Every revision of “Where things stand”

In July 2026 Manipal, India’s largest private hospital network by beds, opened its ₹9,275 crore share sale 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.

Since 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 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 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.

The 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.

The 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. 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.

The 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, NITI Aayog told investors in 2021. In 2022-23 households paid 43.41% of all health spending out of their own pockets. 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.

Crisil 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, their yearly operating profit, and expect returns of 20 to 30% a year.

The 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 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.

A fund must sell. Investors interviewed by Benjamin Hunter and colleagues in Maharashtra described a cycle of three to seven years: 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.

What 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 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.

Debt 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, 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.

On 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 where the state pays for most care.

India 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; 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 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.

Research 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 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.॥