{ "license": { "ours": "https://creativecommons.org/licenses/by/4.0/", "terms": "/licence/", "note": "Notes, \"Where things stand\" and the record are CC BY 4.0. Excerpts and quotations belong to their owners." }, "no": 6, "slug": "private-equity-hospitals-india", "title": "Who owns India's hospitals now: private equity in health care", "nativeTitle": { "text": "अस्पतालों के नए मालिक", "lang": "hi" }, "nativePending": null, "summary": "Since about 2020, private equity funds and foreign investment companies have bought control of many of India's largest hospital chains, and of fertility, eye, dialysis and cancer chains. Studies abroad, mostly American, find prices rise under such owners and quality is mixed to worse. No Indian study has yet measured what this ownership does to patients.", "standfirst": "A record of who has bought India's hospitals and clinics, why the money came and how investors leave, what research in America, Britain and Europe finds private equity does to prices, staff and patients, and how little is known in India.", "opened": "2026-10-01", "closed": null, "keptBy": "The editors", "url": "/long-view/6-private-equity-hospitals-india/", "whereThingsStand": { "revision": 1, "date": "2026-10-01", "changed": "The Long View opened with the deals that put India's largest hospital, fertility, eye and dialysis chains under private equity and other investment funds, the reasons the money came and how it leaves, the research in America, Britain and Europe on what such owners do to prices, debt and patients, and what is and is not known in India.", "body": "In July 2026 Manipal, India's largest private hospital network by beds, [opened its ₹9,275 crore share sale](https://www.businesstoday.in/magazine/cover-story/story/how-indias-private-hospitals-are-expanding-in-different-forms-549606-2026-08-17) to the public, and its shares began trading 11% above the issue price. In 2015 it owned ten hospitals in five states and sold a minority stake to TPG, an investment firm, for ₹900 crore. By September 2025 it ran 48 hospitals with 12,367 licensed beds, and three of the companies that controlled it were registered in Singapore, at one address. In 2023 Temasek, the Singapore investment company, had agreed to buy a further 41%, which took its holding to 59%, as TPG's older fund left and its newer fund kept 11%. Manipal's story, told in its own filings, is the story of this record: Indian hospitals bought, built up and sold on by private equity funds and other investors, whose money comes from pension funds, governments and the very rich.\n\n\nSince 2021, according to Business Today, at least nine large deals involving Temasek, Blackstone, KKR, General Atlantic, Ontario Teachers' Pension Plan and Barings have changed the owners of well-known chains. [Blackstone bought control of CARE Hospitals](https://biospectrumindia.com/news/98/23772/blackstone-to-acquire-care-hospitals-and-kimshealth-creating-largest-healthcare-platform-.html) from a TPG fund in 2023 and agreed to buy KIMSHEALTH, whose investor, True North, sold its whole stake. Rather than sell, Blackstone then merged the chain into the listed Aster DM Healthcare, and with Aster's founders jointly controls the result, which took effect on 1 July 2026 with 10,898 beds. Pune's Sahyadri Hospitals went from one investor, Everstone, to Ontario Teachers' Pension Plan in 2022, and on to Manipal in 2025. In Kerala, where most people rely on private hospitals, [KKR took control of Baby Memorial Hospital](https://www.newslaundry.com/2026/07/04/who-owns-your-hospitals-private-equitys-growing-grip-on-keralas-healthcare) in Kozhikode in 2024, and within months it bought a family hospital in Thodupuzha that had run for 91 years. The rating agency ICRA shows what the new owners watch: occupancy at CARE's parent rose to 64% from 59%, revenue per occupied bed grew 5 to 6% a year, and the operating margin reached 20.2%, helped by a better case mix and revised tariffs.\n\n\nThe money has gone beyond large hospitals, into chains that do one thing many times over. These are roll-ups, built by buying small clinics and bringing them under one owner. EQT's fund took control of Indira IVF, India's largest fertility chain, in 2023, when it had 116 centres; by July 2025 it had 186. In 2024-25 its IVF cycles barely changed, 42,622 against 42,484, but its revenue rose 8.7% because the average price of a cycle went up to about ₹3.7 lakh from ₹3.5 lakh, and when a 2021 law raised the cost of donors the company passed it on to patients.\n\nThe same pattern runs through eye and kidney care. The eye chain ASG raised ₹1,500 crore from two funds with a [pipeline of regional chains to buy](https://www.generalatlantic.com/media-article/general-atlantic-and-kedaara-capital-lead-inr-1500-crore-investment-in-asg-eye-hospitals/). Dr Agarwal's, with 209 eye facilities and about 25% of the market for eye-care chains, took about three in five rupees of its revenue in cash from patients. The dialysis chain NephroPlus, whose promoters include Investcorp's private equity funds, ran 519 clinics; in each of the two years before its 2025 listing, more than half its nephrologists and duty doctors left.\n\n\nThe investors came to a system in which private hospitals already did most of the work and patients paid much of the bill. In 2017-18, private hospitals handled 55.3% of hospital stays other than for childbirth, and a stay there cost a family ₹31,845 in medical bills on average, against ₹4,452 in a government hospital. India has 1.3 hospital beds for every 1,000 people, [less than half the global average of three](https://www.niti.gov.in/sites/default/files/2021-03/InvestmentOpportunities_HealthcareSector_0.pdf#page=25), NITI Aayog told investors in 2021. In 2022-23 households paid [43.41% of all health spending out of their own pockets](https://nhsrcindia.org/sites/default/files/2026-05/NHA%202022-23%20Report.pdf#page=33). That share had fallen from 64.2% in 2013-14 as the state and insurers paid more, to 39.4% in 2021-22, before rising again. Insurance is spreading: in the national family health survey of 2023-24, 60.2% of households had someone covered by a health insurance or financing scheme, up from 41.0% in 2019-21.\n\nCrisil Ratings found private hospitals' revenue growing about 18% a year with healthy margins, which drew ₹55,000 to 60,000 crore from private equity and share sales from 2021-22 on. Average revenue per occupied bed keeps rising, it says, as hospitals treat more complex cases and more insured patients. Buyers now [value hospitals at 20 to 30 times EBITDA](https://www.grantthornton.in/insights/thought-leadership/vitals-for-growth-decoding-healthcare-financing-and-funding-in-india/), their yearly operating profit, and expect returns of 20 to 30% a year.\n\nThe money is large but recent. By EY and IVCA's count, private equity and venture capital put $2.1 billion into Indian healthcare in 2021, $5.1 billion in 2023 and $2.6 billion in 2025. A count of hospitals alone, from deal records, found 38 deals worth US$5,378.65 million between April 2020 and March 2024, with the average deal four times the size of those before Covid. This record has found no published count of how many of India's beds these funds own. The large chains where the deals have been made hold a small part of private care: [ICRA's 18 large chains](https://www.icra.in/Rating/DownloadResearchSummaryReport?id=6779#page=2) plan more than 34,000 new beds by 2030, half again what they have, and that would add only 2.3 to 2.5% to India's private beds.\n\n\nA fund must sell. Investors interviewed by Benjamin Hunter and colleagues in Maharashtra described [a cycle of three to seven years](https://doi.org/10.1111/1467-9566.70041): grow the chain fast, often by buying smaller hospitals in debt, and sell to new investors at a higher value. Sometimes the buyer is the stock market. KKR sold 27% of Max Healthcare in a single day in 2022, for ₹9,185 crore. More often it is another fund. CVC sold control of the cancer chain HCG to KKR at ₹445 a share, listing a transformational value creation program among its achievements, and Apax sold the surgical-products maker Healthium to KKR. Ontario Teachers' agreed to sell Sahyadri to Manipal after three years.\n\n\nWhat such owners do once they are in has been studied mostly in the United States, where private equity has bought hospitals, nursing homes and doctors' practices. The most consistent finding is that prices rise. Across ten specialties, [prices rose in eight](https://www.antitrustinstitute.org/wp-content/uploads/2023/07/AAI-UCB-EG_Private-Equity-I-Physician-Practice-Report_FINAL.pdf#page=5) after private equity bought a practice, by 4% in primary care up to 16% in cancer care, more where one firm held much of a local market. Anaesthesia prices rose 26.0% at management companies backed by private equity and 12.9% at others. At dermatology, gastroenterology and eye practices, charges per claim rose 20.2% and what insurers paid rose 11.0%. Of 12 studies of what patients or insurers pay, nine found it rose and none found it fell.\n\nDebt is the other thread. In a leveraged buyout the loans taken to buy a company are placed on the company itself, and Eileen Appelbaum and Rosemary Batt describe funds [consolidating small providers, loading them with debt](https://www.ineteconomics.org/uploads/papers/WP_118-Appelbaum-and-Batt-2-rb-Clean.pdf#page=2), and selling them on. An American Senate committee found that the fund Leonard Green took $424 million of the $645 million that Prospect Medical paid out, leaving the hospital company in severe financial distress. In Britain, the five largest private equity care home groups paid £102 a bed each week in interest, 16% of the average weekly fee. Among children's homes, private equity owners' profits covered their interest only 1.07 times, against 9 times for other providers. In India, Blackstone and TPG paid for CARE's purchases largely with new equity, but Indira IVF's ₹1,150 crore loan, taken to buy out earlier shareholders, was moved onto the company's own books.\n\n\nOn patients the evidence is less clear, and how it was gathered matters. Most studies use difference-in-differences: they compare the change at places that were bought with the change, over the same years, at similar places that were not. In American nursing homes, deaths during a stay and the 90 days after rose 11% under private equity owners, once researchers allowed for those homes taking in healthier patients. In hospitals, harm from the stay itself, such as falls and infections from central lines, rose 25.4%. In England, care homes in private equity chains were 6.6 percentage points more likely to be rated as needing improvement or inadequate. Other studies found no change: one of 21 million admissions found outcomes mostly unchanged, and one of hospitals bought by private equity found no rise in deaths or prices, though patient satisfaction fell. The main review, of 55 studies, rated none at low risk of bias, and [warns its findings may not hold](https://www.bmj.com/content/bmj/382/bmj-2023-075244.full.pdf#page=14) where the state pays for most care.\n\n\nIndia has warnings but no measurements. In 2018 the drug price regulator found that medicines, devices and tests made up 46% of bills at four private hospitals in Delhi and its suburbs and that [the hospitals, not the manufacturers, took the profit](https://web.archive.org/web/20180304015226/http://www.nppaindia.nic.in/order/overcharging_Details%2820022018%29.pdf); it did not ask who owned them. Oxfam interviewed five patients or their relatives in Chhattisgarh and Odisha; three said CARE or Narayana hospitals would not accept their government insurance cards, which Narayana and CARE's shareholder TPG deny. Researchers in Maharashtra describe doctors working under revenue targets in corporate hospitals. The national family health survey sorts facilities only as public or private, but it shows that private hospitals already practise differently: in 2023-24, [54.1% of births in private facilities](https://www.nfhsiips.in/nfhsuser/assets/National%20Family%20Health%20Survey%20%28NFHS-6%29%202023-2024%20Fact%20Sheets.pdf#page=26) were by caesarean section, against 16.9% in public ones, and the private rate was higher in every state. A count of 274 corporate hospitals found the top 15 taking 56.3% of the profits. Ameer Shahul's book The Silent Syndicate follows the money; its reviewer in Frontline found the effects on patients [more implied than stated](https://frontline.thehindu.com/books/silent-syndicate-ameer-shahul-private-equity-healthcare-india/article71340692.ece/amp/).