Borsa, A., Bejarano, G., Ellen, M., & Bruch, J. D.
(2023). BMJ, e075244.
Abstract
Objective
To review the evidence on trends and impacts of private equity (PE) ownership of healthcare operators.
Data synthesis
Studies were classified as finding either beneficial, harmful, mixed, or neutral impacts of PE ownership on main outcome measures. Results across studies were narratively synthesized and reported. Risk of bias was evaluated using ROBINS-I (Risk Of Bias In Non-randomised Studies of Interventions).
Results
The electronic search identified 1778 studies, with 55 meeting the inclusion criteria. Studies spanned eight countries, with most (n=47) analyzing PE ownership of healthcare operators in the US. Nursing homes were the most commonly studied healthcare setting (n=17), followed by hospitals and dermatology settings (n=9 each); ophthalmology (n=7); multiple specialties or general physician groups (n=5); urology (n=4); gastroenterology and orthopedics (n=3 each); surgical centers, fertility, and obstetrics and gynecology (n=2 each); and anesthesia, hospice care, oral or maxillofacial surgery, otolaryngology, and plastics (n=1 each). Across the outcome measures, PE ownership was most consistently associated with increases in costs to patients or payers. Additionally, PE ownership was associated with mixed to harmful impacts on quality. These outcomes held in sensitivity analyses in which only studies with moderate risk of bias were included. Health outcomes showed both beneficial and harmful results, as did costs to operators, but the volume of studies for these outcomes was too low for conclusive interpretation. In some instances, PE ownership was associated with reduced nurse staffing levels or a shift towards lower nursing skill mix. No consistently beneficial impacts of PE ownership were identified.
Conclusions
Trends in PE ownership rapidly increased across almost all healthcare settings studied. Such ownership is often associated with harmful impacts on costs to patients or payers and mixed to harmful impacts on quality. Owing to risk of bias and frequent geographic focus on the US, conclusions might not be generalizable internationally.
Here are some thoughts:
This systematic review examines the increasing trends and impacts of private equity (PE) ownership in healthcare across eight countries, primarily focusing on the US. Analyzing 55 empirical studies, the review assessed PE's influence on health outcomes, costs to patients/payers and operators, and quality of care in settings like nursing homes, hospitals, and dermatology practices. The findings reveal a rapid increase in PE ownership across various healthcare settings, with PE ownership most consistently associated with increased costs to patients or payers and mixed to harmful impacts on quality. While health outcomes and operator costs showed mixed results due to a limited number of studies, some instances linked PE ownership to reduced nurse staffing levels or a shift toward lower nursing skill mix. The review identified no consistently beneficial impacts of PE ownership, leading the authors to conclude that such ownership is often associated with harmful impacts on costs and mixed to harmful impacts on quality. However, they caution that these conclusions might not be generalizable internationally due to the risk of bias in the included studies and the geographic focus on the US, highlighting the need for increased attention and possibly increased regulation.
