Borsa A, Bejarano G, Ellen M, Bruch J D. Evaluating trends in private equity ownership and impacts on health outcomes, costs and quality: systematic review. BMJ 2023; DOI: 10.1136/bmj-2023-075244.

A view from the USA.

Private equity (PE) firms use institutional and private investors' capital, in tandem with large amounts of debt, to acquire companies for profitable re-selling in 3-5 years' time. Arguments for include the advantages of economies of scale and managerial expertise. Concerns include prioritising profit over patient safety and overemphasising profitable services in place of the less profitable.

This systematic review of 55 relevant papers found that organisational changes frequently led to increased charges for patients and negotiated higher rates to insurers. Staffing changes tended to lead to a decrease in numbers or a shift to a lower skill mix. On quality, 21 studies identified some form of harmful impact and 12, some form of beneficial impact. PE ownership was associated with negative impacts on patient satisfaction and general quality scores.

PE ownership in the healthcare sector is increasing and in this literature review, no consistent benefits were identified. The authors suggest that increased surveillance, reporting and regulation may be warranted.