\n\nResearch has not caught up. Of about 232 articles on private equity in health care indexed by the medical database PubMed since 2000, [84% are about the United States](https://doi.org/10.3389/fpubh.2026.1953760) and none is about India. Of 20 countries the OECD surveyed, only two could count who owns their clinics. This record has found no study that has yet compared prices, care or outcomes at Indian hospitals before and after investors bought them with similar hospitals they did not buy. ॥" }, "entries": [ { "title": "TPG to Invest in Manipal Health Enterprises", "kind": "report", "kindLabel": "Press release", "group": "Reporting", "date": "2015-02-26", "datePrecision": "day", "added": "2026-10-01", "note": "TPG, an investment firm founded in 1992 whose work includes leveraged buyouts, growth investments and restructurings, takes a significant minority stake in Manipal Health Enterprises for ₹900 crore. Manipal then owned and ran ten multi-specialty hospitals in five states and was part of the Manipal Education and Medical Group. The release presents the money as a way to grow and to draw on TPG’s know-how.", "citation": null, "held": null, "figure": null, "authors": [ "TPG" ], "photographers": [], "publication": "TPG", "excerpt": "TPG will take a significant minority stake in MHEPL for Rs. 900 crores. Terms of the transaction were not disclosed.", "url": "https://www.tpg.com/news-and-insights/tpg-invest-manipal-health-enterprises", "archiveUrl": "https://web.archive.org/web/20261001162606/https://www.tpg.com/news-and-insights/tpg-invest-manipal-health-enterprises", "anchor": "/long-view/6-private-equity-hospitals-india/#e-2015-tpg-to-invest-in-manipal", "specimen": false }, { "title": "Surprise! Out-of-Network Billing for Emergency Care in the United States", "kind": "research", "kindLabel": "Research paper", "group": "Entry", "date": "2018-01-01", "datePrecision": "month", "added": "2026-10-01", "note": "How surprise bills worked in American emergency rooms: a patient goes to a hospital in their insurer’s network but is treated by a doctor outside it, who bills at full price. When EmCare, a company that staffs emergency departments, took over a hospital’s emergency room, its doctors left insurers’ networks and raised charges by 96%. KKR, a private equity firm, bought EmCare in 2018; the data predate that.", "citation": null, "held": null, "figure": null, "authors": [ "Zack Cooper", "Fiona Scott Morton", "Nathan Shekita" ], "photographers": [], "publication": "NBER Working Paper 23623", "excerpt": "When EmCare enters into a new contract to manage a hospital’s ED services, they immediately exit networks, bill as out-of-network providers, and seek to collect their charges (which they also raise by 96 percent relative to the charges billed by the prior physician group in that hospital).", "url": "https://www.nber.org/system/files/working_papers/w23623/w23623.pdf", "archiveUrl": "https://web.archive.org/web/20260607013736/https://www.nber.org/system/files/working_papers/w23623/w23623.pdf", "anchor": "/long-view/6-private-equity-hospitals-india/#e-2018-surprise-out-of-network-billing", "specimen": false }, { "title": "Office Memorandum on overcharging by four private hospitals in Delhi/NCR", "kind": "report", "kindLabel": "Government memorandum", "group": "Reporting", "date": "2018-02-20", "datePrecision": "day", "added": "2026-10-01", "note": "The government’s drug price regulator analysed the bills of patients who died at four well-known private hospitals in Delhi and the National Capital Region, after families complained of inflated bills. Medicines, devices and tests made up 46% of the bills; families said the initial estimates had grown three to four times; and some margins were, in its word, exorbitant. NPPA concluded the hospitals, not the manufacturers, took the profit. It looked at four hospitals, and the memorandum does not discuss who owned them.", "citation": null, "held": null, "figure": null, "authors": [ "National Pharmaceutical Pricing Authority" ], "photographers": [], "publication": "Office Memorandum, File No. 27(2)/ 2017-Div-III/NPPA", "excerpt": "Last but not the least, the major beneficiaries of profits in all these cases because of inflated MRPs have been hospitals rather than drugs and devices’ manufacturers.", "url": "https://web.archive.org/web/20180304015226/http://www.nppaindia.nic.in/order/overcharging_Details(20022018).pdf", "archiveUrl": "https://web.archive.org/web/20210812110727/https://web.archive.org/web/20180304015226/http://www.nppaindia.nic.in/order/overcharging_Details(20022018).pdf", "anchor": "/long-view/6-private-equity-hospitals-india/#e-2018-office-memorandum-on-overcharging-by", "specimen": false }, { "title": "Key Indicators of Social Consumption in India: Health, NSS 75th Round (July 2017 – June 2018)", "kind": "data", "kindLabel": "Data", "group": "Data", "date": "2019-11-01", "datePrecision": "month", "added": "2026-10-01", "note": "The government’s household survey of illness and treatment, for July 2017 to June 2018. Private hospitals handled 55.3% of hospital stays other than for childbirth across India, 61.4% in towns and cities. An average stay in a private hospital cost a family ₹31,845 in medical bills, against ₹4,452 in a government hospital. These tables do not separate corporate chains from small private hospitals, so they cannot show what investor ownership adds.", "citation": null, "held": null, "figure": { "value": "55.3%", "unit": "of hospital stays other than for childbirth were in private hospitals, July 2017 to June 2018", "source": "NSS 75th round, Statement 3.10", "verify": false }, "authors": [ "National Statistical Office" ], "photographers": [], "publication": "Ministry of Statistics and Programme Implementation", "excerpt": "Statement 3.10 shows the break-up of hospitalisation cases by type of hospital: Government/public hospitals, charitable/NGO/trust-run hospitals and private hospitals.", "url": "https://mospi.gov.in/sites/default/files/publication_reports/KI_Health_75th_Final.pdf", "archiveUrl": "https://web.archive.org/web/20260905010650/https://www.mospi.gov.in/sites/default/files/publication_reports/KI_Health_75th_Final.pdf", "anchor": "/long-view/6-private-equity-hospitals-india/#e-2019-key-indicators-of-social-consumption", "specimen": false }, { "title": "Plugging the leaks in the UK care home industry: Strategies for resolving the financial crisis in the residential and nursing home sector", "kind": "report", "kindLabel": "Reporting", "group": "Reporting", "date": "2019-11-01", "datePrecision": "month", "added": "2026-10-01", "note": "A study of the accounts of 830 British care home companies, by the Centre for Health and the Public Interest, a think tank, part-funded by the union UNISON. One finding is about debt. The five largest private equity care home groups had borrowed £35,072 for each bed and paid £102 a bed each week in interest, 16% of the average weekly fee; other large for-profit chains paid £14. It recalls that Southern Cross and Four Seasons, which together cared for 45,000 residents, had left the industry or gone into administration.", "citation": null, "held": null, "figure": null, "authors": [ "Vivek Kotecha" ], "photographers": [], "publication": "Centre for Health and the Public Interest", "excerpt": "£102 The aggregate amount paid per bed per week in interest costs by the 5 largest private equity owned or backed care home providers. This is equivalent to 16% of the weighted average weekly fee (£622) paid for a residential care bed in the UK.", "url": "https://chpi.org.uk/s/CHPI-PluggingTheLeaks-Nov19-FINAL.pdf", "archiveUrl": null, "anchor": "/long-view/6-private-equity-hospitals-india/#e-2019-plugging-the-leaks-in-the", "specimen": false }, { "title": "The impacts of corporatisation of healthcare on medical practice and professionals in Maharashtra, India", "kind": "research", "kindLabel": "Research paper", "group": "Entry", "date": "2020-02-01", "datePrecision": "month", "added": "2026-10-01", "note": "What the shift to large corporate hospitals has done to doctors in two large cities of Maharashtra, from interviews with 43 people who know the system well. Doctors increasingly train in expensive private colleges and then work as salaried staff in corporate hospitals, under revenue targets and with less say over their own practice. Respondents tied this to rising costs, malpractice and mistrust between doctors and patients. These are people’s accounts, not measurements.", "citation": "doi:10.1136/bmjgh-2019-002026", "held": null, "figure": null, "authors": [ "Shweta Marathe", "Benjamin M Hunter", "Indira Chakravarthi", "Abhay Shukla", "Susan F Murray" ], "photographers": [], "publication": "BMJ Global Health, volume 5", "excerpt": "We describe a ‘reprofessionalisation’ of medicine encompassing changes in employment relations, performance targets and constraints placed on professional autonomy within the private healthcare sector that is accompanied by trends in cost inflation, medical malpractice, and distrust in doctor-patient relationships.", "url": "https://gh.bmj.com/content/bmjgh/5/2/e002026.full.pdf", "archiveUrl": "https://web.archive.org/web/20250710195446/https://gh.bmj.com/content/bmjgh/5/2/e002026.full.pdf", "anchor": "/long-view/6-private-equity-hospitals-india/#e-2020-the-impacts-of-corporatisation-of", "specimen": false }, { "title": "Private Equity Buyouts in Healthcare: Who Wins, Who Loses?", "kind": "report", "kindLabel": "Reporting", "group": "Reporting", "date": "2020-03-15", "datePrecision": "day", "added": "2026-10-01", "note": "Eileen Appelbaum and Rosemary Batt’s account of the private equity method in American health care, drawn from a wide range of sources. An extended example is Steward Health Care, which Cerberus built in 2010 from Catholic hospitals in Massachusetts and loaded with sale-and-leaseback deals: selling the hospitals’ buildings and renting them back. By 2020, they wrote, Steward’s finances were in ruins while Cerberus had more than recovered its investment.", "citation": null, "held": null, "figure": null, "authors": [ "Eileen Appelbaum", "Rosemary Batt" ], "photographers": [], "publication": "Institute for New Economic Thinking Working Paper No. 118", "excerpt": "In each of these segments, private equity has taken the lead in consolidating small providers, loading them with debt, and rolling them up into large powerhouses with substantial market power before exiting with handsome returns.", "url": "https://www.ineteconomics.org/uploads/papers/WP_118-Appelbaum-and-Batt-2-rb-Clean.pdf", "archiveUrl": "https://web.archive.org/web/20260520213601/https://www.ineteconomics.org/uploads/papers/WP_118-Appelbaum-and-Batt-2-rb-Clean.pdf", "anchor": "/long-view/6-private-equity-hospitals-india/#e-2020-private-equity-buyouts-in-healthcare", "specimen": false }, { "title": "Investment Opportunities in India’s Healthcare Sector", "kind": "report", "kindLabel": "Reporting", "group": "Reporting", "date": "2021-03-01", "datePrecision": "month", "added": "2026-10-01", "note": "NITI Aayog’s report on investment opportunities in health care. It sets out the shortage that private money is meant to fill: 1.3 hospital beds for every 1,000 Indians, less than half the global average of three. It presents PM-JAY, the national scheme that pays for hospital care for poorer families, as a chance to use the private sector to treat the poor, and points private hospitals towards smaller cities, where competition and land cost less.", "citation": null, "held": null, "figure": null, "authors": [ "NITI Aayog" ], "photographers": [], "publication": "NITI Aayog", "excerpt": "India currently has 1.3 hospital beds per 1,000 population.1,16 There is also a shortage of skilled health workers, with 0.65 physicians per 1,000 people (the World Health Organisation standard is 1 per 1,000 people) and 1.3 nurses per 1,000 