Marilyn Anthony still remembers when it felt magical to work at Waterbury Hospital. A registered nurse since 1991, she worked alongside her mother—who went back to nursing school at 57 so they could graduate together—and later her brother, too, on the telemetry floor.

Her sense of pride was rooted in the Connecticut hospital’s life as a small, nonprofit community institution, where she says staffing decisions were driven by common sense rather than spreadsheets. Nurses didn’t count staff-to-patient ratios or hoard supplies. Multiple float nurses stood ready to step in, ICU beds were kept open in case someone coded upstairs, and there was ample time to turn and clean patients before bedsores set in.

“When we were a nonprofit hospital, I like to say we behaved as a hospital,” said Anthony, who is co-president of the Connecticut Health Care Associates District 1199, NUHHCE (National Union of Hospital and Health Care Employees). “Patients were treated like family.”

Then, in 2016, private equity-backed Prospect Medical Holdings took over. Almost immediately, Anthony noticed a different set of priorities. Linen was counted. Signs went up limiting bed changes. Staffing thinned. Supplies, from IVs to working monitors, grew scarcer. Even separate, specialized ICUs—with nurses trained for surgical, medical, and cardiovascular emergencies and an open bed, staffed and ready—were merged.

“It happened fast, and Prospect made no bones about it: We were told in emails we were no longer to call the patients ‘patients.’ They were to be called ‘customers,’” she said. 

What changed at Waterbury Hospital, she says, wasn’t just ownership. It was the definition of care itself. When a community hospital started operating like a business, she said, the consequences didn’t just show up on balance sheets. They also showed up in patient bed sores, delayed responses, a decimated ICU, and nurses stretching themselves to prevent harm in a system that no longer built in a margin for safety.

UConn Health, a nonprofit academic health system funded by the University of Connecticut and state of Connecticut, bought the hospital in late 2025 after Prospect filed for bankruptcy, and there’s cautious optimism, but Anthony’s experience is not unusual. A growing wave of peer-reviewed studies supports the same troubling conclusion: When private equity incentives collide with clinical care, patients—especially those who are sicker, poorer, or harder to treat—are more likely to be killed or harmed.

“Overwhelming” evidence warns of PE’s dangers 

Research published in the last nine months links private equity takeovers to more deaths and medical complications. These studies, which add to previous research, also document excessive understaffing and unsafe conditions in high-risk settings where rapid and experienced decision-making is critical, as well as declining access to essential but less profitable services.

The findings come at a time when for-profit PE groups have invested more than $1 trillion in the U.S. healthcare system. This includes a growing share of everything from hospitals and emergency rooms to oncology practices, home health agencies, assisted living facilities, physical therapy, ambulatory surgery centers, hospices, and specialty clinics serving children, pregnant patients, and the chronically ill.

When private equity incentives collide with clinical care, patients—especially those who are sicker, poorer, or harder to treat—are more likely to be killed or harmed.

Private equity firms are also aggressively investing in healthcare apps and public safety systems, even as experts warn profit maximization has become the dominant organizing principle in U.S. health care, driving health disparities and premature mortality rather than improving population health. 

“The empirical studies are now overwhelming: Private equity puts profits above the well-being of patients,” said Richard M. Scheffler, a distinguished health economics and public policy professor at the University of California, Berkeley.

Stephanie Woolhandler agrees. “Private equity is profit-seeking on steroids,” said Woolhandler, a primary care internist and a distinguished professor of public health at Hunter College in New York. “They are just going harder and faster and getting out of there before they have to bear any consequences.”

Eroding public health for the sake of profits

Private equity firms typically buy companies, manage them for cash, and sell them within three to seven years—a quick turnaround that often involves organizational and financial restructuring, such as cutting costs and targeting specific services to raise prices and boost short-term profits. In other words, they take over businesses, try to increase their value quickly, and then exit.

Private equity firms argue that their investments provide capital and business expertise to improve efficiency and buoy struggling healthcare providers, but little evidence exists that they use their own equity to actually improve technology, workforce skills, productivity, or patient care. Purchases are often financed largely with borrowed money, and the hospital or medical practice becomes responsible for repaying the debt.

More and more studies add to nightmarish news reports of patient care in stripped-down facilities, from rusted stretchers with broken brakes and record rates of bedsores, sepsis and other hospital-acquired conditions to the death of an infant. Costs and risks are shifted to healthcare workers, patients, and communities, with excessive understaffing and unsafe conditions in settings where rapid and experienced decision-making is critical, and declining access to essential but less profitable services, the latest evidence shows.

One major review found that across hospitals, nursing homes, and other sectors, studies reported mostly worse outcomes under private equity ownership, with very few showing better healthcare quality, lower costs, or clear patient benefits.

Another study found private equity ownership of U.S. nursing homes was associated with more care deficiencies, significantly reduced staffing hours, increased hospitalization rates, and higher mortality across 12 studies published between 2000 and 2024. Residents were also more likely to be hospitalized or visit the emergency department for conditions typically manageable with routine care.

