Financial investors and for-profit providers as new players in global healthcare: the politics and practices of health system financialisation

Private for-profit providers and internationally operating financial investors are gaining influence in health systems around the world.Governments of tax-funded national systems (NHS) and social health insurance systems have historically been reluctant to let for-profit actors operate within them.Many now welcome private equity (PE), venture capital and institutional investors as sources of capital and as providers of rapid solutions to pressing policy concerns such as workforce shortages.Examples include the role of private providers in addressing long waiting lists for hospital or nursing home care, and the development of digital infrastructure for technologyenabled home care.Proponents argue that private capital fills funding gaps that public budgets cannot.Critics point to the risks for costs, quality, and system stability and ask how the interests of patients and healthcare workers can be placed above, or at least alongside, those of shareholders.To gain an understanding of how for-profit providers and financial investors operate within domestic health systems and across national borders, we organised a workshop with the Commonwealth Fund of New York and the Health Policy and Management Department at Columbia University in New York City in May 2025.European observers often regard the United States (US) as the birthplace of healthcare capitalism and look across the Atlantic for evidence on what financial ownership does to health outcomes and expenditure.Yet the rapid entry and consolidation of financial actors is an evolving policy challenge in the US too, with many unknowns, not least because financial (trans)actions are fast moving and volatile.American policy experts and scholars, in turn, look to Europe for regulatory strategies.The workshop brought policy experts, clinicians, and PE representatives together with a large group of international scholars, and we invited participants to write comparative papers on the role of for-profit providers and financial investors across health systems.Several of the resulting author teams had never written together, and some had not met before the workshop.The collaborations produced informed and searching debate, and this special issue of Health Economics Policy and Law publishes the results.Alongside perspective articles and research papers, the issue includes a paper based on an expert panel we hosted in July 2026, in which Professor David Blumenthal, Professor Erin Fuse Brown, and Rob Coppedge discussed how financial actors are gaining ground in US healthcare, how this affects traditional, profession-based arrangements for organising care, and where the opportunities for regulation lie.The full panel discussion is available on the website of Health Economics Policy and Law.