Three passengers suspected of having hantavirus were evacuated from the MV Hondius cruise ship on Wednesday and transported to hospitals in the Netherlands, as Swiss authorities also confirmed a new case of the rare virus linked to the same vessel.
The three evacuated passengers include German, Dutch, and British nationals, with the British individual being a crew member.
Cruise operator Oceanwide Expeditions said that a medical aircraft carrying two of the patients landed in the Netherlands, while a second aircraft transporting the third patient experienced a delay; that passenger remained in stable condition, according to The Guardian.
Swiss health authorities announced that a man who had been aboard the MV Hondius and returned home at the end of April tested positive for the Andes strain of hantavirus after seeking medical attention in Zurich. The WHO confirmed this as a third confirmed case. Swiss officials stated there was “currently no risk to the Swiss public.”
The total number of suspected or confirmed cases has climbed to at least nine, including three deaths. Among the dead are a Dutch husband and wife, the man died aboard the ship on Apr. 11, while his wife passed away at a hospital near Johannesburg, South Africa, on Apr. 26, and a German passenger who died on board on May 2. A British passenger remains in critical but stable condition in intensive care in Johannesburg, as per CBS News.
The Andes strain, identified in multiple cases from the ship, is primarily found in Argentina and Chile and is the only known hantavirus strain capable of human-to-human transmission, though such transmission is considered rare and typically requires very close contact.
The MV Hondius departed from Ushuaia, Argentina, on Apr. 1 for a polar expedition cruise that included stops in Antarctica, the Falkland Islands, Saint Helena, and Ascension Island.
Spain’s Health Minister Monica Garcia confirmed on Wednesday that the ship would dock at the port of Granadilla in Tenerife, in the Canary Islands, within three days.
This decision was made despite pushback from local Canary Islands officials, who raised concerns about insufficient communication and the proximity of the port to local residents. Upon arrival, symptomatic passengers will be placed in quarantine, while asymptomatic passengers will be allowed to return to their home countries.
With no approved vaccine or specific treatment for hantavirus, doctors are relying on early supportive care and intensive care unit management to improve survival rates, according to the World Health Organization.
Hospital supply chains haven’t been the same since the upheaval of 2020. Indeed, the issues faced by all healthcare organizations have become increasingly complex and persistent.
For example, consider reports of problems regarding the shipping of critical medical devices and drugs. A recent survey showed that 71% of healthcare leaders deal with constant order delays — that’s unacceptable to providers and patients. In addition, more than half of those leaders said their organizations had issues related to sourcing materials (revealing underlying issues at Tier I and Tier II supplier levels).
Inconsistent and difficult-to-source supplies aren’t the only procurement struggles faced by modern hospitals, of course. Other concerns include maintaining cost efficiency and keeping talent from leaving. However, all of the problems can be mitigated in some way by bringing smart, innovative technology tools and platforms into the mix.
Making Healthcare Supply Chains Healthier
Technology has already enhanced other areas of hospital operations, and with great success.
For instance, artificial intelligence (AI) has shown promise in identifying diseases through the interpretation of patient pictures. Likewise, AI-powered apps have improved the patient experience.
Consequently, bringing smarter solutions into medical supply chains makes sense. It also helps strengthen the hospital’s relationship with its surrounding community via several avenues.
1. It makes tracking of vendors more efficient and reliable.
The bigger a hospital’s supply chain becomes, the more opportunities exist for human error, outdated information, and inefficiencies. According to Nectar iQ, a leading provider of supplier management tracking technology, most modern healthcare entities work with 1,300+ vendors. In that type of ecosystem, the cost of even one error could be extraordinary.
By setting up an AI-based centralized system with clear dashboards, hospitals can manage all their vendors in one location. This allows teams to not just gather accurate data and run reports on demand, but to reduce the need to look elsewhere for insights.
