Introduction and summary
The growing influence of the financial industry over health care emerged, in part, because of regulatory changes in the health care and financial sectors starting around the 1970s.1 In particular, the private equity business model has gained widespread attention for its aggressive pursuit of profit and use of debt financing.2 Private equity firms are increasingly investing in health care entities, including by acquiring reproductive and maternal health facilities.3 While not all private equity health care ownership leads to negative outcomes—and some investments can improve efficiency or expand access—growing evidence suggests that some private equity ownership can prioritize profit maximization at the expense of quality, affordability, and equitable access to quality care if safeguards are not in place.4 As private equity firms increasingly control market share and consolidate health service facilities, communities and individuals—including women seeking reproductive care—could face inadequate health services, poorer health outcomes, and medical debt.5
Since the early 2000s, private equity investment in health care has surged.6 Private equity investments in health care reached an estimated $104 billion in 2024,7 and some estimates indicate that private equity investors have spent more than $1 trillion acquiring health care companies since 2000.8 In 2024 alone, private investors bought, invested in, or added to larger companies in approximately 1,049 unique private equity health care deals in the United States.9 In 2024, almost 7 percent of physicians said their practice was owned by a private equity firm,10 and, as of April 2025, approximately 488 U.S. hospitals were under private equity control.11 This represents almost 9 percent of all private hospitals and more than 22 percent of all proprietary for-profit hospitals.12 As discussed below, in some geographic areas private equity ownership share is much higher.
This issue brief explores the potential impact of private equity on reproductive and maternal health care access and delivery services that are already under threat and underfunded in the current climate, with progressively more barriers being enacted to existing care. The brief explores how common tactics used by private equity fund managers, such as excessive cost cutting,13 can compromise access to comprehensive, affordable care and provides policy recommendations to ensure that the financial interests of a few do not override the fundamental right to reproductive and bodily autonomy for all.
What is private equity?
Private equity investment in health care is a form of for-profit ownership.14 Private equity firms raise funds from private investors to purchase companies and restructure them with the aim of selling them at a profit,15 typically within three to seven years.16 Within the health care sector, private equity firms purchase hospitals, physician practices, or other medical services with the goal of increasing the valuation of the business by cutting costs and generating more revenues within a few years of ownership. In fact, one study found that more than half (51.6 percent) of private equity-acquired practices were sold again, or underwent an exit, within three years of initial investment.17
The private equity investment process often involves:18
- Borrowing money to finance the purchase of a health care facility, also known as a leveraged buyout, which places debt on the company being acquired.
- Cutting costs, which may include reducing staff, supplies, or services that do not generate enough revenue or that fund managers deem unnecessary.
- Raising prices and/or focusing on services that bring in more money.
- Merging similar businesses to streamline operations and increase efficiency.
- Selling the company after improving its short-term financial performance.
While private equity dollars can bring in new resources and management strategies, private equity funds’ aggressive profit-seeking goals and associated management strategies, as well as fund managers’ involvement in health care, also raise concerns about the impact of private equity ownership on patient care and access to services.19
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Private equity firms are increasingly acquiring women’s health care facilities
Reproductive and maternal health services are foundational to public health and gender equity.20 In recent years, private equity firms have acquired thousands of reproductive health care providers including OB-GYN practices, fertility clinics, and maternity care services. Between 2010 and 2019, private equity firms acquired 24 target companies in women’s health care, with a marked acceleration in acquisitions between 2017 and 2019.21 As of 2020, 1,340 women’s health care offices—those providing clinical OB-GYN and fertility services—and 3,989 women’s health clinicians in the United States were affiliated with private equity.22 These affiliations included direct acquisitions, recapitalizations, and undisclosed financial partnerships. Relatedly, a 2023 study showed that in 2021, in 13 percent of metropolitan areas, a single private equity firm owned more than half of the physician market for certain specialties.23
Although the private equity model may be lucrative for investors, it raises serious concerns for patient care—especially in reproductive health, which is already fragmented and under political and economic pressure.24
Private equity creates a range of barriers to equitable and affordable reproductive care
Private equity investment in health care may be changing how reproductive care is delivered in the United States. Although some changes may improve efficiency, private equity ownership can also create serious barriers to high-quality, affordable care.
