Research summary
Research summary
Topic summary
Rising consumer fury traces to private equity buyouts and provider mergers that inflated out-of-pocket costs while cutting care quality.
Key research questions
- Investigate "Why Are Americans So Unhappy With Their Healthcare System?" from this distinct point of divergence: Corporate Financialization and Monopolization.
Important claims and supporting citations
An NBER study by Gupta et al. analyzing 18,000 facility-years found private equity ownership of nursing homes was linked to an 11% higher short-term mortality rate for Medicare patients.
A December 2023 JAMA study of Medicare claims found a 25.4% increase in hospital-acquired conditions following private equity acquisition compared to matched controls.
A 2023 Harvard-led study of 51 private equity-acquired hospitals found that Medicare beneficiary emergency department mortality increased by 13% post-acquisition, especially where staffing was cut.
A 2023 BMJ systematic review of 55 studies found private equity ownership was linked to higher costs in 9 of 12 studies (with none showing decreases) and harmful quality impacts in 21 of 27 studies.
In September 2023, the FTC filed an antitrust lawsuit against U.S. Anesthesia Partners and private equity firm Welsh Carson for rolling up Texas anesthesiology practices; the claim against Welsh Carson was dismissed in May 2024 while proceeding against USAP.
- https://www.ftc.gov/news-events/news/press-releases/2024/03/ftc-doj-hhs-launch-cross-government-inquiry-impact-corporate-greed-health-care
- https://www.ftc.gov/news-events/news/press-releases/2023/09/ftc-challenges-private-equity-firms-scheme-suppress-competition-anesthesiology-practices-across
- https://www.ftc.gov/news-events/news/press-releases/2023/12/ftc-doj-issue-2023-merger-guidelines
A 2017 Yale working paper showed that when EmCare (an Envision subsidiary) assumed management of emergency departments, out-of-network billing rates rose from approximately 32% to over 90%.
A 2022 KFF survey found 41% of U.S. adults hold medical or dental debt, with about 1 in 7 indebted adults reporting that a healthcare provider denied them care due to unpaid bills.
In March 2024, the FTC, DOJ, and HHS jointly launched their first collaborative cross-government inquiry examining private equity and corporate consolidation roll-up strategies in healthcare.
- https://www.ftc.gov/news-events/news/press-releases/2024/03/ftc-doj-hhs-launch-cross-government-inquiry-impact-corporate-greed-health-care
- https://www.ftc.gov/news-events/news/press-releases/2023/09/ftc-challenges-private-equity-firms-scheme-suppress-competition-anesthesiology-practices-across
- https://www.ftc.gov/news-events/news/press-releases/2023/12/ftc-doj-issue-2023-merger-guidelines
View all claims (text)
Claims
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A 2017 Yale working paper showed that when EmCare (an Envision subsidiary) assumed management of emergency de…
A 2017 Yale working paper showed that when EmCare (an Envision subsidiary) assumed management of emergency departments, out-of-network billing rates rose from approximately 32% to over 90%.
Labels: Source-linked, Low, known
Apollo Global Management-owned Lifepoint Health and predecessors breached seven contractual commitments, incl…
Apollo Global Management-owned Lifepoint Health and predecessors breached seven contractual commitments, including capital investment and charity care, made during the 2010 acquisition of Ottumwa Regional Health Center in Iowa.
Labels: Inferred, Medium, known
Private equity-backed firms made up 21% of all healthcare bankruptcies in 2024 and accounted for seven of the…
Private equity-backed firms made up 21% of all healthcare bankruptcies in 2024 and accounted for seven of the eight largest healthcare bankruptcies that year, despite representing only about 7% of U.S. GDP.
Labels: Inferred, Medium, known
A 2023 BMJ systematic review of 55 studies found private equity ownership was linked to higher costs in 9 of…
A 2023 BMJ systematic review of 55 studies found private equity ownership was linked to higher costs in 9 of 12 studies (with none showing decreases) and harmful quality impacts in 21 of 27 studies.
Labels: Source-linked, Medium, known
A 2023 Harvard-led study of 51 private equity-acquired hospitals found that Medicare beneficiary emergency de…
A 2023 Harvard-led study of 51 private equity-acquired hospitals found that Medicare beneficiary emergency department mortality increased by 13% post-acquisition, especially where staffing was cut.
