The impact of private equity acquisition of US hospitals on patient outcomes: A systematic review

BACKGROUND: Private equity (PE) firms are increasingly acquiring US hospitals. While PE ownership may infuse capital and managerial expertise, restructuring by organizations with limited patient-care experience raises safety concerns. The effect of PE ownership on hospital outcomes remains poorly defined. This study evaluated the association between PE hospital acquisition and patient outcomes. OBJECTIVES: To investigate the impact of private equity aquisition of hospitals on patient outcomes. METHODS: A systematic search of PubMed and Web of Science (inception to March 2026) was conducted in accordance with preferred reporting items for systematic reviews and meta-analyses guidelines using terms related to "private equity," "hospital," "mortality," and "complications." Eligible studies were US observational or quasi-experimental analyses comparing outcomes between PE-acquired and nonacquired hospitals. RESULTS: Eight studies published from 2010 to 2026 met the inclusion criteria. PE ownership was consistently associated with higher mortality, complication, and failure-to-rescue rates among surgical patients, while findings for readmissions and length of stay were mixed across studies. Additional findings included more hospital-acquired infections and fewer discharges home. CONCLUSIONS: PE acquisition of US hospitals may be associated with worse patient outcomes, particularly in high-acuity surgical care. Greater ownership transparency, regulatory oversight, and standardized quality safeguards are needed to protect patient safety.