase health care spending, Worsen patients’ access to care, Worsen quality of care	8
Meredith Rosenthal	Increase health care spending, Worsen patients’ access to care, Worsen quality of care	7
Joseph Ross	Increase health care spending, Worsen patients’ access to care, Worsen quality of care	8	My read of the literature is that PE acquisitions are primarily made to boost short-term revenue for subsequent sale, so my expectation is that there will be decisions to focus on higher revenue generating services (increase healthcare spending), limit lower revenue or loss generating services (worsen access to care), and cut costs, the easiest of which is personnel (worsen quality of care).
Brendan Saloner	Increase health care spending, Worsen patients’ access to care, Worsen quality of care	9	There seems to be a fair amount of research demonstrating the harms of PE on patient and cost outcomes.
Kosali Simon	Increase health care spending, Worsen patients’ access to care, Worsen quality of care	7
Jon Skinner	Increase health care spending, Worsen quality of care	4
Ben Sommers	Worsen quality of care	5
Neeraj Sood	Don’t know	0
David Stevenson	Increase health care spending, Worsen patients’ access to care, Worsen quality of care	7	Average effects can differ across deals and markets.
Kevin Volpp	Worsen patients’ access to care	7	Reduce quality of care above the profit maximizing level + reduce access to low income patients with less good insurance.
Rachel Werner	Increase health care spending, Worsen patients’ access to care, Worsen quality of care	5

Question Two

PE acquisition of financially distressed hospitals measurably improves the financial stability of those hospitals.

Name	Vote	Confidence	Comments
Margarita Alegria	Uncertain	8
David Asch	Disagree	5
John Ayanian	Uncertain	3
Peter Bach	No Response
Laurence Baker	Uncertain	10
David Blumenthal	Strongly disagree	9
Erin Fuse Brown	Uncertain	6	It depends on the time-frame of reference. On the one hand, PE acquisitions may increase revenues and profitability of hospitals in the short-term, but may lead to financial instability and risks of bankruptcy and closure over the medium-longer term due to sale-leasebacks, debt service burden, profit distributions, etc.
Melinda Buntin	Agree	5
Michael F. Cannon	No Response
Lawrence Casalino	Disagree	7
Amitabh Chandra	Don’t know	0
Lanhee J. Chen	Agree	7
Michael Chernew	Uncertain	5
Janet Currie	Uncertain	7
Lesley Curtis	Agree	5	Potentially in the short ten.
David Cutler	Disagree	6
Julie Donohue	Disagree	7	I think it depends on hospital being acquired and the PE firm doing the acquiring. Some PE firms are highly extractive and only plan to own the hospital for a short time before selling whereas others may be making more long term commitments and investments.
Joseph Doyle	Agree	7
David Dranove	Uncertain	8	Ditto.
Stacie Dusetzina	Disagree	6
Jose Esarce	No Response
Elliott Fisher	Disagree	9	Again. Depends. Could provide short term infusion of funds, but at cost of long term financial instability or collapse.
Richard Frank	Disagree	7
Craig Garthwaite	Uncertain	5
Darrell Gaskin	Disagree	8
Martin Gaynor	Don’t know	0	I don’t think there’s sufficient evidence.
Sherry Glied	Agree	4
David Grabowski	Disagree	8
Jonathan Gruber	Disagree	3
Vivian Ho	Disagree	8	Steward Health Care
Jason Hockenberry	Uncertain	6
Haiden Huskamp	Disagree	8
Benedic Ippolito	Agree	2
Anupam Jena	Uncertain	6
Nancy Keating	Strongly disagree	9
Aaron Kesselheim	Uncertain	8	It may do this in some cases (although has failed spectacularly in other high-profile cases), but this is not the only way to achieve this goal.
Jonathan Kolstad	Agree	8
R Tamara Konetzka	Uncertain	9	There’s an important time element to consider. In the short run, PE acquisition likely improves stability of financially distressed hospitals through an infusion of capital. In the long run, PE-related debt likely makes hospitals less financially stable.
Rick Kronick	Disagree	5
Valerie Lewis	Disagree	4	I have not read literature on this, so am uncertain. From the larger world of PE, it is my understanding that often PE unloads the debt of a purchase onto the firm itself, so I’m not convinced this will necessarily lead to better financial stability. That said, I have also seen commentary that PE funding has benefits compared to other types of funding or capital that hospitals have access to. I have not looked closely enough at this literature to know more specifics. However, examining the impacts of PE overall, it is hard to see how PE would improve financial stability of hospitals without significant guardrails in place given the overall PE business model– particularly usually a goal of the PE exiting at some point. Who acquires the hospital when PE is ready to exit?
Nicole Maestas	Strongly disagree	10
Tom McGuire	Don’t know	0	I just dont know about this, no experience that I am aware of.
Ellen Meara	Disagree	7
Ateev Mehrotra	Disagree	6
David Meltzer	Uncertain	7
Joseph Newhouse	Agree	5
Sean Nicholson	Disagree	8	There might be a positive effect in the short run due to management practices and higher private prices, but the common practice of leasing the land and assets back to the hospital can definitely create a negative long run impact for the hospital(s).
Steve Parente	Uncertain	7
Stephen Patrick	Uncertain	5
Harold Pollack	Agree	5
Daniel Polsky	Disagree	3	Lots of variability. I have low confidence.
Ninez Ponce	Uncertain	5
Thomas Rice	Strongly disagree	7
Meredith Rosenthal	Uncertain	7
Joseph Ross	Agree	8	But this is a paradox, because while financial stability is likely to improve, the hospital will no longer provide services that are needed in the community.
Brendan Saloner	Disagree	8	The PE model generally sells the assets of distressed companies.
Kosali Simon	Agree	7
Jon Skinner	Disagree	4
Ben Sommers	Uncertain	3
Neeraj Sood	Don’t know	0
David Stevenson	Uncertain	6	There again can be heterogeneity, but also short term improvements might not be sustained, especially if cost cuts have been at expense of quality care.
Kevin Volpp	Agree	7
Rachel Werner	Agree	6

