Science1 publisher2 min readPublished
Brown researchers put 6,000 private equity health-care deals on a free state-by-state map
Brown University researchers released a free tracker mapping more than 6,000 private equity health-care deals across all 50 states from 2015 to 2023. Its state comparisons suggest hospitals and private equity buyers compete for the same independent doctors.
The Scientist · Science desk
Drafted by a language model from the sources cited here and checked against its claim ledger before publication. How we use AISend a correction
What happened
- A Brown researcher who helped build the tracker said such deals are generally not disclosed, so analysts have pieced them together from commercial databases and manual research.
- Users can sort deals by state, county and ZIP code, follow them over time, and look within specialties such as primary care, orthopedics and oncology.
- The tracker was designed with policymakers in mind, and its underlying deal data are available for download.
- The project was supported by the Commonwealth Fund and built in collaboration with the National Academy for State Health Policy.
Compiled by The ScientistSomething wrong?How this is made
Why it matters
- constraint Any state count taken from the tracker understates private equity's footprint by an unknown margin, so a legislator citing it is citing a minimum.
- decision If hospitals and private equity compete for the same independent doctors, lawmakers have to choose between rules aimed at private equity alone and rules that also cover hospital purchases of practices.
- capability With the deal records downloadable, outside researchers can test whether the hospital-employment pattern survives once other differences between states are controlled for.
- constraint Legislatures debating ownership rules this year are working from a deal record that stops at 2023.
More than 6,000 deals across nine years works out to an average of more than 660 a year [1]. That average hides what the tracker was built to show, which is the growth of private equity investment from 2015 to 2023 [2]. The count is also a minimum. The Brown team says the tracker may not capture every private equity investment in U.S. health care, and it calls the tool a starting point for identifying patterns and trends [11].
The most interesting result in the launch material is a pattern across states. Private equity involvement tends to be lower in states where a larger share of doctors are hospital employees, and higher where that share is smaller [6]. Yashaswini Singh, the Brown assistant professor of health services, policy and practice who helped develop the tracker [4], explains the pattern as a question of supply. In Indiana, she said, hospitals and health systems employ most oncologists, leaving private equity firms fewer independent doctors to roll up [7]. Texas, where fewer oncologists are tied to hospitals, sits at the other end [8].
The thing the oncology comparison doesn't tell you is whether hospital employment is what keeps investors out. Two states are an illustration. A state where hospitals already employ most specialists may differ in other ways that also make practices harder to buy, and a correlation across states cannot separate those causes. The launch material does not say how strong the relationship is or how many states follow it.
If the supply explanation holds, it supports the argument Singh makes for the whole project. "If you only look at private equity in isolation, you miss that bigger picture, and you risk regulating one channel of corporatization while the other expands to fill the gap," she said [5]. In the oncology example, hospitals and private equity-backed groups are competing for the same independent doctors [7].
Singh said she built the tool after watching lawmakers react to her testimony. "This year I testified before half a dozen state legislatures debating policies to address health care corporatization," she said [12]. "One thing that was remarkably consistent across all of them was that lawmakers and the public were genuinely surprised by how much private equity was already active in their state's health care system. That reaction, over and over, is what convinced me this tracker needed to exist," she said [13].
What to watch
- An update adding deals after 2023, the first test of whether the growth the tracker maps has continued.
- Published analyses using the downloadable data that test the hospital-employment pattern across all 50 states with controls.
- State ownership bills that cite the tracker, and whether they cover hospital acquisitions of practices as well as private equity.