Ideally, vendors can have access to some areas of the centralized system, giving them more ownership over the data they submit. Once vendor management is stabilized, hospital leaders and staff can have more confidence that they’re able to keep tabs on all their suppliers. And this helps strengthen the hospital-supplier relationship, which 74% of respondents told healthcare association AHRMM they wanted to do.
2. It standardizes onboarding among all vendors.
Standardized onboarding is another advantage of investing in smart supply chain management tools in hospital settings. If all vendors go through the same onboarding procedures — including training modules when applicable — they will all be working from the same playbook.
Unfortunately, many organizations have no systematic onboarding expectations when they bring on new vendors. This can end up being a problem for smaller vendors who might get less time, and therefore less information. It can also mean that some vendors receive incorrect information or may not fully understand their company’s supply chain role.
While it can take time to onboard every vendor systematically, the time pays for itself in the end. Plus, routine onboarding that’s handled through a centralized repository will hold historic data that can be used for auditing purposes later.
3. It makes sure vendors are aligned with the hospital’s community goals.
Many hospitals maintain specific community visions. By constructing smart, centralized database systems, they can identify which vendors support and complement those visions — and, perhaps just as importantly, know vendors fall short.
Hospitals can also gather self-reported data from both Tier I and Tier II suppliers to determine if those suppliers align with the healthcare organization’s goals. If not, the hospital can talk with the suppliers to encourage more alignment. Or, the hospital can replace vendors that aren’t a good community match.
Along these same lines, hospitals can gain visibility into the ESG metrics of their supplier population. These ESG metrics can then be leveraged to support the hospital’s own mission. But none of this is possible if hospitals don’t move past using spreadsheets — and far too many are holding onto Excel as a major organizational tool — and put trust in AI solutions.
4. It reduces the chances of major compliance mistakes.
All healthcare organizations must follow stringent regulations. Otherwise, they risk losing ground both financially and reputation-wise. In fact, HIPAA violations alone can be truly expensive for any healthcare facility.
A smart supply chain means greater oversight into what each vendor is doing. And greater oversight translates into reduced compliance risk. At the same time, the more oversight the hospital has, the faster any gaps or anomalies can be found and corrected.
Compliance is a must for a hospital and its vendors. The more compliant a healthcare entity is, the more protected its patient population (and community) will be.
5. It enhances a healthcare system’s inherent resilience.
Disruptions can and will happen, including in sophisticated healthcare systems. However, being able to know early about vendor PPE shortages, transportation issues, or other disruptions ensures that hospital personnel can make informed decisions based on accurate data faster.
Without a doubt, flexibility is a huge operational and public relations asset for healthcare entities. Everyone knew during the pandemic which hospitals were more adaptable than others.
Remember: Supply chain management extends beyond a hospital’s walls and filters into the community. The hospital that can pivot fastest will often be seen as more of a leader than the hospital that’s taken by surprise when a supplier can’t fulfill orders as intended.
Hospitals can’t continue to maintain their supply chains in the same ways that worked just a decade ago. By experimenting with smart supplier management software that can be tailored to (and trained on) their needs, hospital leaders can drive more successful relationships with all the stakeholders they serve.
Modern healthcare is about more than diagnostics and treatment plans. It is also about how patients feel during their time in care. Stress and discomfort can slow recovery, increase perceived pain, and make hospital visits harder than they need to be. A growing body of research shows that the physical and sensory environment plays a meaningful role in patient wellbeing. From lighting and room layout to staff communication and sound, hospitals that focus on creating calming, human centered spaces often see improvements in comfort, trust and cooperation.
A calming environment does not replace clinical excellence. Instead, it supports it. When patients feel safe and at ease, they communicate more clearly, follow medical guidance more willingly, and experience less emotional strain throughout their stay. Here is how hospitals can use environment based strategies to support better patient outcomes.
Why Patient Comfort Matters in Healthcare
Stress is a normal response to medical uncertainty. Heart rate rises, breathing becomes shallow, and pain sensitivity can increase. In healthcare settings, these psychological responses may affect recovery, adherence to care plans, and overall satisfaction. Improving comfort is not only compassionate but clinically relevant.