Question Three

Prohibiting Medicare payments to PE-owned hospitals would measurably improve patient health outcomes.

Name	Vote	Confidence	Comments
Margarita Alegria	Disagree	8
David Asch	Uncertain	5
John Ayanian	Uncertain	3
Peter Bach	No Response
Laurence Baker	Disagree	5
David Blumenthal	Uncertain	5
Erin Fuse Brown	Uncertain	4	There are too many unknowns in this description to determine the impact of this policy on health outcomes. For instance, would this policy grandfather existing PE-owned facilities, would it apply to REITs, what would the process be for unwinding or forcing the sale of current PE-owned facilities, how would buyers be identified, on what financing terms, what sources of capital or debt guarantees might be made available if financially distressed, etc. Handled poorly, this policy could lead to disruptions in care or accelerated closures. However, if pursued on a moving-forward basis, with alternative financing supports and guardrails for careful unwinding, it could be less disruptive.
Melinda Buntin	Disagree	5
Michael F. Cannon	No Response
Lawrence Casalino	Strongly agree	8
Amitabh Chandra	Don’t know	0
Lanhee J. Chen	Disagree	6
Michael Chernew	Disagree	6
Janet Currie	Disagree	8
Lesley Curtis	Uncertain	8	Although evidence strongly supports the notion that PE involvement reduces quality, I’m not confident that prohibiting PE involvement would improve quality. Quality is multi-dimensional and the financial pressures that PE involvement can mitigate (in the short term) could erode health care quality.
David Cutler	Uncertain	4	This is not my preferred way to address these issues.
Julie Donohue	Strongly disagree	8	More regulation of PE and hospital acquisitions in general is needed but ending Medicare payment is too blunt an instrument that would harm patients.
Joseph Doyle	Disagree	7	As noted above, quality improvement/degradation depends on the context.
David Dranove	Don’t know	0
Stacie Dusetzina	Uncertain	6
Jose Esarce	No Response
Elliott Fisher	Disagree	8
Richard Frank	Disagree	8
Craig Garthwaite	Disagree	5
Darrell Gaskin	Strongly disagree	9	This is not the right policy. This is SEC or FTC or some kind of investment regulatory oversight.
Martin Gaynor	Don’t know	0	I don’t think we have the evidence to know much about what this might do.
Sherry Glied	Strongly disagree	7
David Grabowski	Disagree	8	Hospitals still need capital. Patient outcomes would only improve if there were other (non-PE) investors for these hospitals.
Jonathan Gruber	Uncertain	1
Vivian Ho	Uncertain	10	There would be a mass sell-off of PE-owned hospitals, and it’s uncertain who would acquire these hospitals and how they would behave.
Jason Hockenberry	Disagree	7
Haiden Huskamp	Disagree	8
Benedic Ippolito	Disagree	2	Among other issues, this would create some near-term access issues to consider.
Anupam Jena	Disagree	6
Nancy Keating	Disagree	7	This seems like too blunt a tool, which could harm patients who receive care from these hospitals, especially if there are not other places to obtain care.
Aaron Kesselheim	Disagree	5	I would find it hard to believe that such a blunt tool policy intervention would have this outcome.
