The Global Wealth Chains of Private‐Equity‐Run Physician Practices

Abstract

Currently, numerous physician practices in industrial and emerging countries are being taken over by private equity firms and integrated into novel physician corporations. This involves private equity firms producing a global wealth chain (GWC) between their investors and the target asset, using offshore financial centres to facilitate tax-avoiding reflux of capital. Moreover, they are opening up ambulatory health care as an asset for capital investment by overcoming previous market barriers to ambulatory health care via a legal construct. In this paper, we trace the spatial links of these finance-side and sector-specific corporate chains based on a capital flow analysis of private equity takeovers of Medical Care Centres (MCCs) in Bavaria, Germany. With our heuristics of a double-layered GWC, which enables the extraction of value from the German health system, we contribute to the emerging GWC debate that aims to conceptualise the complex and often opaque spatialisations of financialisation processes.

Evaluating trends in private equity ownership and impacts on health outcomes, costs, and quality: systematic review

“…During this stage, 26 further studies were excluded, leaving 55 studies in the final sample (fig 1). Of these studies, 32 evaluated the impacts of PE ownership on at least one category of health outcomes, costs to patients or payers, costs to operators, or quality, or a combination of these factors,2236373839404142434445464748495051525354555657585960616263646566 (table 1, table 2, and table 3) and 38 reported trends or prevalence of PE among healthcare operators (see supplementary material 3) 2136383940414245495355606163646567686970717273747576777879808182838485868788. Fifteen studies in total reported findings for both impacts and trends 36383940414245495355606163…”

“…The included studies spanned eight countries, with most (n=47) evaluating PE ownership of healthcare operators solely in the US 2122363739404142434445464748495051525354555657586062636566686970717275767778798081828384868788. Other regions that were analyzed independently included Sweden (n=2),5961 the UK, Turkey, the Netherlands, Canada, and Germany (n=1 each) 3864677385. One study compared developments across Canada, Norway, Sweden, the UK, and the US 74.…”

“…In total, studies assessed 16 different medical settings: nursing homes2237384047484950565758596061646774 were the most commonly studied settings (n=17) followed by hospital414243444552535573 and dermatology394662777883848865 settings (n=9 each); ophthalmology62657281828688 (n=7); urology54668088 (n=4); gastroenterology626588 and orthopedics697988 (n=3 each); surgical centers,6368 fertility,3671 and obstetrics and gynecology7188 (n=2 each); and anesthesia,51 hospice care,70 oral or maxillofacial surgery,75 otolaryngology,87 and plastics76 (n=1 each). Five studies considered multiple specialties or general physician groups 2162658588. Among nursing home studies, 14 included nursing homes specifically2237384047484950565758596074 and three included either residential or long term care homes, which tend to provide more daily living and social support 61...…”

“… 21 22 36 37 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 60 62 63 65 66 68 69 70 71 72 75 76 77 78 79 80 81 82 83 84 86 87 88 Other regions that were analyzed independently included Sweden (n=2), 59 61 the UK, Turkey, the Netherlands, Canada, and Germany (n=1 each). 38 64 67 73 85 One study compared developments across Canada, Norway, Sweden, the UK, and the US. 74 In total, studies assessed 16 different medical settings: nursing homes 22 37 38 40 47 48 49 50 56 57 58 59 60 61 64 67 74 were the most commonly studied settings (n=17) followed by hospital 41 42 …”

Vom Aussterben bedroht? – Eine Demografie der Nuklearmedizin in Deutschland 1996–2021 anhand der Zahlen der Bundesärztekammer

“…Von diesen Veränderungen werden die ambulanten Versorgungsstrukturen in Praxen und Medizinischen Versorgungszentren (MVZ) zuerst betroffen sein, die sich derzeit durch Zentralisierungen und zunehmende Investorentätigkeit [24] sowieso in einer Umbruchphase befinden. Der Nachwuchsmangel kann hier zumindest in der Nuklearmedizin ein potenzieller Katalysator sein.…”