people.", "url": "https://www.niti.gov.in/sites/default/files/2021-03/InvestmentOpportunities_HealthcareSector_0.pdf", "archiveUrl": "https://web.archive.org/web/20250804111939/https://www.niti.gov.in/sites/default/files/2021-03/InvestmentOpportunities_HealthcareSector_0.pdf?", "anchor": "/long-view/6-private-equity-hospitals-india/#e-2021-investment-opportunities-in-indias-healthcare", "specimen": false }, { "title": "Prevalence and Performance of Private Equity-Affiliated Fertility Practices in the United States", "kind": "research", "kindLabel": "Research paper", "group": "Entry", "date": "2021-09-15", "datePrecision": "day", "added": "2026-10-01", "note": "Fertility care is where private equity holds the largest share of any American medical specialty, the authors find. In 2018, 14.7% of fertility practices were tied to private equity but did 29.3% of IVF cycles. Their patients were more likely to have embryos genetically tested before transfer, and success rates for women under 35 were no different. It is a snapshot of one year, not a before-and-after study.", "citation": null, "held": null, "figure": null, "authors": [ "Alexander Borsa", "Joseph Dov Bruch" ], "photographers": [], "publication": "Fertility and Sterility", "excerpt": "A major portion of fertility practices in the U.S. are private equity-affiliated, and these practices perform an even greater portion of ART cycles in the U.S. each year. Fertility appears to be the medical specialty with the greatest market share owned by private equity.", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC8714667/", "archiveUrl": "https://web.archive.org/web/20260324000953/https://pmc.ncbi.nlm.nih.gov/articles/PMC8714667/", "anchor": "/long-view/6-private-equity-hospitals-india/#e-2021-prevalence-and-performance-of-private", "specimen": false }, { "title": "Association of Private Equity Investment in US Nursing Homes With the Quality and Cost of Care for Long-Stay Residents", "kind": "research", "kindLabel": "Research paper", "group": "Entry", "date": "2021-11-01", "datePrecision": "month", "added": "2026-10-01", "note": "Long-term residents of American nursing homes, followed before and after 302 homes were bought by private equity, against residents of other for-profit homes. Emergency visits for conditions good care should prevent rose 11.1%, hospital admissions for them 8.7%, and the cost to Medicare 3.9%. Use of antipsychotic drugs, severe pain and bedsores did not change measurably.", "citation": null, "held": null, "figure": null, "authors": [ "Robert Tyler Braun", "Hye-Young Jung", "Lawrence P. Casalino", "Zachary Myslinski", "Mark Aaron Unruh" ], "photographers": [], "publication": "JAMA Health Forum", "excerpt": "In adjusted differences-in-differences comparisons, PE firm acquisition was associated with an 11.1% relative increase in ACS ED visits (1.7 of 15.3; 1.7 percentage points; 95% CI, 0.3-3.0 percentage points; P = .02), an 8.7% relative increase in ACS hospitalizations (1.0 of 11.5; 1.0 percentage point; 95% CI, 0.2-1.1 percentage points; P = .003)", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC8796926/", "archiveUrl": "https://web.archive.org/web/20260316193000/https://pmc.ncbi.nlm.nih.gov/articles/PMC8796926/", "anchor": "/long-view/6-private-equity-hospitals-india/#e-2021-association-of-private-equity-investment", "specimen": false }, { "title": "Children's social care market study: final report", "kind": "report", "kindLabel": "Reporting", "group": "Reporting", "date": "2022-03-10", "datePrecision": "day", "added": "2026-10-01", "note": "Britain’s competition regulator on the companies that run children’s homes in England. It found steady operating profit margins of 22.6% among the largest providers. On private equity its finding is about fragility rather than price: private equity owners’ profits covered their interest only 1.07 times, against 9 times for other providers, leaving homes for vulnerable children exposed if a company failed. Prices at private equity homes were only slightly higher.", "citation": null, "held": null, "figure": null, "authors": [ "Competition and Markets Authority" ], "photographers": [], "publication": "Competition and Markets Authority", "excerpt": "The average level of interest coverage (ie profit divided by interest charge) for private equity owned operators of children’s homes over the last three years was 1.07 times, compared to 9 times for non-PE owned providers.", "url": "https://assets.publishing.service.gov.uk/media/6228726cd3bf7f158c844f65/Final_report.pdf", "archiveUrl": "https://web.archive.org/web/20260501021528/https://assets.publishing.service.gov.uk/media/6228726cd3bf7f158c844f65/Final_report.pdf", "anchor": "/long-view/6-private-equity-hospitals-india/#e-2022-childrens-social-care-market-study", "specimen": false }, { "title": "Association of Physician Management Companies and Private Equity Investment With Commercial Health Care Prices Paid to Anesthesia Practitioners", "kind": "research", "kindLabel": "Research paper", "group": "Entry", "date": "2022-04-01", "datePrecision": "month", "added": "2026-10-01", "note": "Many American hospitals and surgery centres get their anaesthetists through management companies; half of those in this study were backed by private equity. Using claims from commercial insurers, the authors find prices rose after a hospital or surgery centre signed with such a company, and rose twice as much when the company was backed by private equity: 26.0% against 12.9%. It measures prices only, not patients’ outcomes.", "citation": null, "held": null, "figure": null, "authors": [ "Ambar La Forgia", "Amelia M Bond", "Robert Tyler Braun", "Leah Z Yao", "Klaus Kjaer", "Manyao Zhang", "Lawrence P Casalino" ], "photographers": [], "publication": "JAMA Internal Medicine", "excerpt": "In subsample analyses, PMCs without PE investment increased allowed amounts by 12.9% (+$89.88; 95% CI, $42.07 to $137.69; P < .001), while PE-backed PMCs (representing half of the PMCs in the sample) increased allowed amounts by 26.0%", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC8886444/", "archiveUrl": null, "anchor": "/long-view/6-private-equity-hospitals-india/#e-2022-association-of-physician-management-companies", "specimen": false }, { "title": "Association Between Hospital Private Equity Acquisition and Outcomes of Acute Medical Conditions Among Medicare Beneficiaries", "kind": "research", "kindLabel": "Research paper", "group": "Entry", "date": "2022-04-29", "datePrecision": "day", "added": "2026-10-01", "note": "A large study that found little change. It follows 21 million older Americans admitted through emergency departments for heart attacks, strokes, heart failure, lung disease and pneumonia between 2001 and 2018, at hospitals that private equity did and did not buy. Outcomes mostly did not change; deaths after heart attacks fell more at private equity hospitals.", "citation": null, "held": null, "figure": null, "authors": [ "Marcelo Cerullo", "Kelly Yang", "Karen E. Joynt Maddox", "Ryan C. McDevitt", "James W. Roberts", "Anaeze C. Offodile" ], "photographers": [], "publication": "JAMA Network Open", "excerpt": "In this cross-sectional study using a difference-in-differences approach, PE acquisition had no substantial association with the patient-level outcomes examined, although it was associated with a moderate improvement in mortality among Medicare beneficiaries hospitalized with AMI.", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC9055457/", "archiveUrl": "https://web.archive.org/web/20250416010334/https://pmc.ncbi.nlm.nih.gov/articles/PMC9055457/", "anchor": "/long-view/6-private-equity-hospitals-india/#e-2022-association-between-hospital-private-equity", "specimen": false }, { "title": "General Atlantic and Kedaara Capital Lead INR 1,500 Crore Investment in ASG Eye Hospitals", "kind": "report", "kindLabel": "Press release", "group": "Reporting", "date": "2022-07-27", "datePrecision": "day", "added": "2026-10-01", "note": "The largest private equity deal in single-specialty care at the time: ₹1,500 crore from General Atlantic and Kedaara into ASG, an eye-hospital chain founded in Jodhpur in 2005. It gives Investcorp, which came in in 2017, a way out. ASG had doubled its hospitals in three years, and its backers spell out the roll-up plan in so many words: a pipeline of regional chains to buy.", "citation": null, "held": null, "figure": null, "authors": [ "General Atlantic" ], "photographers": [], "publication": "General Atlantic", "excerpt": "With imminent plans to explore and build upon a high-quality M&A pipeline of regional players spanning key markets across India, we are excited to welcome and partner with two highly regarded and forward-thinking investors at this transformational inflection point in the history of ASG Eye Hospitals.", "url": "https://www.generalatlantic.com/media-article/general-atlantic-and-kedaara-capital-lead-inr-1500-crore-investment-in-asg-eye-hospitals/", "archiveUrl": "https://web.archive.org/web/20251208185313/https://www.generalatlantic.com/media-article/general-atlantic-and-kedaara-capital-lead-inr-1500-crore-investment-in-asg-eye-hospitals/", "anchor": "/long-view/6-private-equity-hospitals-india/#e-2022-general-atlantic-and-kedaara-capital", "specimen": false }, { "title": "KKR Sells 27% Stake Worth Rs 9,185 Crore In Max Healthcare Institute", "kind": "report", "kindLabel": "Reporting", "group": "Reporting", "date": "2022-08-16", "datePrecision": "day", "added": "2026-10-01", "note": "How a private equity firm can leave a hospital chain once it is listed on the stock market: in blocks of shares sold to other investors. In 2018 Radiant Life Care, a hospital firm backed by KKR, announced a deal to take a majority of Max Healthcare. Here KKR sells 27% in a single day for ₹9,185 crore, to buyers that include the government of Singapore and several investment funds. Its stake had fallen from 47.24% in June 2021 to 27.54% in June 2022.", "citation": null, "held": null, "figure": null, "authors": [ "Outlook Business" ], "photographers": [], "publication": "Outlook Business", "excerpt": "The US private equity major KKR on Tuesday sold 27 per cent stake in the hospital chain Max Healthcare Institute for Rs 9,185 crore through open market transactions.", "url": "https://www.outlookbusiness.com/news/kkr-sells-27-stake-worth-rs-9-185-crore-in-max-healthcare-institute-news-216822", "archiveUrl": "https://web.archive.org/web/20261001162742/https://www.outlookbusiness.com/news/kkr-sells-27-stake-worth-rs-9-185-crore-in-max-healthcare-institute-news-216822", "anchor": "/long-view/6-private-equity-hospitals-india/#e-2022-kkr-sells-27-stake-worth", "specimen": false }, { "title": "Ontario Teachers' Announces Agreement to Acquire a Significant Majority Stake in Sahyadri Hospitals from the Everstone Group", "kind": "report", "kindLabel": "Press release", "group": "Reporting", "date": "2022-08-16", "datePrecision": "day", "added": "2026-10-01", "note": "Ontario Teachers’ Pension Plan agrees to buy a significant majority of Sahyadri Hospitals, which it calls the largest private hospital chain in Maharashtra, from the Everstone Group, which keeps a minority stake with the founders. Sahyadri then had eight hospitals with about 900 operating beds, concentrated around Pune. The pension fund calls it its first private equity buyout of control in India. The release also quotes thanks to Everstone for executing the playbook of consolidation and growth.", "citation": null, "held": null, "figure": null, "authors": [ "Ontario Teachers' Pension Plan Board" ], "photographers": [], "publication": "CNW Group", "excerpt": "Ontario Teachers’ Pension Plan Board (“Ontario Teachers’”), today announced an agreement to acquire a significant majority stake in Sahyadri Hospitals Group (“Sahyadri”), the largest private hospital chain in the state of Maharashtra, from the Everstone Group. Existing sponsor, Everstone Group, along with key management and founders will retain minority stakes in the company. Sahyadri has 8 hospitals with c. 900 operating beds and 300 critical-care beds.", "url": "https://www.newswire.ca/news-releases/ontario-teachers-announces-agreement-to-acquire-a-significant-majority-stake-in-sahyadri-hospitals-from-the-everstone-group-815300612.html", "archiveUrl": null, "anchor": "/long-view/6-private-equity-hospitals-india/#e-2022-ontario-teachers-announces-agreement-to", "specimen": false }, { "title": "Association of Private Equity Acquisition of Physician Practices With Changes in Health Care Spending and