Private equity ownership contributes to rising costs and reduced affordability for patients
Private equity ownership often leads to increased health care costs for patients or payers and significant financial barriers to necessary care—particularly for low-income patients.25 Multiple studies have shown that health care costs increase after private equity firms acquire hospitals or physician practices.26 A systematic review of trends in private equity ownership and impacts on health outcomes—with 55 studies included in the final sample—found that none of the 12 studies that examined costs showed lowered costs to patients or payers, whereas nine showed increased costs to patients or payers.27 Researchers found this increase occurred primarily due to increased charges and higher rates negotiated with payers.28
Another study, using data from Medicare hospital cost reports from 2005 to 2019, found that per-unit prices for health services rose between 10 percent and 20 percent after private equity acquisition of physician practices and between 7 percent to 16 percent for hospitals.29 At the same time, hospitals reduced salary expenditures by as much as 27 percent, even as patient volume remained the same or even increased.30 An uptick in costs for patients surely would also arise for reproductive and maternal care. Hospitals are the most common place of birth in the United States,31 with maternal and neonatal care accounting for more than 1 in 5 inpatient hospital stays in 2021.32
This trend is concerning considering how many women and young people already forgo or delay care because they are unable to afford it. One 2024 study of a sample of low-income, reproductive-age women in the Atlanta metropolitan area found that many respondents cited cost as a barrier to receiving the birth control method of their choice, some having to pay hundreds in out-of-pocket costs or simply go without.33 Private equity may be compounding the already prohibitively high cost of reproductive care for low-income and uninsured or underinsured people.
Private equity ownership may be contributing to the rising medical debt crisis
A 2022 review of medical bills from a dozen patients across five states showed that patients were surprised with emergency charges on their bills for being triaged in an obstetrics emergency department while in labor.34 According to reports from patients, the departments neglected to tell patients that they were accessing emergency services, adding hundreds of dollars to already large hospital bills. As reported by KFF Health News in 2022, three of the four leading companies that staff and operate obstetrics emergency departments were affiliated with private equity firms, and all operated on a for-profit basis.35
Furthermore, in recent years private equity investment in medical debt collection companies has increased.36 These companies have facilitated loans—via medical credit cards, high-interest payment plans, and strategic partnerships with financial service providers—that impose additional financial burdens on patients who cannot afford to pay a full medical bill at one time.37
This investment in patient financing creates an incentive for private equity-owned debt collectors to employ aggressive practices38 and raises questions about potential conflicts of interest between fund managers and patients. For example, NPR reported in 2022 that a woman in Florida received a loan from AccessOne with an 11.5 percent interest rate after having a hysterectomy for ovarian cancer.39 Generally speaking, when patients take loans from companies, those who are not able to make large monthly payments may face higher interest rates, while wealthier patients are able to secure lower rates.
When it comes to maternity care, new mothers are already twice as likely to have medical debt as young women who did not recently give birth.40 The infiltration of private equity into debt collection could further compound this disparity.
Private equity ownership diminishes access to maternal and reproductive care among marginalized communities
People of color, low-income people, and women in rural areas may be disproportionately affected by private equity’s influence on maternal and reproductive health care services. One of the most direct consequences of private equity investments in health care is the closure of maternity wards and reproductive health facilities in underserved regions, sometimes contributing to what are known as maternity care deserts.41
Maternity care deserts are counties where there is no access to birthing hospitals, birth centers offering obstetric care, or obstetric providers.42 A 2024 study found that more than 35 percent of counties qualify as maternity care deserts—meaning that 1,104 U.S. counties lack a single birthing facility or obstetric clinician.43 The latest data show that more than 5.5 million American women live in counties with limited or no access to maternity care services, driven in part by recent hospital closures and reductions in obstetric services.44 These deserts are particularly harmful given the broader maternal health crisis in the United States,45 which disproportionately affects Black, Indigenous, and Latina pregnant individuals.46
More than 35 percent of counties qualify as maternity care deserts—meaning that 1,104 U.S. counties lack a single birthing facility or obstetric clinician.