Studies have shown that soothing environments can reduce blood pressure, shorten perceived wait times, and help patients feel more in control of their experience. A calm space signals safety. When patients sense that their surroundings are organized and caring, they often relax more naturally. This relaxation supports both physical and emotional recovery.
Patient comfort also affects families and caregivers. Waiting rooms are often the first point of contact and can set the tone for the entire visit. A stressful environment can heighten worry, while a thoughtful space encourages clarity, patience and resilience.
Light as a Foundation for Calm
Good lighting is fundamental in hospitals. Natural light supports circadian rhythms, improves mood, and may contribute to faster recovery times. Windows that let sunlight into patient rooms can reduce feelings of confinement and lift morale.
However, lighting quality matters just as much as quantity. Harsh fluorescent fixtures can contribute to anxiety, headaches, and fatigue. Warmer tones create a more welcoming ambiance without compromising visibility. Adjustable lighting allows patients to control brightness during rest, procedures or nighttime recovery. Dimmer controls, bedside lamps and soft corridor lighting all help reduce overstimulation.
Color also plays a role. Neutral palettes blended with calming tones like soft greens, muted blues or warm beige can reduce visual stress. Visual clutter can overwhelm the senses, so keeping spaces clean and uncluttered supports mental clarity.
Layout and Spatial Design that Reduces Overwhelm
Hospitals are often fast moving environments filled with equipment, signage and foot traffic. A well structured layout helps patients navigate without confusion. Clear pathways and intuitive wayfinding reduce the cognitive load associated with finding departments, rooms or services. Less confusion means less anxiety.
In patient rooms, layout should focus on comfort and accessibility. Space for personal belongings, comfortable seating for family, and unobstructed movement paths help people feel more settled. Small details like a place to charge phones, a surface for water or snacks, and shelves for personal items tell patients that their everyday needs matter.
Privacy also influences emotional comfort. Curtains, acoustic barriers and thoughtful placement of beds can protect dignity and reduce exposure during care. When people feel that their personal space is respected, trust in the environment strengthens.
Waiting Rooms as Emotional Entry Points
The waiting room experience shapes perception long before treatment begins. Clinical efficiency is essential, but emotional comfort is equally valuable. Patients often wait during moments of uncertainty. A space that feels calm can reduce anticipatory stress.
Comfortable seating, access to water, gentle lighting and thoughtful layout help make waiting time easier. Access to nature even through digital screens or artwork can reduce anxiety. Research shows that imagery of trees, oceans or landscapes often has a soothing effect on the nervous system.
Providing options also matters. Some patients prefer quiet areas while others relax better with light activity or gentle conversation. Offering zones for privacy and zones for social waiting supports different needs and personalities.
Clear communication reduces stress as well. Knowing how long the wait is likely to be, who will assist next, and what steps come afterward gives patients a sense of predictability. Predictability reduces fear of the unknown.
Staff Communication as an Environment of Its Own
Design does not begin and end with physical materials. Human interaction shapes atmosphere too. Warm, patient forward communication can make clinical procedures feel more manageable.
Tone, pace and clarity matter. Introducing oneself before touching a patient, explaining what will happen next, and checking in on comfort levels builds connection. When staff maintain open listening and avoid rushed or dismissive language, patients often feel more secure.
Small gestures go a long way such as explaining where to place belongings, offering a blanket if a room feels cold, or simply asking if the patient needs a moment. These practices reinforce safety and dignity.
The Role of Sound in Patient Wellbeing
Hospitals are filled with noise. Alarms, rolling carts, ventilation systems and conversations all contribute to sensory overload. Continuous noise can make it difficult to rest or think clearly, which may slow emotional recovery.
Managing sound is an essential part of creating calm. Acoustic panels, soft furnishings, and door dampening reduce harsh echoes. Encouraging quiet hallways at night supports better sleep which is linked to healing quality.