Other research indicates:

• Higher mortality after PE hospital takeovers: People undergoing major surgical procedures at PE-acquired hospitals had a 17% higher odds of dying within 90 days than those treated at non-acquired centers, according to a new study of more than one million Medicare patients. Worse outcomes, including complication rates, length of stay, and readmission, were most pronounced for unplanned (emergent) surgeries, suggesting staffing and post-operative management, rather than surgical skill, are the main issues. “Private equity acquisition of hospital centers needs to be carefully scrutinized to ensure that care quality is prioritized over financial returns,” the authors concluded. 
• Increases in post-operative deaths: A separate study found patients undergoing common inpatient surgeries at PE-acquired hospitals were also more likely to die within 30 days. The increase, especially for unplanned surgeries, reflected poorer complication management, not higher complication rates, the authors said: “These findings raise concerns that staffing and resource changes aligned with PE’s financial objectives may be compromising the quality of inpatient surgical care.”

“We’ve found zero evidence private equity improves anything.”

• Emergency department deaths rise as staffing falls: Emergency department deaths rose more than 13% after private equity acquisition, equivalent to 7 additional deaths per 10,000 visits. The September study of one million emergency department visits by Medicare patients at 49 private-equity owned hospitals from 2009 to 2019 linked the increase to staffing and salary cuts in emergency departments and intensive care units, shorter ICU stays, and more transfers of critically ill, high-risk patients. Full-time staffing fell by nearly 12%, while salary expenditures dropped 18% in emergency departments and 16% in ICUs. “Among Medicare patients, who are often older and more vulnerable, this study shows that those financial strategies may lead to potentially dangerous, even deadly consequences,” said senior author Zirui Song, an associate professor of health care policy and medicine at Harvard Medical School who has published extensively on the implications of private equity in health care.
• Staffing reductions are a consistent mechanism of harm: PE ownership is associated with lower nurse-to-bed ratios, fewer full-time clinicians, and greater reliance on less experienced or unlicensed staff, multiple studies suggest. Salaries fell in both emergency departments and ICUs, with reductions in total hospital employees. Researchers also report shorter ICU stays, higher transfer rates, and higher rates of deaths among patients due to a failure or delay in responding to complications (failure to rescue). Failure to rescue is widely regarded as a sensitive indicator of hospital quality.

PE harms expanding across health sectors

Private equity’s footprint now dominates entire specialties, reshaping not only individual facilities but entire lines of care. By the end of 2023, for instance, roughly 28% of fertility clinics in the U.S. had private equity affiliations—up from less than 4% in 2013 and accounting for more than half of all IVF cycles nationwide. Bankruptcies such as Steward Health Care have shuttered PE-owned hospitals in multiple states. Even nonprofit health systems have begun to adopt the private equity playbook, some reports suggest, to acquire and close community hospitals. 

“I know it sounds like the sky is falling,” Pennsylvania Rep. Tarik Khan, who is a nurse, recently told The New Republic. “But actually there are places in Pennsylvania where there is no hospital. Where if you are having a heart attack or a stroke, you cannot get to a hospital within a reasonable amount of time. People are dying.”

Patients most at risk include Medicaid recipients, rural residents, and those needing emergency or complex care, the most recent research shows. Behavioral health, psychiatry, trauma care, and obstetric services are disproportionately closed or scaled back after PE acquisitions, especially in rural and low-income areas. Meanwhile, maternal health, ophthalmology, cardiology, addiction treatment, and end-of-life care all show patterns of reduced access or poorer outcomes. 

For instance, PE-owned physician practices performed nearly 20% fewer retinal detachment repairs, a time-sensitive procedure that is often reimbursed below cost. That means urgent treatment for retinal detachment is less likely, which can result in permanent vision loss, says David Himmelstein, a distinguished professor of public health at Hunter College. 

Nearly 30 percent of retina specialists are affiliated with PE firms nationally, and the stakes are equally high in other medical settings, Himmelstein notes: “When maternity services are shut down, that means not just inconvenience—it can be dangerous for pregnant people and their infants.”

Consider:

• Maternal health: PE hospital acquisitions were linked to a 12–16% decline in Medicaid labor-and-delivery services. Medicaid covers over 40% of U.S. births, and a decline of this magnitude signals that hospitals may be cutting or deprioritizing care for more vulnerable, lower-reimbursing patients, even when those services are medically necessary. “Obstetrics and delivery services are among the leading money-losing services offered by hospitals, which may contribute to this trend, as PE-owned hospitals may face pressure from investors to avoid low-profit services,” researchers said.
• Emergency equipment: PE-backed companies now dominate markets for fire engines, emergency radios, and fire retardants, with fire and police agencies objecting to sharply rising costs. One firm serves about 20,000 of the nation’s 30,000 fire departments, managing scheduling, inventory, and medical information on people treated for injuries.
• Cardiology: Private equity ownership of U.S. hospitals does not improve outcomes among older adults with heart failure compared to similar hospitals, even though its admitted patients were less sick. Fewer white patients but many more Black patients, nearly double pre-acquisition levels, were transferred out after the hospitals were acquired.
• Addiction: PE-acquired opioid treatment programs (OTPs) have raised concerns that firms might consolidate ownership without expanding market-level access to methadone, despite a widespread expert consensus on the need to expand methadone access to address a public health emergency and save lives.
• End-of-life care: Compared with for-profit PE-owned hospices, which reported the highest profits, not-for-profit hospices spent substantially more on direct patient care, driven by differences in nursing salaries. “Reduced spending on patient care may undermine hospice quality and shift costs to other areas of the health care system,” the researchers said.

