How Private Equity Is Eroding Public Access To Hospitals And Emergency Care

For more than two decades I have worked in emergency departments across Chicago. I have watched what happens when a community loses its hospital: ambulances travel farther, waiting rooms overflow, and patients arrive sicker because timely care was not available. What surprised me was seeing this occur not because a neighborhood could not support a hospital, but because investors found the hospital's assets more valuable when stripped or repurposed than when used to provide care.

Closures in Chicago and Beyond

In March 2026, West Suburban Medical Center in Oak Park, Ill., became the third hospital in Chicago's safety net to close abruptly. Weiss Memorial Hospital closed unexpectedly in 2025, and Westlake Hospital in Melrose Park shut in 2019. All three were at one time owned by Pipeline Health, a private‑equity‑backed chain that acquired them in 2019.

This is not only a Chicago story. About 447 hospitals nationwide are currently owned by private equity, and roughly 25 percent of those serve rural communities. While private‑equity‑backed firms generate roughly 7 percent of U.S. GDP, they accounted for 21 percent of U.S. health care bankruptcies in 2024, including seven of the eight largest health care bankruptcies that year.

Evidence of Harm

Multiple investigations and peer‑reviewed studies link private‑equity ownership with worse clinical and financial outcomes. A bipartisan U.S. Senate Budget Committee review of more than a million internal documents concluded that private‑equity firms "extracted huge profits from hospitals, while increasing their debt and allowing patient care and safety to decline," and found that this strategy directly precipitated some closures.

A 2023 study in JAMA reported a 25 percent increase in preventable adverse events after private‑equity acquisition, including a 38 percent rise in central‑line bloodstream infections and a doubling of surgical‑site infections. A subsequent study in the Annals of Internal Medicine linked private‑equity ownership to staffing reductions and a related 13 percent increase in emergency‑room deaths. Research published in July 2024 found that hospital assets dropped an average of 24 percent in the two years after acquisition—about $28 million per hospital in buildings, equipment and infrastructure that effectively disappeared.

Why Safety‑Net Hospitals Are Vulnerable

Safety‑net hospitals disproportionately serve low‑income, publicly insured and racially and ethnically diverse patients. According to America's Essential Hospitals, roughly 75 percent of these patients are uninsured or covered by Medicaid or Medicare. These institutions often provide the only local high‑acuity services for their communities and handle about twice as many emergency visits on average.

Because they care for large volumes of low‑reimbursing patients, many safety‑net hospitals depend on targeted public financing to offset uncompensated care. That mission‑driven model yields thin margins and heavy reliance on public payers—conditions that make these hospitals attractive targets for leveraged buyouts, sale‑leasebacks and other transactions that prioritize short‑term returns over sustained clinical operations.

Policy Responses And The Road Ahead

These outcomes are not inevitable; they stem from specific financing models and business incentives. Lawmakers in 25 states, including Illinois, have introduced at least 79 bills addressing private‑equity ownership of medical facilities, and several states have enacted reforms aimed at greater oversight.

At the same time, federal Medicaid restructuring passed in 2025 is projected to reduce federal Medicaid spending by roughly $1 trillion over the next decade, with provisions beginning to affect Illinois in January 2027. Because safety‑net hospitals serve the highest shares of Medicaid patients, they are likely to absorb much of that reduction—raising urgent questions about the viability of remaining hospitals and local emergency access.

What’s At Stake

Safety‑net hospitals are not distressed assets waiting to be flipped. They are often the difference between a stroke recognized in time and one that is not, between a gunshot wound stabilized quickly and one that is not, and between a neighborhood that can rely on local care and one that must endure long, time‑sensitive transports.

Private‑equity groups promise efficiency and turnaround. As a physician and health‑care advocate committed to equitable care, I continue to ask: efficient for whom?

Heather Prendergast, MD is a professor of emergency medicine, attending physician and vice dean of clinical affairs at the University of Illinois College of Medicine, and a Public Voices Fellow of the OpEd Project at the University of Illinois.