Journal of gastrointestinal oncology · 2026
Private equity acquisitions of hospitals and the changing landscape of care for patients with gastrointestinal cancer.
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Worku Eshetu, Rashid Zayed, Khalil Mujtaba, Woldesenbet Selamawit, Pawlik Timothy M
Аннотация
BACKGROUND: The growing presence of private equity (PE) in the United States (U.S.) healthcare raises concern about access, costs, care quality, and outcomes. This study explores the specific impact of PE-owned hospitals on gastrointestinal (GI) cancer care.
METHODS: Patients undergoing GI cancer surgery were identified from the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database (2012-2020). Propensity score matching compared PE and non-PE hospitals. Difference-in-difference and multivariable models evaluated GI surgical outcomes, adjusting for patient and hospital-level characteristics.
RESULTS: Among 1,887 GI cancer patients (hepatopancreatic: n=127, 6.7%; colorectal: n=1,760, 93.3%), the majority were male (n=1,030, 54.6%), White (n=1,526, 80.9%), with early-stage disease (stage I/II: n=1,009, 54%) and a median age of 75 [interquartile range (IQR), 70-82] years. Surgeries at PE-owned hospitals comprised 31.7% (n=599). Compared to non-PE hospitals, patients treated at PE-owned centers were more often Black (18.7% vs. 12.1%), socioeconomically vulnerable (48.4% vs. 36.1%), and had early-stage cancer (57.1% vs. 52.5%) (P<0.05). PE ownership correlated with reduced clinical staffing (physicians: -19; nurses: -43), fewer Medicaid patients (-194), and lower surgical costs (-$341) (all P<0.05). Hospital-acquired infections rose post-acquisition (30.4% to 43.7%, P=0.02), while non-PE hospitals maintained lower rates (11.2% to 19.6%, P<0.001). The risk of perioperative-complications [risk ratio (RR) =0.80; 95% confidence interval (CI): 0.54-1.20], hospital-acquired infections (RR =0.77; 95% CI: 0.37-1.63), and 90-day-mortality (RR =1.27; 95% CI: 0.60-2.66) were comparable at PE-acquired versus non-acquired hospitals.
CONCLUSIONS: PE hospital acquisitions reduce staffing, limit Medicaid patient's access, and increase infection risks-underlining the need to protect equity and quality in GI cancer care.
METHODS: Patients undergoing GI cancer surgery were identified from the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database (2012-2020). Propensity score matching compared PE and non-PE hospitals. Difference-in-difference and multivariable models evaluated GI surgical outcomes, adjusting for patient and hospital-level characteristics.
RESULTS: Among 1,887 GI cancer patients (hepatopancreatic: n=127, 6.7%; colorectal: n=1,760, 93.3%), the majority were male (n=1,030, 54.6%), White (n=1,526, 80.9%), with early-stage disease (stage I/II: n=1,009, 54%) and a median age of 75 [interquartile range (IQR), 70-82] years. Surgeries at PE-owned hospitals comprised 31.7% (n=599). Compared to non-PE hospitals, patients treated at PE-owned centers were more often Black (18.7% vs. 12.1%), socioeconomically vulnerable (48.4% vs. 36.1%), and had early-stage cancer (57.1% vs. 52.5%) (P<0.05). PE ownership correlated with reduced clinical staffing (physicians: -19; nurses: -43), fewer Medicaid patients (-194), and lower surgical costs (-$341) (all P<0.05). Hospital-acquired infections rose post-acquisition (30.4% to 43.7%, P=0.02), while non-PE hospitals maintained lower rates (11.2% to 19.6%, P<0.001). The risk of perioperative-complications [risk ratio (RR) =0.80; 95% confidence interval (CI): 0.54-1.20], hospital-acquired infections (RR =0.77; 95% CI: 0.37-1.63), and 90-day-mortality (RR =1.27; 95% CI: 0.60-2.66) were comparable at PE-acquired versus non-acquired hospitals.
CONCLUSIONS: PE hospital acquisitions reduce staffing, limit Medicaid patient's access, and increase infection risks-underlining the need to protect equity and quality in GI cancer care.