Jonathan Kolstad	Disagree	8
R Tamara Konetzka	Uncertain	7	Prohibiting Medicare payments is a blunt tool that would strongly disincentivize PE acquisition. But, PE is likely filling a need for capital that is not being filled by other sources, so prohibiting PE may leave a hospital with unmet needs for capital. Of course, if PE acquisition somehow takes place despite the ban on Medicare payments, losing those payments would be fatal for most hospitals.
Rick Kronick	Uncertain	4
Valerie Lewis	Agree	7	Given the quality literature I agree overall with this statement from a quality perspective. One caveat would be if the alternative to PE acquisition is closure of a hospital, particular in a rural region with no other hospitals nearby, there may be downstream consequences to quality outcomes. Another important perspective is long term — what happens when PE firms are trying exit health care? I fear heavy PE investment in health care without significant guardrails could produce some disastrous effects. There have been some important examples – Crozer is one that comes to mind, where PE involvement ended with a pretty dramatic collapse of a health system.
Nicole Maestas	Uncertain	7	I’m not sure this would “improve patient outcomes” as much as prevent very bad patient outcomes.
Tom McGuire	Strongly disagree	9	This is a bad idea. What’s next, prohibiting payment to Catholic hospitals?
Ellen Meara	Uncertain	4
Ateev Mehrotra	Agree	3	I’m not sure what would happen to existing hospitals that are PE owned.
David Meltzer	Disagree	7
Joseph Newhouse	Don’t know	0	Would existing PE hospitals close or become another type of health care facility such as a nursing home or ambulatory surgical center? Would they be sold to a for-profit hospital chain and continue as a hospital? Would they be acquired by a non-profit system and continue to operate?
Sean Nicholson	Disagree	7	This is a heavy-handed policy that does not allow the government to take specific circumstances into effect.
Steve Parente	Disagree	6
Stephen Patrick	Uncertain	5
Harold Pollack	Don’t know	0	My gut is that this would be poor policy, especially if the alternative is effective Medicare oversight and regulation.
Daniel Polsky	Strongly disagree	8	It might discourage future aquisitions, but for the hospitals currently owned by PE, this is not a wise policy.
Ninez Ponce	Uncertain	5
Thomas Rice	Disagree	5
Meredith Rosenthal	Disagree	10
Joseph Ross	Uncertain	1
Brendan Saloner	Uncertain	6	Difficult to know how this policy could be gamed.
Kosali Simon	Disagree	7
Jon Skinner	Disagree	5
Ben Sommers	Disagree	3
Neeraj Sood	Disagree	6
David Stevenson	Disagree	6	Would rather see payment and oversight policy be aligned to ensure good patient health outcomes across all ownership types.
Kevin Volpp	Uncertain	7
Rachel Werner	Uncertain	2

Meet our panel of experts

Cornell Health Policy Center

Cornell Health Policy Center

Private Equity in Health Care

Key Findings

Survey Questions

Individual Survey Responses

Question One

Question Two

Question Three

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