Does Private Equity Investment in Healthcare Benefit Patients? Evidence from Nursing Homes

Abstract

The past two decades have seen a dramatic increase in private equity investment in healthcare, a sector in which intensive government subsidy and market frictions could lead high-powered for-profit incentives to be misaligned with the social goals of quality care at a reasonable cost. This paper studies the effects of private equity ownership on patient welfare and spending at nursing homes. With administrative patient-level data, we use a within-facility instrumental variables strategy to address both non-random targeting of facilities and non-random matching of patients into nursing homes. The estimates show that private equity ownership increases short-term mortality by 10%, which implies about 21,000 lives lost due to private equity ownership over our sample period. Private equity ownership also increases spending by 19%, the vast majority of which is billed to taxpayers. We observe several channels that help explain the increase in mortality: declines in patient-level health measures, such as worsening mobility and elevated use of anti-psychotic medications; declines in nurse availability per patient; and declines in compliance with federal and state standards of care.