Prevalence and performance of private equity-affiliated fertility practices in the United States

Evaluating trends in private equity ownership and impacts on health outcomes, costs, and quality: systematic review

“…Gupta and colleagues48 found that before the covid-19 pandemic, PE acquisition was associated with an increase in mortality during patient stay duration plus 90 days at nursing homes, and Braun and colleagues60 found higher rates of emergency department visits and hospital admissions in PE owned nursing homes. Lastly, Liu53 found no difference in 30 day hospital mortality rates, Bruch and colleagues found no differences in unplanned hospital visits from surgical centers,63 and Borsa and Bruch36 found no differences in fertility outcomes, although the last study had a serious risk of bias.…”

“…Of the eight studies that included health outcomes, two found beneficial impacts4447 and three found harmful impacts,404860 and in three the findings were neutral 365363. Six of the studies had a moderate risk of bias444748536063 and two had a serious risk 3640.…”

“…Impacts on quality were most frequently measured in the literature. Of the 27 studies that assessed healthcare quality, 12 found harmful impacts,373841434849525561626466 three found beneficial impacts,424647 nine found mixed impacts,224045505354565859 and in three the results were neutral 364460. To summarize, 21 studies in total identified at least some form of harmful impact, whereas 12 identified some form of beneficial impact.…”

“…During this stage, 26 further studies were excluded, leaving 55 studies in the final sample (fig 1). Of these studies, 32 evaluated the impacts of PE ownership on at least one category of health outcomes, costs to patients or payers, costs to operators, or quality, or a combination of these factors,2236373839404142434445464748495051525354555657585960616263646566 (table 1, table 2, and table 3) and 38 reported trends or prevalence of PE among healthcare operators (see supplementary material 3) 2136383940414245495355606163646567686970717273747576777879808182838485868788. Fifteen studies in total reported findings for both impacts and trends 36383940414245495355606163…”

“…Certain studies identified particularly high market shares of PE owned healthcare operators. Borsa and Bruch estimated that as of 2018, 14.7% of fertility practices in the US were owned by PE firms 36. Bos and colleagues found that in 2019, PE firms owned 20.5% of the for profit nursing homes in the Netherlands that had a contract with the regional long term care office 38.…”