Background sound also influences how patients feel. Gentle audio can mask stressful noises and create a more soothing atmosphere. Many hospitals use soft instrumental music in waiting rooms, corridors or recovery areas to help ease tension. A curated approach makes a difference. Playing music intentionally rather than passively ensures the tone fits the moment whether that means peaceful melodies for imaging areas or uplifting tracks for rehabilitation rooms.
Some facilities use licensed audio programs so they can schedule music for different parts of the day. This allows control over tempo, volume and genre without leaving staff to manage playlists manually. When used thoughtfully, background music for hospitals supports emotional regulation and promotes a sense of calm.
A Calm Hospital Environment Is a Therapeutic Tool
Comfort is not decoration. It is a component of healthcare. When lighting is softer, layout intuitive, sound controlled and communication compassionate, patients are more likely to feel grounded. Emotional ease helps the body relax. Relaxation helps recovery.
These strategies do not require major renovation to begin. Small improvements such as dimmable lighting, clearer signage, quieter corridors or curated music in waiting areas can shift the experience quickly. Over time, hospitals that continue to refine their sensory environments often see improved satisfaction and more positive emotional responses.
Patient centered design is an ongoing practice. It adapts to new research, feedback and technology. The aim is steady progress toward spaces that feel safe to enter, supportive to recover in, and reassuring to return to if needed.
Hospitals can heal, and environments can help. When the physical space respects human comfort, patients are better able to focus on what matters most: getting well with dignity, calm and trust in the care around them.
New guidelines implemented under an executive order by President Donald Trump now allow VA hospital staff to refuse healthcare to veterans based on political affiliation and marital status, prompting concerns that Democratic and unmarried veterans may be denied treatment.
On January 30, Trump signed an executive order titled “Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government.” While its primary aim was to curtail federal protections for transgender individuals, the order also triggered sweeping changes within the Department of Veterans Affairs (VA), according to the Guardian.
The VA, which serves over 9 million veterans across more than 170 hospitals and 1,000 clinics, revised its internal bylaws to strip longstanding protections against discrimination based on political party, marital status, sexual orientation and national origin.
The updated policies allow doctors, psychologists, dentists and other healthcare workers at VA hospitals to refuse treatment to veterans based on characteristics not explicitly protected by federal law. While veterans are still legally entitled to care, there is now no rule preventing staff from declining service to individuals based on their political beliefs or whether they are unmarried.
Internal documents reviewed by the outlet confirm that the changes are already in effect at some VA centers. The VA’s press secretary confirmed the revisions were made to align with Trump’s executive order but did not clarify what federal law required such shifts.
The new rules have drawn sharp criticism from medical experts and ethics professionals. Dr. Kenneth Kizer, the VA’s top health official, warned the policy could allow providers to deny care to patients based on rape allegations, political activity or substance use. Dr. Arthur Caplan of NYU’s Grossman School of Medicine called the changes “unethical” and “an effort to exert political control over the VA medical staff.”
Home / News / Private equity’s appetite for hospitals may put patients at risk
Illustration: Traci Daberko
In the wake of the Steward Health Care crisis, corporate and private equity ownership of health care has come under new scrutiny. Here, Harvard health policy experts weigh in on the growing corporatization of the U.S. health care system and what it means for patients, practitioners, and public health.
Throughout 2024, eye-opening news headlines from around the country trained a spotlight on the collapse of Steward Health Care:
As Steward hospitals teeter, CEO’s $40 million yacht is docked in the Galapagos Islands
Sick patients collapsed waiting for care in overwhelmed Steward hospital’s emergency department
Steward Health Care files for Chapter 11 bankruptcy
Steward owned more than 30 hospitals across Arizona, Arkansas, Florida, Louisiana, Massachusetts, Ohio, Pennsylvania, and Texas. Its volatility and eventual crash jeopardized access to health care for millions of patients.
How did Steward, at one point the largest private for-profit health system in the U.S., go belly up?