Utilization", "kind": "research", "kindLabel": "Research paper", "group": "Entry", "date": "2022-09-01", "datePrecision": "month", "added": "2026-10-01", "note": "What happened at 578 dermatology, gastroenterology and eye practices in America after private equity bought them, compared with 2,874 similar practices, over two years. Charges per claim rose 20.2% and what insurers paid rose 11.0%. The practices also saw 25.8% more patients and billed more visits as long ones. The patients were no sicker than before. The study uses commercial insurance claims only and measures no outcomes of care.", "citation": null, "held": null, "figure": null, "authors": [ "Yashaswini Singh", "Zirui Song", "Daniel Polsky", "Joseph D Bruch", "Jane M Zhu" ], "photographers": [], "publication": "JAMA Health Forum", "excerpt": "Compared with the 2874 control practices, the 578 PE-acquired physician practices exhibited an average increase of $71 (+20.2%) charged per claim (95% CI, 13.1%-27.3%; P < .001) and $23 (+11.0%) in the allowed amount per claim (95% CI, 5.6%-16.5%; P < .001).", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC9440392/", "archiveUrl": "https://web.archive.org/web/20261001164223/https://pmc.ncbi.nlm.nih.gov/articles/PMC9440392/", "anchor": "/long-view/6-private-equity-hospitals-india/#e-2022-association-of-private-equity-acquisition", "specimen": false }, { "title": "Effects of chain ownership and private equity financing on quality in the English care home sector: retrospective observational study", "kind": "research", "kindLabel": "Research paper", "group": "Entry", "date": "2022-12-01", "datePrecision": "month", "added": "2026-10-01", "note": "The inspection ratings of 10,803 English care homes for older people, by who owned them. Homes in private equity chains were 6.6 percentage points more likely than not-for-profit homes to be rated as needing improvement or inadequate. Independent for-profit homes did about as badly. The study takes a single moment and could not account for staffing or for how sick residents were, and its list of private equity chains came from a 2019 think tank report.", "citation": null, "held": null, "figure": null, "authors": [ "Sharvari Patwardhan", "Matthew Sutton", "Marcello Morciano" ], "photographers": [], "publication": "Age and Ageing", "excerpt": "all three for-profit ownership types had lower average overall ratings than not-for-profit homes, especially independent (6.8% points (p.p.) more likely rated as ‘Requires Improvement/Inadequate’, 95% CI: 4.7–8.9) and private equity chains (6.6 p.p. more likely rated as ‘Requires Improvement/Inadequate’, 95% CI: 2.9–10.2).", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC9792077/", "archiveUrl": "https://web.archive.org/web/20250202093525/https://pmc.ncbi.nlm.nih.gov/articles/PMC9792077/", "anchor": "/long-view/6-private-equity-hospitals-india/#e-2022-effects-of-chain-ownership-and", "specimen": false }, { "title": "Private equity investment in Europe’s primary care sector—a call for research and policy action", "kind": "research", "kindLabel": "Editorial", "group": "Entry", "date": "2023-01-01", "datePrecision": "year", "added": "2026-10-01", "note": "Researchers at the European Observatory on Health Systems and Policies on private equity buying doctors’ and outpatient practices across Europe. In Germany, about 750 of 3,800 outpatient centres were estimated to be held by private equity funds in 2020, despite rules meant to stop it. A third of Sweden’s private for-profit primary care practices belong to international private equity firms. Robust data on who owns Germany’s centres, they write, do not exist.", "citation": null, "held": null, "figure": null, "authors": [ "Bernd Rechel", "Florian Tille", "Peter Groenewegen", "Rob Timans", "Giovanni Fattore", "Katja Rohrer-Herold", "Dheepa Rajan", "Sophie Lopes" ], "photographers": [], "publication": "European Journal of Public Health", "excerpt": "In 2020, about 750 of overall 3800 ambulatory health care centres were estimated to be in the hands of private equity funds, despite regulations aimed at preventing this type of ownership. However, robust data on the ownership situation do not exist, as there are no legal requirements for disclosures and many investors are located in tax havens.", "url": "https://researchonline.lshtm.ac.uk/id/eprint/4675226/1/Rechel-etal-2023-Private-equity-investment-in-Europes-primary-care-sector.pdf", "archiveUrl": "https://web.archive.org/web/20251003154830/https://researchonline.lshtm.ac.uk/id/eprint/4675226/1/Rechel-etal-2023-Private-equity-investment-in-Europes-primary-care-sector.pdf", "anchor": "/long-view/6-private-equity-hospitals-india/#e-2023-private-equity-investment-in-europes", "specimen": false }, { "title": "Manipal Health Enterprises announces agreement for Temasek to acquire 41% stake", "kind": "report", "kindLabel": "Press release", "group": "Reporting", "date": "2023-04-10", "datePrecision": "day", "added": "2026-10-01", "note": "Eight years after TPG invested, Temasek, the Singapore investment company, agreed to buy a further 41% of Manipal, adding to the 18% it already held through Sheares Healthcare. TPG said its 2015 fund would fully exit while its newer fund would hold 11%, and the National Investment and Infrastructure Fund, which invested during the pandemic, would exit too. Manipal by then had 29 hospitals and more than 8,300 beds, after buying Columbia Asia’s Indian hospitals and Vikram Hospital in Bengaluru.", "citation": null, "held": null, "figure": null, "authors": [ "TPG" ], "photographers": [], "publication": "TPG", "excerpt": "Following the closing of the transaction, Manipal Group will hold about 30% of MHE. Sheares Healthcare Group, a wholly-owned subsidiary and independently-managed portfolio company of Temasek, will retain its existing 18% stake. Leading global alternative asset management firm TPG, which first invested in MHE through TPG Asia VI in 2015, will fully exit, but it will hold an interest of 11% in MHE, through its new Asia fund - TPG Asia VIII.", "url": "https://www.tpg.com/news-and-insights/manipal-health-enterprises-announces-agreement-temasek-acquire", "archiveUrl": null, "anchor": "/long-view/6-private-equity-hospitals-india/#e-2023-manipal-health-enterprises-announces-agreement", "specimen": false }, { "title": "Sick Development: How rich-country government and World Bank funding to for-profit private hospitals causes harm, and why it should be stopped", "kind": "report", "kindLabel": "Reporting", "group": "Reporting", "date": "2023-06-01", "datePrecision": "month", "added": "2026-10-01", "note": "Oxfam’s case against public development banks that fund private hospitals, including through private equity funds. In India it looked at CARE Hospitals, then held by an Abraaj fund later run by TPG, and Narayana Health. In five interviews in Chhattisgarh and Odisha, three patients said they were blocked from using their government health insurance cards altogether. The India evidence rests on five interviews. TPG and Narayana deny that their hospitals reject the cards.", "citation": null, "held": null, "figure": null, "authors": [ "Anna Marriott" ], "photographers": [], "publication": "Oxfam briefing paper", "excerpt": "Oxfam conducted five interviews with patients (and/or their relatives) with government health insurance cards who sought care at Narayana and CARE hospitals. Three of the patients, including Eva’s mother (see introduction), were blocked from using their cards altogether; one patient’s card was used only selectively; and the final patient did not know whether or not his card had been used at all due to a lack of transparency about his bill.", "url": "https://www.medbox.org/index.php/dl/64d217a98dc672025f060eb6", "archiveUrl": "https://web.archive.org/web/20261001163240/https://www.medbox.org/index.php/dl/64d217a98dc672025f060eb6", "anchor": "/long-view/6-private-equity-hospitals-india/#e-2023-sick-development-how-rich-country", "specimen": false }, { "title": "Monetizing Medicine: Private Equity and Competition in Physician Practice Markets", "kind": "report", "kindLabel": "Reporting", "group": "Reporting", "date": "2023-07-10", "datePrecision": "day", "added": "2026-10-01", "note": "How private equity bought up American doctors’ practices, and what happened to prices. Deals rose from 75 in 2012 to 484 in 2021. Using insurance claims, the authors compare practices bought by private equity with similar ones that were not: prices rose in eight of ten specialties, by 4% in primary care up to 16% in cancer care. Increases were larger where one firm held more than 30% of a local market.", "citation": null, "held": null, "figure": null, "authors": [ "Richard M. Scheffler", "Laura Alexander", "Brent D. Fulton", "Daniel R. Arnold", "Ola A. Abdelhadi" ], "photographers": [], "publication": "American Antitrust Institute, Petris Center and Washington Center for Equitable Growth", "excerpt": "In 8 of the 10 physician practice specialties we study, we find statistically significant price increases associated with PE’s acquisition of a practice. These price increases range from 16% in oncology to 4% in primary care and dermatology.", "url": "https://www.antitrustinstitute.org/wp-content/uploads/2023/07/AAI-UCB-EG_Private-Equity-I-Physician-Practice-Report_FINAL.pdf", "archiveUrl": "https://web.archive.org/web/20260923100018/https://www.antitrustinstitute.org/wp-content/uploads/2023/07/AAI-UCB-EG_Private-Equity-I-Physician-Practice-Report_FINAL.pdf", "anchor": "/long-view/6-private-equity-hospitals-india/#e-2023-monetizing-medicine-private-equity-and", "specimen": false }, { "title": "Evaluating trends in private equity ownership and impacts on health outcomes, costs, and quality: systematic review", "kind": "research", "kindLabel": "Research paper", "group": "Entry", "date": "2023-07-19", "datePrecision": "day", "added": "2026-10-01", "note": "The standard summary of the evidence: 55 studies from eight countries, 47 of them American. Across outcomes, private equity ownership was most consistently tied to higher costs for patients or insurers; nine of the 12 studies on costs found them higher, and none lower. Effects on quality were mixed to harmful. No study was judged at low risk of bias. The authors warn the findings may not carry to countries where the state pays for most care.", "citation": "BMJ 2023;382:e075244", "held": null, "figure": null, "authors": [ "Alexander Borsa", "Geronimo Bejarano", "Moriah Ellen", "Joseph Dov Bruch" ], "photographers": [], "publication": "The BMJ", "excerpt": "Across the outcome measures, PE ownership was most consistently associated with increases in costs to patients or payers. Additionally, PE ownership was associated with mixed to harmful impacts on quality.", "url": "https://www.bmj.com/content/bmj/382/bmj-2023-075244.full.pdf", "archiveUrl": null, "anchor": "/long-view/6-private-equity-hospitals-india/#e-2023-evaluating-trends-in-private-equity", "specimen": false }, { "title": "BPEA EQT to acquire a majority stake in Indira IVF – India’s largest chain of fertility clinics", "kind": "report", "kindLabel": "Press release", "group": "Reporting", "date": "2023-07-28", "datePrecision": "day", "added": "2026-10-01", "note": "EQT’s Asian private equity fund takes control of Indira IVF, India’s largest fertility chain, from TA Associates and the founding Murdia family, who keep a minority stake. Started as one clinic in Udaipur in 1988, the chain had 116 centres in 20 states and did about 40,000 IVF cycles a year. The fund says it will widen that footprint across India and into neighbouring countries.", "citation": null, "held": null, "figure": null, "authors": [ "EQT" ], "photographers": [], "publication": "EQT", "excerpt": "EQT is pleased to announce that BPEA Private Equity Fund VIII (“BPEA EQT”) has agreed to acquire a control stake in Indira IVF (the “Company”), from TA Associates and the Company’s founders, Dr. Ajay Murdia, Dr. Kshitiz Murdia, and Dr. Nitiz Murdia, who will retain a significant minority stake and continue to lead the Company.", "url": "https://eqtgroup.com/news/bpea-eqt-to-acquire-a-majority-stake-in-indira-ivf-indias-largest-chain-of-fertility-clinics-2023-07-28", "archiveUrl": "https://web.archive.org/web/20260616064042/https://eqtgroup.com/news/bpea-eqt-to-acquire-a-majority-stake-in-indira-ivf-indias-largest-chain-of-fertility-clinics-2023-07-28", "anchor": "/long-view/6-private-equity-hospitals-india/#e-2023-bpea-eqt-to-acquire-a", "specimen": false }, { "title": "Owner Incentives and Performance in Healthcare: Private Equity Investment in Nursing Homes", "kind": "research", "kindLabel": "Research paper", "group": "Entry", "date": "2023-08-01", "datePrecision": "month", "added": "2026-10-01", "note": "A study of what private equity did to patients in American nursing homes. It follows about 4.2 million short-stay Medicare patients in American for-profit nursing homes, in data running from 2000 to 2017. After buyouts, homes took in healthier patients, so the authors use distance to compare patients who went to a private equity home only because it was nearer. On that comparison, deaths during the stay and the 90 days after rose 11%. Staff hours from nursing assistants fell 3%, and interest payments rose by over 200%.", "citation": null, "held": null, "figure": null, "authors": [ "Atul Gupta", "Sabrina T. Howell", "Constantine Yannelis", "Abhinav Gupta" ], "photographers": [], "publication": "NBER Working Paper 28474", "excerpt": "We show that PE ownership leads to lower-risk patients and increases mortality. After instrumenting for the patient-nursing home match, we recover a local average treatment effect on mortality of 11%.", "url": "https://www.nber.org/system/files/working_papers/w28474/w28474.pdf", "archiveUrl": "https://web.archive.org/web/20260826090744/https://www.nber.org/system/files/working_papers/w28474/w28474.pdf", "anchor": "/long-view/6-private-equity-hospitals-india/#e-2023-owner-incentives-and-performance-in", "specimen": false }, { "title": "Blackstone to acquire CARE Hospitals and KIMSHEALTH creating largest healthcare platform", "kind": "report", "kindLabel": "Press release", "group": "Reporting", "date": "2023-10-30", "datePrecision": "day", "added": "2026-10-01", "note": "CARE Hospitals has passed from one private equity fund to another. Here funds managed by Blackstone buy a majority of it from Evercare, a TPG platform, which keeps a significant minority stake, and CARE agrees to buy a majority of KIMSHEALTH, whose investor True North sells its entire stake. The release gives the combined size, more than 4,000 beds in 23 facilities, and quotes Blackstone’s aim to build a patient-centric hospital platform.", "citation": null, "held": null, "figure": null, "authors": [ "Blackstone" ], "photographers": [], "publication": "Blackstone", "excerpt": "Private equity funds managed by Blackstone have acquired a majority shareholding in CARE Hospitals from Evercare, a platform of TPG RISE funds. In addition, CARE Hospitals has signed a definitive agreement to acquire a majority stake in KIMSHEALTH.", "url": "https://biospectrumindia.com/news/98/23772/blackstone-to-acquire-care-hospitals-and-kimshealth-creating-largest-healthcare-platform-.html", "archiveUrl": "https://web.archive.org/web/20251111053405/https://biospectrumindia.com/news/98/23772/blackstone-to-acquire-care-hospitals-and-kimshealth-creating-largest-healthcare-platform-.html", "anchor": "/long-view/6-private-equity-hospitals-india/#e-2023-blackstone-to-acquire-care-hospitals", "specimen": false }, { "title": "Changes in Hospital Adverse Events and Patient Outcomes Associated With Private Equity Acquisition", "kind": "research", "kindLabel": "Research paper", "group": "Entry", "date": "2023-12-26", "datePrecision": "day", "added": "2026-10-01", "note": "A study of harm to patients in American hospitals. It compares 51 hospitals bought by private equity with 259 similar hospitals, before and after the purchase, using Medicare claims for all stays at those hospitals. Harm caused by the hospital stay itself, such as falls and infections from central lines, rose 25.4%. Deaths in hospital fell slightly, which the authors link to younger, healthier patients being admitted; 30 days after discharge there was no difference.", "citation": null, "held": null, "figure": null, "authors": [ "Sneha Kannan", "Joseph Dov Bruch", "Zirui Song" ], "photographers": [], "publication": "JAMA", "excerpt": "After private equity acquisition, Medicare beneficiaries admitted to private equity hospitals experienced a 25.4% increase in hospital-acquired conditions compared with those treated at control hospitals (4.6 [95% CI, 2.0-7.2] additional hospital-acquired conditions per 10 000 hospitalizations, P = .004).", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC10751598/", "archiveUrl": "https://web.archive.org/web/20260920075316/https://pmc.ncbi.nlm.nih.gov/articles/PMC10751598/", "anchor": "/long-view/6-private-equity-hospitals-india/#e-2023-changes-in-hospital-adverse-events", "specimen": false }, { "title": "India’s Healthcare Industry Comes of Age", "kind": "report", "kindLabel": "Reporting", "group": "Reporting", "date": "2024-01-03", "datePrecision": "day", "added": "2026-10-01", "note": "Bain & Company’s case for investing in Indian health care. Bain names the attractions: a middle class willing to pay for private care, insurance spreading, and hospitals that are fragmented and too few. It reports that more deals now buy control, as founders grow comfortable handing over the reins, and that investors earned generous returns on their exits. It closes that the risk-return profile is very favorable.", "citation": null, "held": null, "figure": null, "authors": [ "Homer Paneri", "Vikram Kapur", "Nirad Jain", "Kara Murphy", "Dmitry Podpolny", "Franz-Robert Klingan", "Alex Boulton" ], "photographers": [], "publication": "Bain & Company", "excerpt": "In 2023, India is expected to host 22 healthcare deals, a slight decline from the 26 in 2022. Deal value is expected to come in at $4.6 billion in 2023, just below the $4.7 billion in 2022, with India remaining the leader in deal value across the region.", "url": "https://www.bain.com/insights/india-global-healthcare-private-equity-report-2024/", "archiveUrl": null, "anchor": "/long-view/6-private-equity-hospitals-india/#e-2024-indias-healthcare-industry-comes-of", "specimen": false }, { "title": "Apollo 24|7 to raise INR 2,475 Crores from Advent International; Merge Keimed with Apollo 24|7", "kind": "report", "kindLabel": "Press release", "group": "Reporting", "date": "2024-04-26", "datePrecision": "day", "added": "2026-10-01", "note": "Advent International agrees to put ₹2,475 crore into Apollo HealthCo, which runs the Apollo 24|7 online health business, for 12.1% once it merges with Keimed, a large wholesale medicine distributor. Apollo Hospitals keeps control. The deal joins the selling of medicines, wholesale and retail, online and in shops, in one company valued at ₹22,481 crore.", "citation": null, "held": null, "figure": null, "authors": [ "Advent International" ], "photographers": [], "publication": "Advent International", "excerpt": "Advent shall invest in compulsory convertible instruments over 2 tranches to secure 12.1% stake in the merged entity, by valuing the combined entity at an enterprise value of INR 22,481 Crores.", "url": "https://www.adventinternational.com/news/apollo-247-to-raise-inr-2475-crores-from-advent-international-merge-keimed-with-apollo-247/", "archiveUrl": "https://web.archive.org/web/20261001163431/https://www.adventinternational.com/news/apollo-247-to-raise-inr-2475-crores-from-advent-international-merge-keimed-with-apollo-247/", "anchor": "/long-view/6-private-equity-hospitals-india/#e-2024-apollo-24-7-to-raise", "specimen": false }, { "title": "KKR to Acquire Healthium from Apax Funds", "kind": "report", "kindLabel": "Press release", "group": "Reporting", "date": "2024-05-06", "datePrecision": "day", "added": "2026-10-01", "note": "A secondary buyout, in which one private equity owner sells a company to another. Apax bought Healthium, an Indian maker of sutures and surgical products founded in 1992, in 2018 and here sells control to KKR. Apax credits itself with turning a domestic suture company into a global one, sold in more than 90 countries. KKR promises to grow it further by building and by buying. The price was not disclosed.", "citation": null, "held": null, "figure": null, "authors": [ "Apax Partners" ], "photographers": [], "publication": "Apax Partners", "excerpt": "The Apax Funds acquired Healthium in 2018 and transformed the company from a domestic suture player into a global medical devices leader.", "url": "https://www.apax.com/news-views/kkr-to-acquire-healthium-from-apax-funds/", "archiveUrl": "https://web.archive.org/web/20260201071400/https://www.apax.com/news-views/kkr-to-acquire-healthium-from-apax-funds/", "anchor": "/long-view/6-private-equity-hospitals-india/#e-2024-kkr-to-acquire-healthium-from", "specimen": false }, { "title": "Trends in the financialisation of outpatient care", "kind": "report", "kindLabel": "Reporting", "group": "Reporting", "date": "2024-11-07", "datePrecision": "day", "added": "2026-10-01", "note": "A survey of 20 OECD countries on investors buying clinics, laboratories, dental and eye practices. Half of 20 countries saw the trend as high or moderate. In France the share of laboratories owned by financial investors rose from 16% in 2010 to 78% in 2022. Only two of 20 countries could add up who owns their health practices. The evidence on what this does to quality, cost and access, it says, is scarce and mostly American.", "citation": null, "held": null, "figure": null, "authors": [ "OECD Health Committee" ], "photographers": [], "publication": "OECD Directorate for Employment, Labour and Social Affairs", "excerpt": "In many cases, policymakers are flying blind when it comes to understanding the potential impacts of financialisation in their health systems. Across 20 surveyed countries, only two reported that data on healthcare practice ownership is collected and can be aggregated nationally.", "url": "https://p4h.world/app/uploads/2025/01/trends-financialisation-outpatient-care_dec-2024.x23411.pdf", "archiveUrl": null, "anchor": "/long-view/6-private-equity-hospitals-india/#e-2024-trends-in-the-financialisation-of", "specimen": false }, { "title": "Aster DM and Blackstone-backed Quality Care to merge: Investor Presentation", "kind": "report", "kindLabel": "Investor presentation", "group": "Reporting", "date": "2024-11-29", "datePrecision": "day", "added": "2026-10-01", "note": "How a private equity owner can stay in after a stock-market listing. Blackstone merges Quality Care into the listed Aster DM Healthcare, and with Aster’s founders jointly controls the merged company. The deck prices the two hospital businesses at 36.6 and 25.2 times a year’s operating profit.", "citation": null, "held": null, "figure": null, "authors": [ "Aster DM Healthcare Limited" ], "photographers": [], "publication": "Investor Presentation", "excerpt": "Aster promoters, along with Blackstone, will hold equal representation on the board and jointly control the Merged Entity. Independent directors to have a 50% representation on the board of the Merged Entity", "url": "https://www.bseindia.com/xml-data/corpfiling/AttachHis/4c409a4d-d70f-4d17-b8eb-521f80192a0a.pdf", "archiveUrl": "https://web.archive.org/web/20251207012808/https://www.bseindia.com/xml-data/corpfiling/AttachHis/4c409a4d-d70f-4d17-b8eb-521f80192a0a.pdf", "anchor": "/long-view/6-private-equity-hospitals-india/#e-2024-aster-dm-and-blackstone-backed", "specimen": false }, { "title": "Fortis Healthcare: disclosure on acquiring shares of Agilus Diagnostics from IFC", "kind": "report", "kindLabel": "Stock exchange filing", "group": "Reporting", "date": "2024-12-20", "datePrecision": "day", "added": "2026-10-01", "note": "How investors left one of India’s largest diagnostic chains. Agilus ran 407 laboratories. Fortis Healthcare, of which Agilus is a subsidiary, agreed to buy 31.52% from its financial investors: the International Finance Corporation, the NYLIM Jacob Ballas India Fund and Resurgence PE Investments. This filing records the first tranche, IFC’s 7.61%, at ₹719.2 a share.", "citation": null, "held": null, "figure": null, "authors": [ "Fortis Healthcare Limited" ], "photographers": [], "publication": "Disclosure under Regulation 30 of SEBI (Listing Obligations & Disclosure Requirements) Regulations 2015", "excerpt": "the Company on December 20, 2024 at 07:18 PM (IST) has acquired 5,970,149 equity shares as held by International Finance Corporation (“IFC”) (representing 7.61% equity