When private equity ownership takes over a hospital, the first units to go are often the least profitable ones, such as obstetrics units.47 These closures are happening against a backdrop in which American women, especially Black women, are more likely to die during or immediately after childbirth in states with abortion bans or heavy restrictions on reproductive care.48 At baseline, the United States already has one of the highest maternal mortality rates among higher-income countries.49 Within the United States, Black women are at least three times more likely to die from pregnancy-related causes than white women.50
Even when facilities do stay open, private equity firms often cut staff, merge departments, or reduce services to maximize profits.51 This can lead to longer wait times, fewer specialists, and reduced patient capacity, all of which hurt pregnant patients and families who need timely care.52 They may also avoid less profitable patients: One 2024 study found that private equity acquisitions led to a nearly 7 percent drop in Medicaid childbirths per hospital per year, suggesting that some private equity-owned hospitals avoid treating patients with lower reimbursement rates.53 At the same time, many fertility clinics and women’s health centers in wealthy areas cater primarily to white, privately insured clients.54 This creates an inequitable system where affluent patients have easier access to comprehensive reproductive care and others must navigate a shrinking network of care with higher costs and longer travel times for basic services.55
How private equity ruined a health system that served one community for generations
In January 2025, Prospect Medical Holdings (PMH), a private for-profit company that had been majority owned by a private equity firm, filed for bankruptcy.56 PMH was the parent company of Crozer Health, a health system in the eastern Pennsylvania area.57 Crozer first opened in 189358 and became one of the largest employers in Delaware County. In late April 2025, a U.S. bankruptcy court judge authorized59 PMH’s plan to close all Crozer Health hospitals after PMH was unable to find a buyer,60despite PMH’s purchasing agreements to keep all acute care hospitals open for at least 10 years.61
Initially acquired by PMH in 2016, Crozer hospitals struggled significantly.62 In 2022, PMH shuttered the maternity unit at Delaware County Memorial Hospital, ending access to vital maternity services that parents-to-be had relied on since 1927.63 The unit provided critical labor and delivery services and neonatal intensive care. At the time, its closure left just two maternity wards for the entire county. Crozer physicians warned that moving services to another hospital would make it harder for patients, particularly those without reliable transportation, to access timely maternity care.
In response to the announcement of Crozer’s full closure in April 2025, Delaware County issued an emergency declaration64 and called the closure a “local emergency and a national policy failure driven by private equity mismanagement.”65 Further, state Sen. Tim Kearney (D) and state Rep. Lisa Borowski (D) reintroduced companion bills to strengthen oversight of health care mergers and acquisitions in Pennsylvania.66 The bills, S.B. 322 and H.B. 1460,67are intended to shield facilities from the “harmful effects of unchecked corporate ownership” in health care.