The long and short: In 2010, private equity firm Cerberus Capital Management purchased Caritas Christi Health Care, a struggling eastern Massachusetts hospital system, from the Archdiocese of Boston, converting it from non-profit to for-profit and rebranding it as Steward Health Care. In 2016, after years of continued financial instability, Steward signed a sale-leaseback agreement with Medical Properties Trust (MPT), selling the land and buildings occupied by its hospitals to the real estate investment trust then leasing them back. Steward made $1.25 billion from the agreement—enough to steady its financial footing, pay off Cerberus, and fund a growth spree. The next year, the company purchased 26 more hospitals across the country. But with the agreement came what many viewed as inflated rents.
By 2020, Cerberus, having made $800 million in profit on its initial investment, decided to sell Steward hospitals to a group of its physicians, essentially transferring ownership back to Steward’s management team, led by CEO Ralph de la Torre. Over the next several years, concerns about patient care and safety at Steward hospitals mounted as the company opted to cut costs and neglect bills in order to keep up with its rent payments to MPT. In January 2024, MPT announced that Steward was $50 million behind on those payments. By May, the company filed for bankruptcy. Financial documents made clear that the company had paid hundreds of millions to investors and leadership, including de la Torre, who enjoyed a lavish lifestyle while patients at Steward hospitals faced increasingly unsafe conditions. De la Torre was subpoenaed by Congress in July; he failed to appear.
After months of tense negotiations between state governments, Steward, MPT, and potential buyers, by November, most Steward hospitals had found new owners, a mix of non- and for-profit hospital systems and private equity firms. But two hospitals didn’t survive: Carney Hospital, which served Boston’s low-income, majority Black and Hispanic southern neighborhoods, and Nashoba Valley Medical Center, which served 17 suburban and rural communities across central Massachusetts. Thousands of patients and hundreds of staff have been left to find health care and jobs with new providers farther away.
The Steward meltdown has captured the attention of the public and policymakers not as an outlier, but as an object lesson. Its story shines a light on the growing role of private equity in the U.S. health system, helps explain rising discontent among patients and clinicians, and lays bare the dangers of prioritizing profits over people in health care.
A ‘core contradiction’
John McDonough, professor of the practice of public health at Harvard Chan School, calls private equity “the sharp end of capitalism.”
“It’s otherwise often described as ‘capitalism on steroids,’” McDonough said. “It’s for-profit business in its most aggressive form. [Private equity firms] seek returns on their investment as high as possible as quickly as possible, then rush to sell off that investment and go on to their next conquest.”
After decades establishing a presence everywhere from manufacturing, to telecommunications, to grocery stores, in the mid 2000s private equity firms began targeting health care. It was a natural next step: The industry is worth nearly $5 trillion in the U.S., offering significant, dependable cash flow. Firms saw the potential for profits and began buying up physician practices and health facilities, from hospitals to nursing homes to fertility clinics, looking to at least double their initial investment and then sell within a short time, often three to seven years.
Private equity’s foothold in health care has continued to grow. In 2021, according to researchers at UC Berkeley, 5,779 physician practices, specializing in everything from primary care to oncology, were owned by private equity firms—up from 816 in 2012. Nonprofit watchdog the Private Equity Stakeholder Project (PESP) reported that, as of February 2024, nearly 460 U.S. hospitals were owned by private equity firms. These hospitals—which include non-specialty acute care hospitals, rehabilitation hospitals, psychiatric facilities, and long-term acute care facilities—represent 8% of all private (not owned by the government) hospitals and 22% of for-profit hospitals.
5,779
physician practices were owned by private equity in 2021—up from 816 in 2012
22%
of for-profit hospitals—460 in total—are currently owned by private equity
80%
of physicians are employed by a hospital system or corporation—up from 60% in 2019
But ownership by private equity is just the latest version of capitalism’s creep into health care. Its way was paved by corporations entering the industry in the 1980s as an era of free market fundamentalism emerged and the “maximizing shareholder value” movement began to boom. Publicly traded companies began buying up hospitals and health facilities, as well as physicians and physician practices, to establish their own health systems. Today, nearly a quarter of U.S. hospitals are run by for-profit entities that promise to bring business smarts and a flow of capital to health care delivery.
