Study: Patient care experience declined after private equity hospital acquisitions

Editor's Note

Patients fared worse in the wake of private equity acquisitions of US hospitals, according to research published January 9 in JAMA Network. 

Over a decade-long analysis of 73 acquired hospitals and 293 matched controls, declines became more pronounced in the years following acquisition, researchers wrote. Key findings include:

• Patients rating hospitals as "9 or 10" out of 10 decreased at acquired hospitals from 65.0% to 65.2%, while ratings improved at control hospitals from 66.2% to 69.2%. The difference-in-differences (DiD) estimate showed a significant −2.4 percentage point decline (95% CI, −3.9 to −0.9) for acquired hospitals post-acquisition. The gap grew over time, reaching −5.2 percentage points by the third year (95% CI, −8.8 to −1.5).
• The proportion of patients willing to "definitely recommend" acquired hospitals declined from 66.9% to 65.5%, compared to an increase from 68.2% to 69.3% at control hospitals. The DiD estimate showed a −2.1 percentage point drop (95% CI, −3.6 to −0.7), expanding to −4.4 points by year three (95% CI, −8.0 to −0.7).
• Patient-reported staff responsiveness declined at acquired hospitals relative to controls (−1.3 percentage points, 95% CI, −2.4 to −0.2). No significant changes were observed in other domains, such as communication or environmental factors.

Authors cite staffing reductions and cost-cutting measures often linked to private equity strategies as potential reasons for the decline. The worsening over time suggests post-acquisition structural changes increasingly impact patient care. Pointing out that the findings align with previous studies, researchers suggest greater oversight and more protective regulations, such as minimum staffing ratios.