Corporatisation and ownership concentration in diagnostic imaging: an audit of Australian practices.

Abstract

ObjectiveIncreasing ownership of health service providers by large for-profit corporations, along with high ownership concentration that reduces competition, may negatively affect healthcare access, quality, and costs. Our objective was to determine the ownership of Australian diagnostic imaging clinics by ownership category and identify areas of high ownership concentration.MethodsA list of clinics providing ultrasound, X-ray, and at least one advanced imaging modality (computed tomography and/or magnetic resonance imaging (MRI)) were obtained from Services Australia on 31 March 2024. Information about ownership of diagnostic imaging clinics was extracted from the Australian Business Register, the Orbis database, and if necessary, a search of the clinic website. The number and proportion of diagnostic imaging clinics by ownership category were calculated. Areas of high ownership concentration were defined as one company owning ≥30% of non-government owned clinics within a jurisdiction.ResultsA total of 1235 diagnostic imaging clinics were identified, with ownership data obtained for 1226 (99.3%). Most clinics are owned by for-profit corporations (public limited n=412; 33.6%, institutional investor-backed n=277; 22.6%). Areas of high ownership concentration were identified in South Australia, Tasmania, Northern Territory, and Australian Capital Territory. Four companies (two public limited and two investor-backed) own ≥50% of clinics that provide Medicare-rebatable MRI services.ConclusionsThe Australian diagnostic imaging sector is dominated by large for-profit corporations, with high ownership concentration apparent in four jurisdictions. For-profit corporations, healthcare system managers, and funders may have conflicting goals. It is incumbent upon Australian federal, state, and territory governments to ensure that public funds are used to provide affordable, high-value care.