“The pitch is that corporations can raise capital and invest in improving the business—quality of care, operations, professional management—in a way non-profits can’t,” said Meredith Rosenthal, C. Boyden Gray Professor of Health Economics and Policy. “But the challenge is that because health care is so important, the public expects these corporations to prioritize public interest over profits. And that’s not what they’re built to do.”
Because health care is so important, the public expects corporations to prioritize public interest over profits. And that’s not what they’re built to do.
Meredith Rosenthal, C. Boyden Gray Professor of Health Economics and Policy
“Medical care has always had a for-profit element. Physicians were mostly small businesspeople,” McDonough said. “But there’s a difference between a sole proprietor or small business and a mega-corporation that believes its only purpose in the world is return on equity to shareholders. Hold that belief up against a medical provider’s belief that patients come first, and right away there’s conflict. It’s this core contradiction that I think American society has never sufficiently grappled with.”
Non-profits like profits, too
It’s not just corporate health care providers producing this dilemma. Non-profits, which remain the majority of U.S. hospitals and health care facilities, sometimes prioritize profits over their social missions—and community benefit requirement cementing their tax-exempt status—in order to grow, and even just survive, in a tight economy and increasingly competitive health care market.
“Economists have studied whether non-profits behave differently than for-profits. Do they provide more charity care [free or discounted medical services for poor patients]? Do they invest more in community well-being? The answer generally has been no,” Rosenthal said.
One study, conducted in 2020 by Joseph Bruch, PhD ‘21 and David Bellamy, PhD ’23, indeed found no significant difference between what non-profit and for-profit hospitals spend on charity care as a percent of their total expenses.
“It’s getting harder and harder to tell the difference between a non-profit and for-profit board of directors,” McDonough said. “It’s this for-profit ethos that has swarmed and swamped the U.S. medical space. Many people think the system can prioritize patients and profits at the same time and that it will be okay. But then we look at calamities like Steward, and we think to ourselves, maybe it can’t. And maybe it won’t be okay.”
Consequences of cost-cutting
For Steward patients, it wasn’t okay. Reports of poor-quality care and compromised patient safety ran the gamut: from understaffed emergency rooms and ill-equipped maternity wards, to stairwells infested with bats, to cancelled surgeries and suspended trash service due to unpaid invoices. These extreme examples represent what a growing body of research suggests: Health care quality declines when private equity and its extreme for-profit approach take over.
A 2023 study found that Medicare patients at private equity-owned hospitals suffered a 25% increase in hospital-acquired complications compared to Medicare patients at hospitals not owned by private equity. These complications included a 38% increase in bloodstream infections from central lines—longer-term, surgically inserted ports through which patients can intravenously receive fluids, medications, and blood—despite 16% fewer central lines placed. Similarly, the rate of surgical site infections doubled at private equity-owned hospitals while those at the control hospitals decreased. And while falls at hospitals not owned by private equity have been trending downward—a product of a nationwide, decades-long hospital safety movement—falls at private equity-owned hospitals have remained steady, amounting to a 27% relative increase.
“We believe [these findings are] largely explained by staffing cuts,” said the study’s senior author Zirui Song, PhD ’12, associate professor at Harvard Medical School and Massachusetts General Hospital. “The unique financial pressures private equity-owned hospitals face, such as new debt placed on them from the acquisition and expectations of profitability in the short run, may lead to cutting the costs of delivering care—such as through reducing staffing. But while you may be able to substitute people with machines in other industries, health care remains human-labor intensive, especially inpatient care. Cutting staff can have salient consequences for quality of care and patient outcomes.”