stake) in Agilus Diagnostics Limited (a material subsidiary of the Company) from IFC.", "url": "https://nsearchives.nseindia.com/corporate/FORTIS_20122024203907_FHLSEintimationlatestsd.pdf", "archiveUrl": "https://web.archive.org/web/20261001163716/https://nsearchives.nseindia.com/corporate/FORTIS_20122024203907_FHLSEintimationlatestsd.pdf", "anchor": "/long-view/6-private-equity-hospitals-india/#e-2024-fortis-healthcare-disclosure-on-acquiring", "specimen": false }, { "title": "Dr. Agarwal’s Health Care Limited: Abridged Prospectus", "kind": "report", "kindLabel": "Prospectus", "group": "Reporting", "date": "2025-01-01", "datePrecision": "month", "added": "2026-10-01", "note": "The eye-hospital chain’s summary for investors before its 2025 share sale, in which its investors sold part of their holdings. It shows how fast the chain grew: 209 facilities by September 2024 and about 25% of the market for eye-care chains. Up to 35% of the money raised was set aside for general purposes and acquisitions not yet identified. In every period it reports, about three in five rupees of revenue came from patients paying cash rather than through insurance.", "citation": null, "held": null, "figure": null, "authors": [ "Dr. Agarwal’s Health Care Limited" ], "photographers": [], "publication": "Abridged Prospectus", "excerpt": "Market Share: According to the CRISIL MI&A Report, we had a market share of approximately 25% of the total eye care service chain market in India during the Financial Year 2024.", "url": "https://investmentbank.kotak.com/downloads/agarwals-healthcare-limited-abridged-prospectus.pdf", "archiveUrl": "https://web.archive.org/web/20261001163402/https://investmentbank.kotak.com/kib-cms/sites/default/files/offer-documets/agarwals-healthcare-limited-abridged-prospectus_20250617_033837.pdf", "anchor": "/long-view/6-private-equity-hospitals-india/#e-2025-dr-agarwals-health-care-limited", "specimen": false }, { "title": "Profits Over Patients: The Harmful Effects of Private Equity on the U.S. Health Care System", "kind": "report", "kindLabel": "Reporting", "group": "Reporting", "date": "2025-01-01", "datePrecision": "month", "added": "2026-10-01", "note": "An American Senate committee’s bipartisan staff report of two private equity hospital owners, based in part on more than a million pages of documents. At Prospect Medical, the fund Leonard Green took $424 million of $645 million paid out in dividends and preferred stock redemptions and left the company in severe financial distress. It also summarises the research: in the first three years, private equity hospitals showed lower quality, fewer staff and higher prices.", "citation": null, "held": null, "figure": null, "authors": [ "Senate Budget Committee" ], "photographers": [], "publication": "United States Senate Committee on the Budget, bipartisan staff report", "excerpt": "Recent peer-reviewed studies have generally found negative consequences for general acute care hospitals during the first three years of PE ownership as compared to non-PE-owned hospitals, including lower quality of care, increased transfers to other hospitals, decreased staffing, and higher prices.", "url": "https://web.archive.org/web/20250108115957/https://www.budget.senate.gov/imo/media/doc/profits_over_patients_the_harmful_effects_of_private_equity_on_the_ushealthcaresystem1.pdf", "archiveUrl": "https://web.archive.org/web/20261001164105/https://www.budget.senate.gov/imo/media/doc/profits_over_patients_the_harmful_effects_of_private_equity_on_the_ushealthcaresystem1.pdf", "anchor": "/long-view/6-private-equity-hospitals-india/#e-2025-profits-over-patients-the-harmful", "specimen": false }, { "title": "Private Equity in the Hospital Industry", "kind": "research", "kindLabel": "Research paper", "group": "Entry", "date": "2025-01-01", "datePrecision": "year", "added": "2026-10-01", "note": "A study that found private equity did American hospitals no clear harm, in its May 2025 version. Comparing hospitals bought by private equity with similar ones bought by others, the authors find the targets survived as often, and cut jobs, mostly administrative ones, and wages. Using insurance claims, they find no significant change in inpatient prices or in patients, and no rise in deaths or readmissions, though patient satisfaction fell.", "citation": "Working Paper N° 787/2021", "held": null, "figure": null, "authors": [ "Janet Gao", "Yong Seok Kim", "Merih Sevilir" ], "photographers": [], "publication": "ECGI Working Paper Series in Finance", "excerpt": "Using proprietary insurance claims data, we find no significant changes in patient demographics or inpatient prices at PE-acquired hospitals. While patient satisfaction declines, there is no evidence of increased patient mortality or readmission rates at PE-acquired hospitals.", "url": "https://www.ecgi.global/sites/default/files/2026-09/fin-787-2021_private_equity_in_the_hospital_industry_0.pdf", "archiveUrl": "https://web.archive.org/web/20261001164043/https://www.ecgi.global/sites/default/files/2026-09/fin-787-2021_private_equity_in_the_hospital_industry_0.pdf", "anchor": "/long-view/6-private-equity-hospitals-india/#e-2025-private-equity-in-the-hospital", "specimen": false }, { "title": "Vitals for growth: Decoding healthcare financing and funding in India", "kind": "report", "kindLabel": "Reporting", "group": "Reporting", "date": "2025-01-01", "datePrecision": "year", "added": "2026-10-01", "note": "A summary of a report by Grant Thornton Bharat with the Association of Healthcare Providers India. It counts the money: 594 deals worth more than US$30 billion in healthcare and pharmaceuticals from 2022 to 2024, mergers, acquisitions and private equity deals together, with hospitals taking about 40% of the value. It also tells hospital owners what investors expect: returns of 20 to 30% a year on equity and prices of 20 to 30 times operating profit.", "citation": null, "held": null, "figure": null, "authors": [ "Grant Thornton Bharat" ], "photographers": [], "publication": "Grant Thornton Bharat", "excerpt": "Between 2022 and 2024, healthcare and pharma recorded 594 major deals worth over USD 30 billion, with hospitals accounting for 40% of total deal value, signaling strong investor confidence. Investors are valuing hospitals at 20x to 30x EBITDA, with higher valuations for those improving operational efficiencies, expanding specialised services, and achieving strong patient volume growth.", "url": "https://www.grantthornton.in/insights/thought-leadership/vitals-for-growth-decoding-healthcare-financing-and-funding-in-india/", "archiveUrl": "https://web.archive.org/web/20261001163211/https://www.grantthornton.in/insights/thought-leadership/vitals-for-growth-decoding-healthcare-financing-and-funding-in-india/", "anchor": "/long-view/6-private-equity-hospitals-india/#e-2025-vitals-for-growth-decoding-healthcare", "specimen": false }, { "title": "Private Equity and Venture Capital Trendbook 2025", "kind": "data", "kindLabel": "Data", "group": "Data", "date": "2025-02-01", "datePrecision": "month", "added": "2026-10-01", "note": "The yearly tally of private equity and venture deals by the accounting firm EY and the industry association IVCA, from VCCEdge deal data. It shows 2023 as the peak for India’s life sciences, US$6.2 billion across 79 deals, and 2024 down 31%. In 2024 hospitals and clinics took 39% of healthcare investment. This record charts the healthcare line from this and the other editions.", "citation": null, "held": null, "figure": { "value": "39%", "unit": "of private equity and venture investment in Indian healthcare went to hospitals and clinics, 2024", "source": "EY–IVCA Trendbook 2025", "verify": false }, "authors": [ "EY" ], "photographers": [], "publication": "EY and IVCA", "excerpt": "Healthcare investments were primarily directed towards hospitals, clinics and medical devices, which collectively accounted for 76% of overall investments (39% by hospitals / clinics and 38% by medical devices), whereas formulations accounted for 89% of pharmaceuticals investments.", "url": "https://www.ey.com/content/dam/ey-unified-site/ey-com/en-in/insights/private-equity/documents/ey-private-equity-and-venture-capital-trendbook-2025-v1.pdf", "archiveUrl": "https://web.archive.org/web/20251109110649/https://www.ey.com/content/dam/ey-unified-site/ey-com/en-in/insights/private-equity/documents/ey-private-equity-and-venture-capital-trendbook-2025-v1.pdf", "anchor": "/long-view/6-private-equity-hospitals-india/#e-2025-private-equity-and-venture-capital", "specimen": false }, { "title": "Private hospitals to add ~10,000 beds over this fiscal and next", "kind": "report", "kindLabel": "Press release", "group": "Reporting", "date": "2025-02-01", "datePrecision": "month", "added": "2026-10-01", "note": "A credit rating agency’s view of why money flows to private hospitals, from its study of 91 of them. Revenue grew about 18% a year from 2019–20 to 2023–24 with healthy profit margins, and India has few beds for its population. That combination, it says, drew ₹55,000 to 60,000 crore from private equity and share sales since 2021–22, which in turn paid for new beds.", "citation": null, "held": null, "figure": null, "authors": [ "Crisil Ratings" ], "photographers": [], "publication": "Crisil Ratings", "excerpt": "Their strong performance and the relatively low bed capacity per person in India vis-a-vis developed and developing nations has spurred substantial investments through private equity and initial public offerings (IPOs). This has strengthened balance sheets and enabled hospitals to pursue ambitious bed additions without materially impacting their credit profiles.", "url": "https://www.crisilratings.com/en/home/newsroom/press-releases/2025/02/private-hospitals-to-add-10000-beds-over-this-fiscal-and-next.html", "archiveUrl": "https://web.archive.org/web/20250405035513/https://www.crisilratings.com/en/home/newsroom/press-releases/2025/02/private-hospitals-to-add-10000-beds-over-this-fiscal-and-next.html", "anchor": "/long-view/6-private-equity-hospitals-india/#e-2025-private-hospitals-to-add-10000", "specimen": false }, { "title": "CVC agrees the sale of up to 54% stake in Healthcare Global Enterprises for up to US$400m", "kind": "report", "kindLabel": "Press release", "group": "Reporting", "date": "2025-02-24", "datePrecision": "day", "added": "2026-10-01", "note": "Another handover from one fund to the next. CVC, which took control of HCG, a cancer hospital chain founded in 1989, in 2020, sells up to 54% to KKR at ₹445 a share. HCG then had 25 centres in 19 cities and 2,500 beds. CVC lists what its ownership did: a transformational value creation program to raise revenue, improve key performance indicators and buy other hospitals. The founder becomes non-executive chairman.", "citation": null, "held": null, "figure": null, "authors": [ "CVC" ], "photographers": [], "publication": "CVC", "excerpt": "Since CVC Asia V invested in 2020, CVC’s India team have worked closely with HCG on a transformational value creation program to drive revenue growth through and beyond COVID, improve key performance indicators, source and execute acquisitions and digital transformation, whilst ensuring continuous improvement in patient care and clinical outcomes.", "url": "https://cvc.com/media/news/2025/cvc-agrees-the-sale-of-up-to-54-stake-in-healthcare-global-enterprises-for-up-to-us-400m", "archiveUrl": null, "anchor": "/long-view/6-private-equity-hospitals-india/#e-2025-cvc-agrees-the-sale-of", "specimen": false }, { "title": "Financialisation and the Reshaping of Private Healthcare: A Case Study in India", "kind": "research", "kindLabel": "Research paper", "group": "Entry", "date": "2025-05-01", "datePrecision": "month", "added": "2026-10-01", "note": "A study of how private equity works inside Indian hospitals, from interviews in Maharashtra that include private equity investors themselves. They describe a cycle of three to seven years: grow the chain fast, often by buying smaller hospitals in debt, then sell to the next investor at a higher value. One investor said almost every corporate chain had taken private equity money. The study is qualitative. It measures no prices or patient outcomes, and does not claim to.", "citation": "https://doi.org/10.1111/1467-9566.70041", "held": null, "figure": null, "authors": [ "Benjamin M. Hunter", "Indira