Labels: Source-linked, Medium, known
Hospital prices in monopoly markets are approximately 12% higher than in markets with at least four competito…
Hospital prices in monopoly markets are approximately 12% higher than in markets with at least four competitors, with merged hospitals increasing prices by over 6% within two years.
Labels: Source-linked, Low, known
Mortality and Staffing Outcomes in PE-Owned Nursing Homes
Mortality and Staffing Outcomes in PE-Owned Nursing Homes
Labels: Inferred, Low
Antitrust Oversight and Healthcare Roll-Up Enforcement
Antitrust Oversight and Healthcare Roll-Up Enforcement
Labels: Inferred, Low
Market Concentration and Price Impacts of Practice Acquisitions
Market Concentration and Price Impacts of Practice Acquisitions
Labels: Inferred, Low
Public Sentiment on Healthcare Costs and Medical Debt
Public Sentiment on Healthcare Costs and Medical Debt
Labels: Inferred, Low
Prospect Medical Holdings Dividend Extraction and Quality Failures
Prospect Medical Holdings Dividend Extraction and Quality Failures
Labels: Inferred, Low
No Surprises Act and Independent Dispute Resolution Claims
No Surprises Act and Independent Dispute Resolution Claims
Labels: Inferred, Low
Envision Healthcare and Out-of-Network Surprise Billing
Envision Healthcare and Out-of-Network Surprise Billing
Labels: Inferred, Low
Steward Health Care Collapse and Senate Scrutiny
Steward Health Care Collapse and Senate Scrutiny
Labels: Inferred, Low
Hospital-Acquired Conditions and Care Quality Under Private Equity
Hospital-Acquired Conditions and Care Quality Under Private Equity
Labels: Inferred, Low
A 2022 JAMA Internal Medicine study established that private equity acquisitions of dermatology, gastroentero…
A 2022 JAMA Internal Medicine study established that private equity acquisitions of dermatology, gastroenterology, and ophthalmology practices led to a roughly 20% increase in charges and an 11% increase in allowed amounts.
Labels: Source-linked, Low, known
In September 2023, the FTC filed an antitrust lawsuit against U.S.
In September 2023, the FTC filed an antitrust lawsuit against U.S. Anesthesia Partners and private equity firm Welsh Carson for rolling up Texas anesthesiology practices; the claim against Welsh Carson was dismissed in May 2024 while proceeding against USAP.
Labels: Source-linked, Low, known
A December 2023 JAMA study of Medicare claims found a 25.4% increase in hospital-acquired conditions followin…
A December 2023 JAMA study of Medicare claims found a 25.4% increase in hospital-acquired conditions following private equity acquisition compared to matched controls.
Labels: Source-linked, Medium, known
Approximately 6.5% of U.S.
Approximately 6.5% of U.S. physicians were employed by private equity-owned practices in 2024, with PE penetration exceeding 30% in gastroenterology, dermatology, and ophthalmology.
Labels: Inferred, Low, known
Envision Healthcare filed for bankruptcy after the implementation of the No Surprises Act curtailed its out-o…
Envision Healthcare filed for bankruptcy after the implementation of the No Surprises Act curtailed its out-of-network surprise billing revenue following KKR's 2018 $9.9 billion buyout.
Labels: Inferred, Medium, known
Federal Independent Dispute Resolution claim volume reached 1.4 million disputes in 2024 and 2.6 million in 2…
Federal Independent Dispute Resolution claim volume reached 1.4 million disputes in 2024 and 2.6 million in 2025, compared to an initial projection of roughly 17,000 per year.
Labels: Inferred, Low, known
A 2022 KFF survey found 41% of U.S.
A 2022 KFF survey found 41% of U.S. adults hold medical or dental debt, with about 1 in 7 indebted adults reporting that a healthcare provider denied them care due to unpaid bills.
Labels: Source-linked, Low, known
In March 2024, the FTC, DOJ, and HHS jointly launched their first collaborative cross-government inquiry exam…
In March 2024, the FTC, DOJ, and HHS jointly launched their first collaborative cross-government inquiry examining private equity and corporate consolidation roll-up strategies in healthcare.
Labels: Source-linked, Low, known
Private equity firms own roughly 30% of for-profit U.S.
Private equity firms own roughly 30% of for-profit U.S. hospitals and acquired the majority of practices post-2015 in specialties including dermatology, gastroenterology, and anesthesiology.
