Article
Private Equity Ownership in Healthcare and Its Effects on Cost, Quality, and Access: A Systematic Review of Evidence and Regulatory Implications
Private equity (PE) investment in United States health care has expanded across hospitals, physician practices, hospice, behavioral health, primary care, and substance-use treatment. This systematic review updates the open-access evidence published after the 2023 BMJ systematic review and examines regulatory implications for cost, quality, and access. PubMed/MEDLINE and PubMed Central were searched through August 29, 2026, with citation chasing and separate review of open government sources for the legal analysis. Seventeen post-2023 empirical studies met the update criteria. The clearest recurring economic signal was higher prices or revenue-oriented utilization in selected physician markets, while hospital studies reported reductions in salary expenditure or capital assets. Quality findings were heterogeneous: hospital studies identified more hospital-acquired adverse events and worse patient experience, and one surgical study reported worse postoperative outcomes, whereas psychiatric-hospital, gastroenterology, and primary-care studies showed neutral or favorable findings on several measured outcomes. Access was also mixed. PE acquisition was associated with reduced Medicaid labor-and-delivery market share in one national study but increased buprenorphine treatment volume in another, with shorter treatment retention. The evidence supports targeted, risk-based oversight rather than categorical assumptions about ownership. Priority measures include ownership transparency, review of serial acquisitions, financial-resilience safeguards, post-closing monitoring of prices and quality, protection of clinical governance, and access-sensitive transaction review. Minnesota's health-care transaction framework illustrates how state review can incorporate affordability, workforce, access, and public-interest considerations alongside competition analysis.