Lack of PE ownership transparency, accountability, 

Despite private equity’s rapid growth—nearly 500 hospitals as of April 2025 and thousands of clinics—federal oversight remains limited. Fewer than 10% of PE health-care deals receive federal antitrust review, largely because they fall below reporting thresholds or are obscured by complex ownership structures. 

Many private equity firms don’t rebrand the clinics or practices they buy. Patients often can’t tell—and may not be legally entitled to know—whether their healthcare provider is PE-owned, and to what extent their physicians maintain true autonomy.

Several states, including Massachusetts, Oregon, and Indiana, have begun proposing or passing laws to require more disclosure, expand regulators’ authority to review or block deals, and strengthen Corporate Practice of Medicine (CPOM) rules aimed at preventing undue corporate influence on patient care.

In October, California enacted a law that prohibits private investors from interfering with the judgment of physicians and dentists. And Connecticut’s state Public Health Committee announced its plans to reintroduce legislation in the upcoming session next month that would restrict private equity from managing the core function of hospitals. However, most of these legislative efforts are recent, researchers say, and their effectiveness remains untested.

Pushing toward profit, backing off needed care

Meanwhile, the most recent studies show that healthcare acquisitions by private equity firms continue to push care toward profitable procedures, while strategically retreating from essential services for patients with conditions that are less profitable to treat.

“The empirical studies are now overwhelming: Private equity puts profits above the well-being of patients.”

After the $33 billion purchase of Hospital Corporation of America (HCA), the largest private equity hospital takeover, private equity owners focused on higher complexity surgeries, researchers reported in September. Similarly, as the percentage of U.S. dental offices backed by private equity nearly doubled between 2015 and 2021, these practices moved from diagnostic and preventive services to higher reimbursement restorative, specialty, and surgical procedures to enhance revenue.

“In other words, financial enhancement of dental practices under private equity may not translate into benefits for providers or patients,” the authors wrote.

Meanwhile, new oncology research shows PE-acquired practices charged 5.3% higher office visit prices and increased radiation therapy spending by more than 50% than non-acquired practices, without evidence of improved patient outcomes. Colonoscopy prices, spending, and use also increased at PE-acquired gastroenterology practices without improved quality.

Similar patterns have been documented in cardiology, ophthalmology, dentistry, plastic surgery, and reproductive and fertility care. One study found that hospital- and PE-affiliated specialty physicians overall negotiate higher prices than independent physicians—for instance, 6% higher for cardiology and 10% higher for gastroenterology procedures.

“The recent research shows that no healthcare segment is beyond the reach of private equity owners who exploit publicly-funded healthcare organizations for their own gains,” said Rosemary Batt, the Alice Hanson Cook Professor of Women and Work at Cornell University’s School of Industrial and Labor Relations.

More concerns as PE moves into new frontiers

Most recently, one of the first national assessments of its kind, published in JAMA Pediatrics, found that as childhood autism diagnoses nearly tripled between 2011 and 2022, private equity rapidly acquired more than 500 autism therapy centers across 42 states, becoming the dominant owner in the industry. Among them was Blackstone, whose 2018 buyout of the Center for Autism and Related Disorders ended with the closure of more than 100 clinics and bankruptcy.

The vast majority of these acquisitions took place between 2018 and 2022, concentrating in states with higher rates of autism diagnoses among children and after the widespread adoption of laws mandating private insurance coverage of autism services, the study shows. 

States in the top third for childhood autism prevalence were 24% more likely to have private equity–owned clinics than others. The largest concentrations of centers were in California (97), Texas (81), Colorado (38), Illinois (36) and Florida (36). 

Researchers said they were prompted to investigate amid reports from families and health providers about changes following private equity takeovers. While they did not measure care quality, the authors warn that profit-driven incentives in a Medicaid-heavy pediatric population raise concerns about overtreatment, widening disparities, and potential harm to children.

Previous research indicates how those harms can occur. An earlier study, co-authored by Batt, found that many private equity–owned autism service providers reduced staffing, training, and supervision after acquisition. Some owners prioritized patients who garnered higher billing rates or lived in states with higher reimbursement rates, worsening inequality in access to care.

For people with autism, who depend on stable relationships of trust with caregivers, researchers note that this kind of organizational churn can have a particularly profound negative effect.

Said Yashaswini Singh, co-author of the recent study and a health economist at the Brown University School of Public Health: “The big takeaway is that there is yet another segment of health care that has emerged as potentially profitable to private equity investors and it is very distinct from where we have traditionally known investors to go, so the potential for harm can be a lot more serious.”