Private Equity Owns 130 Rural Hospitals Raising Access Concerns. It’s Coming For More

Private equity firms as of 2023 owned at least 130 rural hospitals, raising concerns about access and quality.

Private equity’s rapid acquisition of rural healthcare providers between 2019 and 2023, encompassing 65% of physician-practice purchases, signals a structural shift with profound implications. This trend jeopardizes healthcare access, inflates costs, and threatens community stability in vulnerable rural areas.

These firms extract value aggressively, charging an average of $669 more per patient without improving care quality. Since 2005, 197 rural hospitals have closed or converted, with 418 more considered vulnerable. Studies published in 2023 and 2026 link private equity ownership to a 25% rise in hospital-acquired conditions and increased postoperative mortality. Additionally, private equity controls nearly a quarter of emergency department visits and 64% of Medicare helicopter air-ambulance services; meanwhile, since 2020, 139 rural labor-and-delivery units have closed. The bankruptcy of Steward Health Care in 2024 after $1.3 billion was extracted highlights the financial risks involved. Policymakers, including Indiana with its 2025 HB 1666 legislation, are beginning to implement oversight measures to curb these impacts.

Looking ahead, public officials are urged to require full disclosure of hospital debt, scrutinize acquisition deals, and track staffing, pricing, and patient outcomes more closely.

Although Montana is not mentioned in the article, its rural communities might face similar risks if private equity ownership expands there. Montana’s geographic and economic challenges could potentially amplify vulnerabilities in healthcare access, highlighting the importance of oversight to protect rural lifelines.

Commentary: Private Equity is Coming for America’s Rural Hospitals
By Niel Ritchie, The Daily Yonder