A practitioner's guide to using data on private equity hospital acquisitions.

Abstract

Introduction: Private equity (PE) investment in US hospitals has attracted substantial policy and research attention, but empirical work has been limited by fragmented and inconsistent transaction data. We aimed to construct a more comprehensive and validated dataset of PE ownership of US hospitals and to provide a practical guide for using these data in research.

Methods: We integrated 6 major commercial deal databases to identify PE investments in US hospitals from 2000 to 2024. We filtered transactions to PE-related hospital deals, matched targets to American Hospital Association (AHA) and the Centers for Medicare & Medicaid Services (CMS) hospital identifiers, manually verified uncertain matches, reconciled duplicate transactions across sources, expanded system-level deals to constituent hospitals, and verified deal and exit dates.

Results: We identified 141 unique PE deals involving 555 unique short-term acute care hospitals, corresponding to 721 hospital-deal observations. The 6 databases differed substantially in deal coverage, deal type, and whether transactions were reported at the hospital or system level. Reliance on a single source would therefore omit many valid deals and could produce biased or incomplete analytic samples. We also found that linking transactions to stable hospital identifiers required substantial manual verification due to system-level transactions, inconsistent reporting, and identifier changes over time.

Conclusion: Accurate study of PE ownership in hospitals requires multisource data construction, transparent validation, and careful linkage to stable hospital identifiers. This harmonized dataset and workflow provide infrastructure for more accurate, transparent, and replicable research on PE ownership in the US hospital sector.