In an article published in ProMarket on May 16, 2025, Brent Fulton discusses the role of lenders in acquisitions of hospitals by private equity firms.
During the past two decades, the number of U.S. companies owned by private equity firms has increased almost sixfold–from 1,900 to 11,200–including private equity firms owning almost 500 hospitals in the U.S. today. While private equity firms have been able to extract their capital prior to some hospital-system bankruptcies, the lenders have been overlooked in these bankruptcies. The capital extraction occurred because the lenders allowed the debt to be paid as a dividend, likely because debt covenants were relaxed by lenders chasing relatively few private equity deals and because hospital market conditions changed for the worse (with lenders pricing loans assuming some default risk). Hence, lenders bore the brunt of the losses.
However, patients bear the brunt of hospital service disruptions. Moreover, taxpayers sometimes bail out these hospitals. Fulton concludes by stating whether private equity-owned hospitals are a competitive model has yet to be determined–the impact of private equity on hospital quality is mixed–but regardless of the ownership model, regulation is needed to ensure transparent financing, along with price and quality transparency, because of the social contract that hospitals have with their communities.
ProMarket is a publication of the Stigler Center at The University of Chicago Booth School of Business and is publishing a series of articles on the impact of private equity in health care. Here’s some information about ProMarket from its website. ProMarket is an academic forum focused on topics of special-interest capture, antitrust, political economy, and the future of capitalism. The vast majority of economists believe that competition is the essential ingredient that makes a market economy work. While a competitive market system ends up benefiting everyone, nobody benefits enough to spend resources to lobby for it. Business has very powerful lobbies; competitive markets do not. This is why we are ProMarket, rather than ProBusiness.