Private equity (PE) firms have increasingly influenced U.S. health care, posing risks to health equity—the idea that everyone should have a fair opportunity for optimal health. In this NEJM Perspective by Marcella Alsan, PhD, a courtesy faculty member at Stanford Health Policy, the health economist writes that while PE investors claim to improve efficiency, raise capital, and leverage economies of scale, evidence indicates that their involvement often leads to reduced access to affordable, high-quality care. Without strong regulation and enforcement, Alsan writes, PE practices are likely to continue transforming health care in ways that could harm patients and burden clinicians.

“Although PE has extended financing to under-resourced health care systems and generated profits for partners, it has done so at a steep price,” Alsan writes. “Evidence has shown that excessively high returns often come at the expense of rural populations, older people, low-income communities, and members of marginalized racial and ethnic groups — populations that already have trouble affording care and navigating the health care system. States can mitigate these problems by monitoring the effects of PE’s operational and accounting practices and punishing entities that compromise access to affordable, high-quality care.”

Read Full NEJM Perspective