Private Equity in the Hospital Industry

This paper studies the growing presence of private equity (PE) acquirers in the hospital industry. We examine employment, operational efficiency and patient outcomes at hospitals acquired by PE firms. While the total employment at target hospitals significantly declines, the proportion of physicians and nurses in the total workforce (skilled worker ratio) increases for hospitals acquired by a publicly traded PE backed hospital. Employment cuts also occur in hospitals acquired by non-PE acquirers, but skilled worker ratio does not increase in those hospitals. PE-backed acquirers, especially publicly traded ones, are also uniquely associated with reductions in overhead costs. Consistent with PE acquirers increasing skilled worker ratio, patient satisfaction scores do not decline at PE-acquired hospitals and even improve along some dimensions. In contrast, patient satisfaction significantly worsens at hospitals acquired by non-PE acquirers. Examining real patient outcomes, we find that PE acquirers are not associated with higher mortality and readmission rates at target hospitals than non-PE acquirers. Overall, our paper provides a comprehensive look at the role of PE acquirers in the hospital industry, and documents nuanced differences between PE and non-PE acquirers, as well as between PE backed acquirers with and without access to public capital markets.