Table 3.

Included studies with identified impacts of private equity ownership. Studies are in alphabetical order (continued from table 1 and table 2)

Reference	Country	Participants	Comparisons	Primary outcomes	Study period	Study type	Findings related to primary outcomes
La Forgia et al 202251	USA	Outpatient anaesthesia facilities (hospitals, ASCs operated by physician management companies)	Non-PE (facilities operated by physician management companies)	Costs to patients or payers	2012-17	Longitudinal	Contracting with a PE physician management company was associated with increased allowed amounts relative to controls ($187.06 ($133.59 to $240.52) or 26%, P<0.001) Contracting with a PE physician management company was associated with increased allowed amounts by $97.18 ($97.18 ($35.38 to $158.97), P=0.002) more than a physician management company without PE
La France et al 202152	USA	Hospital health systems	Non-PE (non-profit)	Quality	2010-19	Case comparison, qualitative review	Non-PE hospital system retained status as pioneer accountable care organization and increased quality scores during expansion; PE hospital system had a decline in quality scores during post-acquisition expansion
Liu 202153	USA	Hospitals	Non-PE	Health outcomes, costs to patients or payers, costs to operator, quality	2013-19	Longitudinal	PE acquisition was associated with increased negotiated prices between a hospital and a private insurer (32%, P<0.01) PE acquisition was associated with an increase in health spending for all privately insured beneficiaries in local markets where PE acquisition occurred (11%, P<0.01), driven by higher PE bargaining with private insurers and a spillover effect to other local competitors Average cost per patient discharge significantly decreased starting 2 years after PE acquisition Hospital-wide 30 day readmission rates significantly decreased after PE acquisition Outpatient brain and sinus CT scan efficiency significantly increased after PE acquisition After PE acquisition, patient consumer scores significantly decreased for: rooms kept clean, doctor communication, nurse communication, explained medicines, staff helpful, overall rating, pain well controlled, would recommend to others, and patients understood care After PE acquisition, significant decreases were observed in certain service lines being offered: ambulatory surgical centers, computer assisted orthopedic surgery, certified trauma center, oncology services, robotic surgery No differences in 30 day mortality rates after acquisition were identified
Nie et al 202266	USA	Urology practices	Non-PE	Costs to patients or payers, quality	2012-19	Longitudinal	PE urologists received greater inflation adjusted mean Medicare payments post-acquisition ($274 221 ($4289 to $544 153) or 11.0% relative change, P=0.054) while non-PE urologists’ payments decreased (−$150 452 (-$16 924 to -$283 980) or −6.0% relative change, P<0.001) Of the 10 healthcare common procedure coding system codes with the largest pre-acquisition difference in mean payment between PE urologists and controls, 4 remained the same post-acquisition, and the other 6 were replaced with higher revenue generating codes ($785 v $233, on average) The magnitude of difference in payments and volume between PE and non-PE urologists doubled for CPT 99213 (established patient visit – 15 minutes) but was reduced by 40.3% for CPT 99214 (established patient visit – 25 minutes) as PE urologists simultaneously saw more patients post-acquisition (945.1 (616.7 to 1273.5) or 12.5% relative change, P<0.001), indicating shorter appointment times on average
Nie et al 202254	USA	Urology practices	Non-PE	Quality	2021	Cross sectional	Appointment availability for patients with Medicaid was higher at controls relative to PE facilities (66.8% (60.4% to 73.2%) v 52.1% (45.0% to 59.2%); P=0.003) Commercially insured patient appointment availability was greater at PE facilities relative to controls (100% (100% to 100%) v 98.1% (96.2% to 99.9%), P=0.047) PE acquisition was independently associated with lower odds of appointment availability for patients with Medicaid (0.55 (0.37 to 0.83), P=0.004) PE practices had shorter mean wait times relative to controls (17.5 v 21.4 days, P=0.017)
Offodile et al 202155	USA	Hospitals	Non-PE (non-governmental)	Costs to patients or payers, costs to operator, quality	2003-17	Longitudinal	All staffing (FTE hours per 1000 patient days) was lower at PE hospitals relative to controls (20.07 v 24.7, P<0.001) Total operating expenses per discharge was lower at PE hospitals relative to controls ($10 018 v $11 690, P<0.001) Charge-to-cost ratio was greater at PE hospitals relative to controls (7.72 v 4.82, P<0.001)
Patwardhan et al 202264	England	Nursing homes	Non-PE (non-profit, public)	Quality	2020	Cross sectional	PE homes were more likely to not meet regulator’s requirements in overall quality ratings compared with controls (6.6 pp (2.9 to 10.2), P<0.01) PE homes were more likely to not meet regulator’s requirements for multiple quality subdomains
Pradhan et al 2014*56	USA	Nursing homes	Non-PE (for-profit)	Quality	2000-07	Longitudinal	PE nursing homes had lower RN hours per patient day relative to controls (−29.2% (7.3), P<0.001) PE homes had higher LPN hours per patient day relative to controls (6.9% (3.2), P<0.05) PE homes had higher CNA hours per patient day relative to controls (30.4% (6.9), (P<0.001) CNA hours decreased with each year of PE ownership (−7.2% (0.014), P<0.001) PE homes had higher total deficiencies relative to controls (21.4% (8.7), P<0.05) PE homes had a lower odds of being reported for an actual harm citation relative to controls (0.53 (0.19), P<0.01) PE homes had worse scores for additional quality metrics including pressure sore/ulcer prevention restorative ambulation
Pradhan et al 201357	USA	Nursing homes	Non-PE (For-profit)	Costs to operator	2000-07	Longitudinal	PE nursing homes reported 11% higher operating costs per patient day (P<0.001)
Singh et al 202265	USA	Dermatology, ophthalmology, gastroenterology physician practices	Non-PE (independent)	Costs to patients or payers	2016-20	Longitudinal	Both average allowed amount per claim and average charges per claim increased for PE practices in each of the 8 quarters after acquisition PE acquired practices experienced a reduction in share of total spending on out-of-network services (-5.4%, (−9.5% to –1.0%); P =0.01)
Stevenson and Grabowski 2008†58	USA	Nursing homes	Non-PE (for profit)	Quality	1999-2007	Longitudinal	PE was associated with a decrease in RN staffing hours per resident day (−3.14, P<0.05) PE was associated with an increase in nurse aide staffing hours per resident day (2.24, P<0.05) PE was associated with mixed impacts on multiple other quality indicators, including measures on pressure ulcers, weight loss, and daily living
Winblad et al 201759	Sweden	Nursing homes	Non-PE (public, private, private for profit, private non-profit)	Quality	2011	Cross sectional	PE nursing homes had fewer employees per resident than public nursing homes (−0.09 (0.02), P<001) PE homes had better quality indicator scores, including on measures related to care plans, medication review, pressure ulcer screenings, and malnutrition

^$1.00 (£0.79; €0.92).

CNA=certified nursing assistant; FTE=full time equivalent; LPN=licensed practical nurse; PE=private equity; pp=percentage points; RN=registered nurse.

^*Results reported as presented in table 3 of the referenced study. Discrepancies in effect sizes were observed in the body text, which stated that CNA hours per patient day compared with controls were 12% higher as opposed to 30.4% higher, and that pressure score prevention scores decreased by 5% each year, whereas the table indicated a non-time sensitive, statistically significant coefficient of −9.9%, and a non-significant yearly coefficient of 0.1%. However, the overall direction of the effects remains constant despite the possible discrepancies.

^†Reported single post-term coefficients only, which reflect the panel data with a large volume of coefficients.