Private equity ownership can compromise care quality and safety
Private equity ownership can often compromise both the quality and safety of care people receive. Common profit-maximizing tactics private equity management employ, such as reducing investment in clinical staff, lowering staffing ratios, and overall focusing on short-term profits, can seriously harm patients and health outcomes.68 For example, a 2023 study found that private equity ownership of hospitals was associated with a 25 percent increase in hospital-acquired infections, adverse events, and other complications.69 Meanwhile, the consolidation of services can leave patients without access to emergency backup care, which can be especially daunting for labor and delivery services.70
Nursing homes—one of the earliest targets of private equity investment—offer an especially cautionary example of patient harms. Multiple studies and anecdotal evidence have linked private equity ownership to declines in care quality,71 increased adverse events,72 and higher mortality rates.73 For example, after the Portopiccolo-affiliated company Accordius Health acquired Citadel nursing home in Salisbury, North Carolina, in February 2020,74 residents filed a lawsuit alleging severe understaffing contributed to one of the “earliest and largest COVID-19 outbreaks” and many deaths.75 The lawsuit also alleged the nursing home was added to the Centers for Medicare and Medicaid Services’ Special Focus Facility program—a program that documents nursing homes with poor inspections and quality ratings for special attention76—after receiving a zero-star rating.77 In another instance, after Portopiccolo acquired St. Joseph’s Home for the Aged in Richmond, Virginia, staffing was reportedly cut.78 According to The New Yorker, this reduction in staffing caused at least some residents to go days without basic hygiene and to receive delayed care, leading to preventable emergency room visits and hospitalizations.79
Although labor and delivery units, fertility services, and OB-GYN clinics are not identical to nursing homes, they share similar vulnerabilities: They serve high-risk populations that often require skilled, specialty care.
Private equity involvement can also put patient safety and well-being at risk in other care settings. For example, under private equity ownership, fertility clinics may be encouraged to perform more expensive, riskier, or scientifically unproven procedures regardless of medical necessity. In 2023, private equity firms invested nearly $3 billion in the fertility industry globally.80 As such, genetic testing is growing in the IVF industry.81 Many biotech companies have reportedly been deceptively marketing genetic testing, such as preimplantation genetic testing for aneuploidy (PGT-A), without sufficient evidence of efficacy or an understanding of the benefits and risks.82 Accordingly, around 700 people joined a set of class action lawsuits against multiple U.S. providers of PGT-A testing.83 Some of the lawsuits alleged patients were pressured to undergo this costly and unproven test that led some to discard their potentially viable embryos.84 When the average cost of fertility treatment is $19,200, and sometimes much higher, care becomes increasingly difficult to access and afford.85
Patients also may be overbilled or encouraged to undergo unnecessary or excess treatments and may not be offered more affordable alternatives or payment assistance programs. For example, in September 2025, NBC News reported that Florida Woman Care allegedly billed seven patients at a higher doctor’s rate even though their deliveries were performed by midwives.86 One physician provided documentation to the Florida attorney general’s office and described alleged questionable billing practices and upcoding from 2017 to 2024.87 These types of practices may disproportionately impact low-income families who already face higher barriers to family planning and family building support.88 In this context, private equity’s aggressive profit-maximizing motives can put essential care out of reach for those who need it most.
See also
Policy recommendations
Private equity’s growing investment in reproductive health is alarming, but it also reflects the broader issue of the increasing corporatization of the U.S. health care system. Private equity firms are just one facet in a larger ecosystem of for-profit ownership business models that may prioritize profit over equitable, quality health care. Not all private equity funds engage in all of the harmful practices detailed in this brief, nor are private equity funds alone responsible for consolidation, increased costs, low wages, reduced services, and facility closures in health care services. To that end, policymakers should address both unscrupulous financial practices by private equity funds and the range of anticompetitive behaviors and corporate structures that may limit access to and affordability of care.
Policymakers must strengthen oversight of private equity involvement in reproductive health care to protect consumers
Stronger regulatory oversight of private equity activity in reproductive and maternal health care is urgently needed to protect patients and ensure equitable access to care. Existing regulatory frameworks often fail to capture the unique risks posed by private equity funds’ and other profit-driven models, particularly in smaller acquisitions that fall below federal antitrust thresholds.89 Many private equity acquisitions—particularly of small or independent reproductive and maternal health facilities—fall below current federal antitrust thresholds and thus escape any regulatory overview. Currently, only transactions of $126.4 million or more must be reported,90 which excludes most deals involving OB-GYN practices, fertility clinics, or abortion providers.