Chakravarthi", "Shweta Marathe", "Susan F. Murray" ], "photographers": [], "publication": "Sociology of Health & Illness, volume 47", "excerpt": "Typically, there will be a 3–7‐year investment cycle during which the number of facilities in a chain can be increased, with potential for a doubling or tripling of the number of facilities. With this, equity can be sold to new investors at a substantially increased value.", "url": "https://doi.org/10.1111/1467-9566.70041", "archiveUrl": null, "anchor": "/long-view/6-private-equity-hospitals-india/#e-2025-financialisation-and-the-reshaping-of", "specimen": false }, { "title": "Ontario Teachers’ announces sale of Sahyadri Hospitals", "kind": "report", "kindLabel": "Press release", "group": "Reporting", "date": "2025-07-09", "datePrecision": "day", "added": "2026-10-01", "note": "Three years after acquiring a majority of Sahyadri, Ontario Teachers’ Pension Plan agrees to sell its stake to Manipal Hospitals, which is backed by Temasek. By then the chain had 11 hospitals and more than 1,400 beds in Pune, Nashik, Ahilyanagar and Karad, grown by building and by buying. An Ontario Teachers’ director describes the partnership as focused on unlocking long-term value. The sale awaited regulatory approval.", "citation": null, "held": null, "figure": null, "authors": [ "Ontario Teachers’ Pension Plan" ], "photographers": [], "publication": "Ontario Teachers’ Pension Plan", "excerpt": "Ontario Teachers’ acquired a majority stake in Sahyadri in 2022 and, since then, has supported its growth into one of India’s leading regional healthcare platforms. Today, Sahyadri is one of Maharashtra’s largest hospital chains, with 11 hospitals and over 1,400 beds, delivering best-in-class healthcare to millions across the region.", "url": "https://www.otpp.com/en-ca/about-us/news-and-insights/2025/ontario-teachers-announces-sale-of-sahyadri-hospitals/", "archiveUrl": "https://web.archive.org/web/20261001162813/https://www.otpp.com/en-ca/about-us/news-and-insights/2025/ontario-teachers-announces-sale-of-sahyadri-hospitals/", "anchor": "/long-view/6-private-equity-hospitals-india/#e-2025-ontario-teachers-announces-sale-of", "specimen": false }, { "title": "Indira IVF Hospital Limited: Rating reaffirmed and assigned for enhanced amount", "kind": "report", "kindLabel": "Rating", "group": "Reporting", "date": "2025-09-24", "datePrecision": "day", "added": "2026-10-01", "note": "In 2025 a rating agency’s note shows where Indira IVF’s growth came from; the chain had grown to 186 centres by July 2025. IVF cycles barely moved, 42,622 against 42,484, but revenue rose 8.7% because the average price per cycle went up to about ₹3.7 lakh from ₹3.5 lakh. When a 2021 law raised the cost of donors, the company passed the increase on to patients. Its operating margin was 33.4%. The ₹1,150 crore borrowed to buy out earlier shareholders was moved onto the company’s own books.", "citation": null, "held": null, "figure": null, "authors": [ "ICRA" ], "photographers": [], "publication": "ICRA rating rationale", "excerpt": "While the number of IVF cycles stagnated in FY2025 at 42,622 compared to 42,484 in FY2024 (a YoY growth of 0.3%), the company’s revenue rose by 8.7% to 1,604.5 crore in FY2025, majorly supported by improvement in realisation per cycle to around Rs. 3.7 lakh in FY2025 from Rs. 3.5 lakh in FY2024 (a YoY growth of 7.2%).", "url": "https://www.icra.in/Rating/GetRationalReportFilePdf?id=137938", "archiveUrl": "https://web.archive.org/web/20261001163350/https://www.icra.in/Rating/GetRationalReportFilePdf?id=137938", "anchor": "/long-view/6-private-equity-hospitals-india/#e-2025-indira-ivf-hospital-limited-rating", "specimen": false }, { "title": "Nephrocare Health Services Limited: Basis of Allotment", "kind": "report", "kindLabel": "Prospectus notice", "group": "Reporting", "date": "2025-12-16", "datePrecision": "day", "added": "2026-10-01", "note": "NephroPlus, a dialysis chain, was due to start trading on the stock exchanges on or about 17 December 2025; its promoters include Investcorp private equity funds and Bessemer Venture Partners. In September 2025 it ran 519 dialysis clinics, 180 of them under public-private partnership contracts with government agencies. Its own list of risks gives its staff turnover: the share of its nephrologists and duty doctors who left in a year was 61.23% and 53.05% in the two years before the listing.", "citation": null, "held": null, "figure": null, "authors": [ "Nephrocare Health Services Limited" ], "photographers": [], "publication": "Public announcement filed with NSE", "excerpt": "Further the attrition rate of our nephrologists, including doctors, physicians on duty and medical directors, was 27.68%, 53.05%, 61.23% and 29.39% in the six months period ended September 30, 2025 and Fiscals 2025, 2024 and 2023, respectively.", "url": "https://nsearchives.nseindia.com/corporate/ADV_INE428V01029_16DEC2025.pdf", "archiveUrl": null, "anchor": "/long-view/6-private-equity-hospitals-india/#e-2025-nephrocare-health-services-limited-basis", "specimen": false }, { "title": "National Family Health Survey (NFHS-6), 2023-24: India and State/UT Fact Sheets", "kind": "data", "kindLabel": "Data", "group": "Data", "date": "2026-01-01", "datePrecision": "year", "added": "2026-10-02", "note": "The sixth national family health survey, which reached 679,238 households. Households with someone covered by a health insurance or financing scheme rose to 60.2% from 41.0% in the round before, 2019–21. Births in private health facilities were far more often by caesarean section: 54.1%, against 16.9% in public facilities, both up from 47.4% and 14.3%. The fact sheets sort facilities only as public or private.", "citation": null, "held": null, "figure": { "value": "60.2%", "unit": "of households had a member covered by a health insurance or financing scheme, 2023-24 (41.0% in 2019-21)", "source": "NFHS-6 India fact sheet, indicator 7", "verify": false }, "authors": [ "International Institute for Population Sciences" ], "photographers": [], "publication": "National Family Health Survey (NFHS-6)", "excerpt": "The National Family Health Survey 2023–24 (NFHS-6), the sixth in the NFHS series, provides information on population, health, and nutrition for India and each State/Union Territory (UT) except Manipur.", "url": "https://www.nfhsiips.in/nfhsuser/assets/National%20Family%20Health%20Survey%20(NFHS-6)%202023-2024%20Fact%20Sheets.pdf", "archiveUrl": "https://web.archive.org/web/20260925073541/https://www.nfhsiips.in/nfhsuser/assets/National%20Family%20Health%20Survey%20(NFHS-6)%202023-2024%20Fact%20Sheets.pdf", "anchor": "/long-view/6-private-equity-hospitals-india/#e-2026-national-family-health-survey-nfhs", "specimen": false }, { "title": "Healthy occupancy, rising realisations to drive 14-15% growth in private hospitals", "kind": "report", "kindLabel": "Press release", "group": "Reporting", "date": "2026-02-01", "datePrecision": "month", "added": "2026-10-01", "note": "Where hospital earnings grow, according to a study of 98 private hospitals with nearly two-thirds of the sector’s revenue. Revenue per occupied bed, the average a hospital earns from a bed each day, is set to rise 5 to 7%, as the mix shifts to complex treatments in cardiology, oncology and the like and more patients come with insurance. Large chains spent about ₹11,000 crore buying 4,300 beds in three years, paying about 2.2 times what building them would cost.", "citation": null, "held": null, "figure": null, "authors": [ "Crisil Ratings" ], "photographers": [], "publication": "Crisil Ratings", "excerpt": "Alongside this shift in expansion strategy, large private hospital players have undertaken acquisitions worth ~Rs 11,000 crore over fiscal 2024-2026, adding ~4,300 beds. This implies a ~2.2 times valuation premium3 paid for acquiring operational assets upfront.", "url": "https://www.crisilratings.com/en/home/newsroom/press-releases/2026/02/healthy-occupancy-rising-realisations-to-drive-14-15-percent-growth-in-private-hospitals.html", "archiveUrl": null, "anchor": "/long-view/6-private-equity-hospitals-india/#e-2026-healthy-occupancy-rising-realisations-to", "specimen": false }, { "title": "Indian Hospital Sector: Private sector investments driving capacity growth; outlay of Rs. 40,000 crore seen over FY2026 to FY2030 towards 34,000+ bed additions", "kind": "report", "kindLabel": "Research summary", "group": "Reporting", "date": "2026-02-01", "datePrecision": "month", "added": "2026-10-01", "note": "A useful check on scale. Private hospitals hold 59 to 60% of India’s hospital beds, ICRA says, because public spending on health is only 3 to 3.5% of GDP. Its 18 large chains plan more than 34,000 new beds by 2030, half again what they have, yet that adds only 2.3 to 2.5% to all private beds. Against all private beds, even the biggest chains’ plans are small.", "citation": null, "held": null, "figure": null, "authors": [ "ICRA" ], "photographers": [], "publication": "ICRA research", "excerpt": "Cumulatively, ICRA’s sample set of 18 large hospital chains is expected to add over 34,000 beds during FY2026–FY2030, translating to a cumulative 48-50% addition over their existing capacity as on March 31, 2025. However, this translates to about a 2.3-2.5% addition to the existing total private hospital bed capacity in India.", "url": "https://www.icra.in/Rating/DownloadResearchSummaryReport?id=6779", "archiveUrl": "https://web.archive.org/web/20261001163106/https://www.icra.in/Rating/DownloadResearchSummaryReport?id=6779", "anchor": "/long-view/6-private-equity-hospitals-india/#e-2026-indian-hospital-sector-private-sector", "specimen": false }, { "title": "Quality Care India Limited: Rating assigned and Placed on Rating Watch with Positive Implications", "kind": "report", "kindLabel": "Rating", "group": "Reporting", "date": "2026-03-16", "datePrecision": "day", "added": "2026-10-01", "note": "A credit rating agency’s report on Quality Care India, the Blackstone-controlled company that runs CARE Hospitals and KIMS Health, and its plain account of where the money comes from. Occupancy rose to 64% from 59%, revenue per occupied bed grew 5 to 6% a year, and the operating margin climbed to 20.2%, which ICRA credits partly to a better case mix and revised tariffs. Some new beds and stake purchases are funded with debt. Among the risks it lists: restrictive government pricing of treatments and medicines.", "citation": null, "held": null, "figure": null, "authors": [ "ICRA" ], "photographers": [], "publication": "ICRA rating rationale", "excerpt": "In October 2023, Blackstone Inc. acquired majority stake of 71.8% in the company. Subsequently, QCIL acquired majority stake in Kims Healthcare Management Limited (KHML /KIMS Health) and STS Holdings Limited and STS Hospital Chittagong Limited (Evercare hospitals) in October 2023, which led to bed addition of around 1,800. These acquisitions were largely funded through equity infusion from Blackstone Inc and TPG Rise Fund (TPG).", "url": "https://www.icra.in/Rating/GetRationalReportFilePdf?id=141615", "archiveUrl": "https://web.archive.org/web/20261001162732/https://www.icra.in/Rating/GetRationalReportFilePdf?id=141615", "anchor": "/long-view/6-private-equity-hospitals-india/#e-2026-quality-care-india-limited-rating", "specimen": false }, { "title": "Manipal Health Enterprises Limited: Draft Abridged Prospectus", "kind": "report", "kindLabel": "Prospectus", "group": "Reporting", "date": "2026-03-23", "datePrecision": "day", "added": "2026-10-01", "note": "The summary of Manipal’s draft prospectus of 23 March 2026, for its proposed share sale to the public. It describes the largest pan-India multi-specialty network by beds: 48 hospitals and 12,367 licensed beds in 14 states and union territories in September 2025. Its promoters include three Singapore companies beside Ranjan Pai and the Manipal group. Imperius Healthcare Investments, a promoter, had paid ₹68.73 a share on average, and TPG’s company ₹265.23.", "citation": null, "held": null, "figure": null, "authors": [ "Manipal Health Enterprises Limited" ], "photographers": [], "publication": "Draft Abridged Prospectus", "excerpt": "We are the largest pan-India multispecialty hospital network by bed capacity as of September 30, 2025 (Source: CRISIL Report). We focus on tertiary and quaternary care, particularly cardiac