Labels: Inferred, Low, known
Private equity acquisitions of physician practices across 10 specialties rose from 75 deals in 2012 to 484 de…
Private equity acquisitions of physician practices across 10 specialties rose from 75 deals in 2012 to 484 deals in 2021.
Labels: Inferred, Low, known
Steward Health Care filed for bankruptcy in January 2024 following a 2016 sale-leaseback transaction with Med…
Steward Health Care filed for bankruptcy in January 2024 following a 2016 sale-leaseback transaction with Medical Properties Trust orchestrated by private equity firm Cerberus Capital Management.
Labels: Inferred, Low, known
Patient-reported high ratings (9/10 or 10/10) declined by 2.4 percentage points and willingness to recommend…
Patient-reported high ratings (9/10 or 10/10) declined by 2.4 percentage points and willingness to recommend dropped 2.1 percentage points at PE-acquired hospitals relative to controls.
Labels: Inferred, Low, known
A Senate Budget Committee investigation found Prospect Medical Holdings paid $645 million in dividends and st…
A Senate Budget Committee investigation found Prospect Medical Holdings paid $645 million in dividends and stock redemptions, including $424 million to majority owner Leonard Green & Partners, while accumulating unsustainable debt that later defaulted.
Labels: Inferred, High, known
Four private equity-owned staffing firms initiated 70% of non-air-ambulance Independent Dispute Resolution cl…
Four private equity-owned staffing firms initiated 70% of non-air-ambulance Independent Dispute Resolution claims under the No Surprises Act during the first half of 2023.
Labels: Inferred, Medium, known
An NBER study by Gupta et al.
An NBER study by Gupta et al. analyzing 18,000 facility-years found private equity ownership of nursing homes was linked to an 11% higher short-term mortality rate for Medicare patients.
Labels: Source-linked, Medium, known
Private equity acquisitions correlated with statistically significant price increases in 8 of 10 studied spec…
Private equity acquisitions correlated with statistically significant price increases in 8 of 10 studied specialties, spanning from 4% in dermatology and primary care up to 16.4% in oncology and 14% in gastroenterology.
Labels: Inferred, Medium, known
Surgical-site infections doubled from 10.8 to 21.6 per 10,000 hospitalizations at private equity-acquired hos…
Surgical-site infections doubled from 10.8 to 21.6 per 10,000 hospitalizations at private equity-acquired hospitals despite an 8.1% decline in surgical volume.
Labels: Inferred, Medium, known
Price increases after private equity acquisition were 1.5 to more than 3 times larger in metropolitan statist…
Price increases after private equity acquisition were 1.5 to more than 3 times larger in metropolitan statistical areas where one PE firm controlled over 30% of a specialty market.
Labels: Inferred, Medium, known
Radiology Partners and TeamHealth accounted for 43% of resolved line-item Independent Dispute Resolution clai…
Radiology Partners and TeamHealth accounted for 43% of resolved line-item Independent Dispute Resolution claims in 2023–2024, typically prevailing and receiving 3 to 4 times standard in-network rates.
Labels: Inferred, Medium, known
By 2021, a single private equity firm held over 30% market share by FTE physicians in at least one specialty…
By 2021, a single private equity firm held over 30% market share by FTE physicians in at least one specialty in 28% of U.S. metropolitan statistical areas, and over 50% share in 13% of MSAs.
Labels: Inferred, Medium, known
Hospitals acquired by private equity experienced a 27.3% rise in patient falls and a 37.7% rise in central-li…
Hospitals acquired by private equity experienced a 27.3% rise in patient falls and a 37.7% rise in central-line-associated bloodstream infections despite placing 16.2% fewer central lines.
Labels: Inferred, Medium, known
Gupta et al.
Gupta et al. determined that private equity-owned nursing homes increased per-patient Medicare billing by roughly 11% while reducing frontline caregiver staffing.
Labels: Inferred, Low, known
Steward Health Care CEO Ralph de la Torre was held in contempt of the U.S.
Steward Health Care CEO Ralph de la Torre was held in contempt of the U.S. Senate for refusing to testify regarding the hospital chain's asset management.
Labels: Inferred, Medium, known
During Leonard Green's ownership of Prospect Medical Holdings, all but one hospital ranked in the bottom 17%…
During Leonard Green's ownership of Prospect Medical Holdings, all but one hospital ranked in the bottom 17% of CMS quality-of-care rankings, prompting state understaffing investigations in Pennsylvania, Rhode Island, and Connecticut.
Labels: Inferred, Medium, known