Table 1.
Included studies with identified impacts of private equity ownership. Studies are in alphabetical order (continued in table 2 and table 3)
| Reference | Country | Participants | Comparisons | Primary outcomes | Study period | Study type | Findings related to primary outcomes |
|---|---|---|---|---|---|---|---|
| Borsa and Bruch 202236 | USA | Fertility practices | Non-PE | Health outcomes, quality | 2018 | Cross sectional | No differences in fertility success rates or quality were identified |
| Bos and Harrington 2017*37 | USA | Nursing homes | Non-PE (for profit) | Quality | 2000-12 | Case study, longitudinal, mixed methods | PE facilities had lower RN staffing hours per patient day pre-acquisition and post-acquisition compared with controls PE facilities had lower total nurse staffing (RN+LVN+CNA) hours per patient day pre-acquisition and post-acquisition compared with controls PE facilities had lower numbers of total deficiencies pre-acquisition, but comparable scores to the national average post-acquisition, indicating a worsening of quality |
| Bos et al 202038 | Netherlands | Nursing homes | Non-PE (for profit) | Quality | 2014-17 | Cross sectional, interviews, mixed methods | PE facilities had lower employee quality scores relative to controls (8.46 (0.44) v 8.91 (0.44), P<0.01) PE facilities had lower client rating scores relative to controls PE facilities had lower recommendation scores relative to controls (0.92 (0.07) v 0.97 (0.04), P<0.05) |
| Braun et al 202139 | USA | Dermatology practices | Non-PE | Costs to patients or payers | 2012-17 | Longitudinal | Prices paid for routine visits were significantly higher for PE dermatologists relative to controls 7 quarters after acquisition ($2.60 or 4%, P<0.05) and 9 quarters after and beyond ($3.20 or 5%, P<0.05) |
| Braun et al 202160 | USA | Nursing homes | Non-PE (for profit) | Health outcomes, costs to patients or payers, quality | 2012-18 | Longitudinal | PE nursing homes had a relative increase in ambulatory care sensitive emergency department visits relative to controls from pre-acquisition to post-acquisition (11.1%, or 1.7 pp (0.3 to 3.0 pp); P=0.02) PE nursing homes had a relative increase in ambulatory care sensitive emergency department hospital admissions relative to controls from pre-acquisition to post-acquisition (8.7%, or 1.0 pp (0.2 to 1.1 pp); P=0.003) PE nursing homes had a relative increase in total quarterly costs relative to controls from pre-acquisition to post-acquisition (3.9%, or $270.37 ($41.53 to $499.20); P=0.02) No statistically significant differences were found in use of antipsychotics, pressure ulcer incidence, or self-reported severe pain |
| Braun et al 202040 | USA | Nursing homes | Non-PE (for profit, non-profit, government) | Health outcomes, quality | 2020 | Cross sectional | PE homes reported more confirmed covid-19 cases per 1000 residents relative to government nursing homes (35.5 (1.8 to 69.2), P=0.03) For-profit, non-profit, and government nursing homes were more likely to report having at least a one week supply of N95 masks compared with PE homes (10.5% or 9.1 pp (1.8 to 16.3 pp.), P=0.006; 15.0% or 13.0 pp (5.5 to 20.6 pp), P<0.001; 17% or 14.8 pp (6.5 to 23.0 pp), P<0.001, respectively) For-profit, non-profit, and government nursing homes were more likely to have at least a one week supply of medical gowns than PE homes (24.3% or 21.3 pp (11.8 to 30.8 pp), P<0.001; 30.7% or 27.0 pp (17.7 to 36.2 pp), P<0.01; 29.2% or 25.7 pp (16.1 to 35.3 pp), P<0.001, respectively) Government nursing homes had a higher probability of having a nursing shortage than PE homes (6.9 pp (0.0 to 13.9 pp), P=0.049) |
| Broms et al 202361 | Sweden | Nursing homes | Non-PE (for profit, non-profit) | Quality | 2012-19 | Longitudinal | PE nursing homes had lower staffing density compared with private nursing homes (−2.034 (0.007), or approximately 2 staff per 100 residents, P<0.01) PE nursing homes had lower staff education compared with private nursing homes (−4.534 pp (0.007), P<0.01) PE nursing homes had lower staff density compared with non-profit nursing homes (−3.240 (0.000), or approximately 3 staff per 100 residents, P<0.001) PE nursing homes had higher care plan ratings compared with non-profit nursing homes (1.844 (0.035), P<0.05) PE nursing homes also reported lower nurse education and client satisfaction scores |
| Bruch et al 202362 | USA | Dermatology, ophthalmology, and gastroenterology physician practices | Non-PE | Quality | 2014-19 | Longitudinal | Clinicians at PE clinics had a higher relative probability of both entering and exiting the practice, relative to controls (15.74 pp (10.79 to 20.69), P<0.001; 6.00 pp (1.91 to 10.07), P=0.004, respectively) |
| Bruch et al 202263 | USA | Ambulatory surgical centers | Non-PE | Health outcomes; costs to patients or payers | 2009-17 | Longitudinal | No statistically significant relative differences were found in the probability of an unplanned hospital visits between PE and non-PE centers No statistically significant relative differences were found in total costs per patient between PE and non-PE centers |
| Bruch et al 202141 | USA | Hospitals | Non-PE | Quality, costs to patients or payers | 2018 | Cross sectional | PE hospitals had lower patient experience scores relative to controls (−2.68 (−3.56 to −1.80), P<0.001) PE hospitals had fewer full time equivalent employees than non-PE hospitals, adjusted for occupied beds (−164.9 (−250.6 to −79.1), P<0.001) No differences in patient charges or charge-to-cost ratios were identified |
| Bruch et al 202042 | USA | Hospitals | Non-PE | Costs to patients or payers, quality | 2002-18 | Longitudinal | PE hospitals had an increase in total charge per inpatient day relative to controls from pre-acquisition to post-acquisition ($407 ($296 to $518), P<0.001) PE hospitals had an increase in emergency department charge-to-cost ratio relative to controls from pre-acquisition to post- acquisition (0.61 (0.48 to 0.73), P<0.001) PE hospitals had an increase in total charge-to-cost ratio relative to controls from pre-acquisition to post- acquisition (0.31 (0.26 to 0.37), P<0.001) PE hospitals had an increase in acute myocardial infarction quality scores relative to controls from pre-acquisition to post-acquisition (3.3 pp (1.6 to 5.0 pp), P=0.002) PE hospitals had an increase in pneumonia quality scores relative to controls from pre-acquisition to post-acquisition (2.9 pp (1.8 to 3.9 pp), P<0.001) |
Standard errors are reported when studies did not provide confidence intervals.
$
1.00 (£0.79; €0.92).
CNA=certified nursing assistant; LVN=licensed vocational nurse; PE=private equity; pp=percentage points; RN=registered nurse.
*
Panel data with a high volume of coefficients are reported qualitatively.