sciences, oncology, neurosciences, gastro sciences, orthopedics, and renal sciences", "url": "https://investmentbank.kotak.com//kib-cms/sites/default/files/offer-documets/Manipal%20Health%20Enterprises%20Ltd%20Draft%20Abridged%20Prospectus.pdf", "archiveUrl": "https://web.archive.org/web/20261001162718/https://investmentbank.kotak.com//kib-cms/sites/default/files/offer-documets/Manipal%20Health%20Enterprises%20Ltd%20Draft%20Abridged%20Prospectus.pdf", "anchor": "/long-view/6-private-equity-hospitals-india/#e-2026-manipal-health-enterprises-limited-draft", "specimen": false }, { "title": "National Health Accounts Estimates for India 2022-23", "kind": "data", "kindLabel": "Data", "group": "Data", "date": "2026-05-01", "datePrecision": "month", "added": "2026-10-01", "note": "The government’s count of who pays for health care in India. In 2022–23 households paid 43.41% of all health spending out of their own pockets, ₹3,82,629 crore. Private health insurance paid 9.19%. Of the money spent on care, 30.83% went to private hospitals, close to twice the 16.73% spent in government hospitals. Households’ out-of-pocket spending was 49.90% of current health spending.", "citation": null, "held": null, "figure": { "value": "43.41%", "unit": "of India’s health spending paid by households out of pocket, 2022-23", "source": "National Health Accounts Estimates for India 2022-23", "verify": false }, "authors": [ "National Health Accounts Technical Secretariat, National Health Systems Resource Centre" ], "photographers": [], "publication": "Ministry of Health & Family Welfare", "excerpt": "Households’ Out-of-pocket expenditure on health (OOPE) is Rs 3,82,629 crores (43.41% of THE, 1.47% of GDP3, Rs 2,767 per capita). Private Health Insurance expenditure is Rs 81,012 crores (9.19% of THE).", "url": "https://nhsrcindia.org/sites/default/files/2026-05/NHA%202022-23%20Report.pdf", "archiveUrl": null, "anchor": "/long-view/6-private-equity-hospitals-india/#e-2026-national-health-accounts-estimates-for", "specimen": false }, { "title": "Private Equity’s Growing Presence in Health Care—Promise or Peril?: A Healthy Dialogue With Sneha Kannan", "kind": "report", "kindLabel": "Podcast", "group": "Reporting", "date": "2026-06-03", "datePrecision": "day", "added": "2026-10-02", "note": "JAMA’s summary of a podcast in which Derek Angus talks to Sneha Kannan, a critical care physician at the University of Pittsburgh. It puts private equity’s share at almost 10% of American hospitals, and calls the research mixed and often troubling: staffing cuts, price rises, worries over quality and falling satisfaction, with a few neutral results. It explains the split of a hospital into a property company and an operating company, and notes that funds sell within three to ten years. JAMA says GPT-4.1 drafted the text, which Angus reviewed.", "citation": "doi:10.1001/jama.2026.8432", "held": null, "figure": null, "authors": [ "Derek C. Angus", "Matthew B. O’Connor" ], "photographers": [], "publication": "JAMA", "excerpt": "Although PE promises new management strategies and potential operational improvements, current research paints a mixed and often troubling picture. Peer-reviewed studies have identified several key trends, including staffing cuts, price hikes, quality concerns, and declining patient and caregiver satisfaction.", "url": "https://jamanetwork.com/journals/jama/fullarticle/2849854", "archiveUrl": null, "anchor": "/long-view/6-private-equity-hospitals-india/#e-2026-private-equitys-growing-presence-in", "specimen": false }, { "title": "Financialization of Healthcare sector in India: Emerging Trends in Private Investment and Profits in Healthcare services", "kind": "research", "kindLabel": "Research paper", "group": "Entry", "date": "2026-06-24", "datePrecision": "day", "added": "2026-10-01", "note": "An Indian count of the money, from deal records and the accounts of 274 corporate hospitals between 2000 and 2024. From April 2020 to March 2024, 38 private equity and venture deals put US$5,378.65 million into hospitals, and the average deal was four times the size of those before Covid. Fifteen big hospital companies took 56.3% of the profits. The authors read profits outpacing sales as possible signs of market power, while noting another explanation: a shift to costlier treatments.", "citation": null, "held": null, "figure": null, "authors": [ "Satyaki Roy", "Sonia Sebastian", "Indranil Mukhopadhyay" ], "photographers": [], "publication": "O.P. Jindal Global University working paper", "excerpt": "Growth of profit can be higher than the growth of sales if the companies are able to increase their mark-ups due to monopoly power in the market or being more focussed to high valued services that fetch higher returns.", "url": "https://doi.org/10.54945/preserve.75", "archiveUrl": "https://web.archive.org/web/20261001163835/https://preserve.jgu.edu.in/index.php/preserve/preprint/view/75/version/82", "anchor": "/long-view/6-private-equity-hospitals-india/#e-2026-financialization-of-healthcare-sector-in", "specimen": false }, { "title": "Who owns your hospitals? Private equity’s growing grip on Kerala’s healthcare", "kind": "report", "kindLabel": "Reporting", "group": "Reporting", "date": "2026-07-04", "datePrecision": "day", "added": "2026-10-02", "note": "Kerala, where 65 to 70% of people rely on private hospitals, has become a favourite of private equity, with more than ₹20,000 crore reportedly invested in five years. The report opens with Chazhikattu Hospital in Thodupuzha, run by one family for 91 years and bought in October 2024 by Baby Memorial Hospital of Kozhikode, months after KKR took control of Baby Memorial. It sets this against Kerala’s health spending: households there spend ₹8,388 a year on health, three times the Indian average of ₹2,767. Only the opening is free to read.", "citation": null, "held": null, "figure": null, "authors": [ "Jisha Surya" ], "photographers": [], "publication": "Newslaundry", "excerpt": "BMH acquired Chazhikattu for an undisclosed amount in October 2024, just months after the US-based private equity firm Kohlberg Kravis Roberts & Co (KKR) acquired a controlling stake in BMH. Chazhikattu, now rebranded as Baby Memorial Hospital, serves as one of BMH’s satellite hospitals, with a focus on orthopedic surgery.", "url": "https://www.newslaundry.com/2026/07/04/who-owns-your-hospitals-private-equitys-growing-grip-on-keralas-healthcare", "archiveUrl": "https://web.archive.org/web/20260709134308/https://www.newslaundry.com/2026/07/04/who-owns-your-hospitals-private-equitys-growing-grip-on-keralas-healthcare", "anchor": "/long-view/6-private-equity-hospitals-india/#e-2026-who-owns-your-hospitals-private", "specimen": false }, { "title": "Aster DM Quality Care Limited: Earnings Presentation Q1 FY27", "kind": "report", "kindLabel": "Investor presentation", "group": "Reporting", "date": "2026-08-05", "datePrecision": "day", "added": "2026-10-01", "note": "The merged company’s results presentation records that the merger of Aster DM Healthcare and Blackstone’s Quality Care took effect on 1 July 2026. It gives the combined chain’s size as 10,898 capacity beds and calls it one of the top three hospital chains in India, strongest in the south and centre of the country.", "citation": null, "held": null, "figure": null, "authors": [ "Aster DM Quality Care Limited" ], "photographers": [], "publication": "Earnings Presentation Q1 FY27", "excerpt": "Merger became effective on July 1, 2026 forming Aster DM Quality Care Limited", "url": "https://nsearchives.nseindia.com/corporate/ASTERDM2_05082026173402_Investor_Presentation_Intimation_-_Final-s.pdf", "archiveUrl": "https://web.archive.org/web/20261001163636/https://nsearchives.nseindia.com/corporate/ASTERDM2_05082026173402_Investor_Presentation_Intimation_-_Final-s.pdf", "anchor": "/long-view/6-private-equity-hospitals-india/#e-2026-aster-dm-quality-care-limited", "specimen": false }, { "title": "How India's private hospitals are expanding in different forms", "kind": "report", "kindLabel": "Reporting", "group": "Reporting", "date": "2026-08-17", "datePrecision": "day", "added": "2026-10-01", "note": "A full account of the boom as it stood in August 2026. Manipal had just opened its ₹9,275 crore share sale, and its shares opened 11% above the issue price. Chains are adding beds and buying regional rivals, insurance is bringing in patients, and investors have paid for much of it. The article lists the funds behind at least nine changes of ownership since 2021, and sets the boom against medical inflation of 12 to 14% a year. Evidence of better clinical care, it notes, remains limited.", "citation": null, "held": null, "figure": null, "authors": [ "Neetu Chandra Sharma" ], "photographers": [], "publication": "Business Today", "excerpt": "Since 2021, at least nine major deals involving Temasek, Blackstone, KKR, General Atlantic, Ontario Teachers’ Pension Plan and Barings have changed the ownership of prominent hospital chains, including Manipal Hospitals, CARE Hospitals, KIMSHEALTH, Sahyadri Hospitals, HealthCare Global (HCG), Ujala Cygnus, Indira IVF and Medicover Hospitals India.", "url": "https://www.businesstoday.in/magazine/cover-story/story/how-indias-private-hospitals-are-expanding-in-different-forms-549606-2026-08-17", "archiveUrl": null, "anchor": "/long-view/6-private-equity-hospitals-india/#e-2026-how-indias-private-hospitals-are", "specimen": false }, { "title": "Healthcare, bought and sold", "kind": "report", "kindLabel": "Book review", "group": "Reporting", "date": "2026-08-24", "datePrecision": "day", "added": "2026-10-02", "note": "Abantika Ghosh, a journalist who has written her own book on hospital costs, reviews Ameer Shahul’s The Silent Syndicate: How Big Finance Is Destroying India’s Healthcare (Hachette India). Shahul traces how funds such as Blackstone, KKR, Carlyle and Temasek came to own Indian hospitals, pharmacies and laboratories, and how measures such as EBITDA and revenue per occupied bed displaced patient outcomes in the way these businesses are run. Ghosh praises the money trail but finds the effects on patients more implied than shown, except in the chapters on insurance and patents.", "citation": null, "held": null, "figure": null, "authors": [ "Abantika Ghosh" ], "photographers": [], "publication": "Frontline", "excerpt": "While the book is a stunning piece of investigative and economic journalism, tracing the “money trail” with unerring, unstinted accuracy, the implications for patients are more implied than stated, except in the last two sections, on insurance and patent policies, where stories of real patients lend a human face to the narrative.", "url": "https://frontline.thehindu.com/books/silent-syndicate-ameer-shahul-private-equity-healthcare-india/article71340692.ece/amp/", "archiveUrl": "https://web.archive.org/web/20261002005006/https://frontline.thehindu.com/books/silent-syndicate-ameer-shahul-private-equity-healthcare-india/article71340692.ece/amp/", "anchor": "/long-view/6-private-equity-hospitals-india/#e-2026-healthcare-bought-and-sold", "specimen": false }, { "title": "A quiet gap: why private equity in primary care remains under-researched in the global south, and why that matters", "kind": "research", "kindLabel": "Opinion", "group": "Entry", "date": "2026-09-30", "datePrecision": "day", "added": "2026-10-01", "note": "This opinion piece from University College London describes a gap in research. Of about 232 articles on private equity in health care indexed by the medical database PubMed since 2000, 84% are about the United States and only three are about the Global South, none of them about India. The authors argue that governments paying private equity-owned providers should ask about ownership, debt and exit, not only services and volumes.", "citation": "doi: 10.3389/fpubh.2026.1953760", "held": null, "figure": null, "authors": [ "Marc Kitten", "Chiara Berardi" ], "photographers": [], "publication": "Frontiers in Public Health, volume 14", "excerpt": "Of approximately 232 articles on PE in health care indexed in PubMed since 2000, 84% concern the United States, 7% Europe, and only 3 address Global South settings", "url": "https://doi.org/10.3389/fpubh.2026.1953760", "archiveUrl": null, "anchor": "/long-view/6-private-equity-hospitals-india/#e-2026-a-quiet-gap-why-private", "specimen": false } ], "related": [ 4 ] }