Recommended policy actions
- Policymakers could broaden regulatory review by lowering the threshold in the Hart‑Scott‑Rodino Antitrust Improvements Act that requires acquisitions to undergo regulatory review by the Federal Trade Commission (FTC).91 They should also ensure that transactions involving health care facilities are reviewed by state health departments or other relevant state officials and licensing boards.92
- Policymakers should mandate pre- and post-acquisition health equity impact assessments to help identify and address potential harms to underserved communities, such as clinic closures, reduced services, or increased out-of-pocket costs. These assessments and processes should always include state-level health officials, even when conducted by the FTC.
- Public comment periods should be established before buyouts of reproductive health facilities, ensuring local communities and health care workers have a voice in decisions that directly affect their access to essential reproductive services. Public comment periods or hearings should be standard practice, particularly in rural communities and other areas that already have access challenges.
Policymakers must prioritize support for public reproductive health services
Investing in public and nonprofit health care options is critical to counterbalancing the influence of private equity and profit-driven actors in reproductive health. These models often prioritize community health, continuity of care, and health equity—values that can be at odds with the short-term profit motives of private equity-owned entities.
Recommended policy actions
- Policymakers should increase funding for public and nonprofit providers, such as Federally Qualified Health Centers and community-based maternal health initiatives. They should also encourage states to establish public options specifically for maternity and reproductive services.
- Federal and state governments should provide grants to support nonprofit acquisition of reproductive health practices or to launch new nonprofit reproductive health clinics in areas with limited access. Expanding access to midwifery and doula care—forms of culturally attuned, community-based reproductive support—can further diversify care models and reduce the dependence on private equity-backed providers, particularly in rural and historically marginalized communities.
Policymakers must increase transparency and accountability for private equity firms
Increasing transparency and accountability in private equity ownership is essential to safeguarding quality and equity in reproductive health care. Currently, patients often have little to no visibility into who owns or controls the clinics where they receive reproductive services—including abortion care, OB-GYN visits, or fertility treatments. Private equity- acquired health facilities should be required to disclose how they operate in the health care sector and how funds are allocated within health organizations.
Recommended policy actions
- State policymakers should pass laws to require disclosure of ownership and control structures—whether by private equity or other for-profit actors—in provider directories, billing documents, and state licensing databases. For example, in January 2025, Massachusetts Gov. Maura Healey (D) signed into law H.B. 5159, An Act Enhancing the Market Review Process, to expand oversight of private equity and other financial actors in health care.93 The law was prompted, in part, because of the collapse of Steward Health Care in 2024.94 Some provisions of the law include requiring providers to report new ownership information and higher penalties for noncompliance. This would help empower patients to make informed decisions about their care and would enable regulators to track how ownership structures affect outcomes.
- Congress should establish and fund a centralized federal database documenting private equity-owned health facilities and key indicators—such as maternal health outcomes, service availability, and patient satisfaction—to enhance oversight over private funds and investors. The database, which could be housed by the U.S. Department of Health and Human Services, should be open access. Similar measures have been proposed at the federal level such as Sen. Ed Markey’s (D-MA) Health Over Wealth Act of 2024,95 which would require reporting from covered entities and make that data publicly available. Such a database could help policymakers, researchers, and the public identify patterns of care disruption, pricing increases, or disparities in access that may emerge after a private equity firm takes over—especially considering that private equity firms’ impact may be more obscure when they own facilities across state lines.
Conclusion
Private equity investment in reproductive and maternal health care is a growing force with profound implications for equity, affordability, and quality of care for sexual and reproductive health outcomes. The private equity model can conflict with patient-centered care and can create and/or exacerbate precarious situations for women and all people seeking reproductive health care. Policymakers must act to ensure that the financial interests of a few do not compromise fundamental rights to health and autonomy for all Americans.
Acknowledgments
The author would like to thank Brian Keyser, Andrea Ducas, Alex Thornton, Jill Rosenthal, and Emily Gee for their contributions to this report. The author would also like to thank Erin Fuse Brown, Zirui Song, and Yashaswini Singh for their reviews of and feedback on this report.