Private equity investment in U.S. health care increased 20-fold from 2000-2018—yet, as this editorial highlights, the financial incentives rarely align with improving patient outcomes or health equity. While proponents argue private equity can streamline fragmented systems and inject needed capital, mounting evidence shows that these investments often reduce access to the most basic, affordable care via elimination of low-profit services. Another sleazy move is sale-leaseback transactions that lead to long-term rent obligations, often increasing operating costs that can eventually result in hospital closures, particularly in settings serving rural and/pr low-income populations. And then there’s dividend recapitalization, a fancy way of saying private equity will take on massive amounts of debt by leveraging a newly-acquired hospital, only to pay cash dividends to investors rather than reinvesting in infrastructure. In other words, without stronger oversight and regulation, the continued expansion of private equity in health care risks undermining decades of progress toward equitable access to care. | Yearby & Alsan, N Engl J Med 2026
