{"title":"Protecting Patients And Society In An Era Of Private Equity Provider Ownership: Challenges And Opportunities For Policy.","authors":"Christopher Cai, Zirui Song","doi":"10.1377/hlthaff.2023.00942","DOIUrl":null,"url":null,"abstract":"<p><p>Private equity (PE) acquisitions in health care delivery nearly tripled from 2010 to 2020. Despite concerns around clinical and economic implications, policy responses have remained limited. We discuss the US policy landscape around PE ownership, using policies in the European Union for comparison. We present four domains in which policy can be strengthened. First, to improve oversight of acquisitions, policy makers should lower reporting thresholds, review sequential acquisitions that together affect market power, automate reviews with potential denials based on market concentration effects, consider new regulatory mechanisms such as attorney general veto, and increase funding for this work. Second, policy makers should increase the longer-run transparency of PE ownership, including the health care prices garnered by acquired entities. Third, policy makers should protect patients and providers by establishing minimum staffing ratios, spending floors for direct patient care, and limits on layoffs and the sale of real estate after acquisition (forms of \"asset stripping\"). Finally, policy makers should mitigate risky financial behavior by limiting the amount or proportion of debt used to finance PE acquisitions in health care.</p>","PeriodicalId":50411,"journal":{"name":"Health Affairs","volume":null,"pages":null},"PeriodicalIF":8.6000,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Health Affairs","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1377/hlthaff.2023.00942","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
引用次数: 0
Abstract
Private equity (PE) acquisitions in health care delivery nearly tripled from 2010 to 2020. Despite concerns around clinical and economic implications, policy responses have remained limited. We discuss the US policy landscape around PE ownership, using policies in the European Union for comparison. We present four domains in which policy can be strengthened. First, to improve oversight of acquisitions, policy makers should lower reporting thresholds, review sequential acquisitions that together affect market power, automate reviews with potential denials based on market concentration effects, consider new regulatory mechanisms such as attorney general veto, and increase funding for this work. Second, policy makers should increase the longer-run transparency of PE ownership, including the health care prices garnered by acquired entities. Third, policy makers should protect patients and providers by establishing minimum staffing ratios, spending floors for direct patient care, and limits on layoffs and the sale of real estate after acquisition (forms of "asset stripping"). Finally, policy makers should mitigate risky financial behavior by limiting the amount or proportion of debt used to finance PE acquisitions in health care.
从 2010 年到 2020 年,私募股权(PE)在医疗服务领域的收购几乎增加了两倍。尽管对临床和经济影响存在担忧,但政策反应仍然有限。我们以欧盟的政策为对比,讨论了美国围绕私募股权所有权的政策环境。我们提出了可加强政策的四个领域。首先,为加强对收购的监督,政策制定者应降低申报门槛,审查会共同影响市场力量的连续收购,根据市场集中效应自动审查可能的拒绝,考虑新的监管机制(如总检察长否决权),并增加对这项工作的资金投入。其次,政策制定者应提高 PE 所有权的长期透明度,包括被收购实体获得的医疗价格。第三,政策制定者应保护患者和医疗服务提供者的利益,规定最低人员配备比例、患者直接护理支出下限、收购后裁员和出售不动产的限制("资产剥离 "的形式)。最后,政策制定者应限制医疗行业 PE 并购所使用的债务金额或比例,从而减少高风险的财务行为。
期刊介绍:
Health Affairs is a prestigious journal that aims to thoroughly examine significant health policy matters both domestically and globally. Our publication is committed to addressing issues that are relevant to both the private and public sectors. We are enthusiastic about inviting private and public decision-makers to contribute their innovative ideas in a publishable format. Health Affairs seeks to incorporate various perspectives from industry, labor, government, and academia, ensuring that our readers benefit from the diverse viewpoints within the healthcare field.