Another study by Song and colleagues found that private equity-owned hospitals earned 27% more income after acquisition than hospitals not owned by private equity. That financial gain was fueled by increasing charges—the asking prices for hospital services—by between 7% and 16%, depending on the department, as well as by issuing more charges per day and seeing fewer patients enrolled in Medicare, which provides lower reimbursements than commercial insurers.
A “Save Our Hospital” sign is displayed outside the former Nashoba Valley Medical Center, which was part of the bankrupt Steward Health Care company and closed on Aug. 31, 2024. (Charles Krupa / AP Photo)
Exacerbating disparities
What type of hospitals does private equity tend to target?
New evidence from Song and colleagues suggests that firms typically set their sights on financially healthier—rather than struggling—hospitals, compared to similar peer hospitals that were not acquired. That’s because private equity firms tend to place new debt onto acquired hospitals, and those on stronger financial footing are better able to take on that debt.
There are examples, however, of hospitals serving mostly uninsured or publicly insured patients being taken over by private equity firms. These takeovers may exacerbate health disparities, as many of these disadvantaged patients belong to racial or ethnic minorities and already suffer worse health outcomes, said Song. When discontinuation of hospital services—or total closure—occurs, it has an outsize impact in communities where access to health care is already limited. Carney Hospital is one such example; in an op-ed, Harvard Chan School’s Alecia McGregor, assistant professor of health policy and politics, called its closure “a matter of life and death” that threatens to deepen Boston’s already extreme racial disparities in health.
“I don’t think there is enough evidence to definitively say that private equity targets hospitals that mostly serve people of color. But in some cases, these financially vulnerable facilities may fit their business model,” McGregor said. “And when private equity backed acquisitions lead to closures, this is when marginalized communities often hurt the most. Take Hahnemann University Hospital, for instance—a historic facility serving mostly low-income Black and Hispanic Philadelphians that was closed by its private equity owner after less than two years. Many viewed the closure as a maneuver for the hospital’s prime city real estate.”
PESP also reports that a quarter of private equity-owned hospitals serve rural populations, whose health care alternatives are sparse if they’re unsatisfied with quality or costs and whose outcomes are jeopardized if the only hospital in town closes. Since Nashoba Valley Medical Center was closed, first responders travel around 15 miles to transport patients to emergency care, according to a local fire chief. They used to travel three.
Policy potential
“Theoretically, there could be benefits to private equity investments in health care. They could provide facilities and clinicians with an infusion of capital, but also with managerial know-how and business acumen that might improve health care, such as through making care more ‘efficient,’” Song said. “Unfortunately, however, the current evidence base does not support that. Rather, evidence seems to suggest that by cutting the human labor and other inputs that make care delivery possible—also seen in private equity acquisitions of physician practices and nursing homes—the care might just become less safe.”
Song published a series of policyrecommendations for officials looking to reduce corporate influence, specifically that of private equity, over health care delivery and outcomes. His recommendations for state policy included reviving or enforcing corporate practice of medicine laws, which, in their aim to protect physicians as independent practitioners, can go as far as prohibiting corporations from hiring physicians or influencing medical decisions. His recommendations for federal policy included:
Strengthening fraud and abuse protections
Improving Federal Trade Commission staffing and bandwidth, in order to improve oversight over health care acquisitions and mergers
Discouraging risk-taking behavior by corporate owners (sometimes referred to as moral hazard), through measures like legally affiliating private equity firms with their rolled-up set of acquired entities, limiting the percent debt a firm can use to make an acquisition, and reforming the tax benefit that allows private equity proceeds to be taxed at 20% (rather than the regular corporate business rate, which is higher)
Regulating health care prices and prohibiting surprise billing
Increasing public transparency into private equity acquisitions
Some policymakers have already begun efforts to enact these recommendations. In June, Massachusetts senators Elizabeth Warren and Edward Markey introduced the Corporate Crimes Against Health Care Act, which would penalize private equity firms if a health facility they own closes or has poor finances resulting in injury or death to a patient. A month later, Markey proposed another bill, the Health Over Wealth Act, which would require greater transparency for private equity firms and for-profit companies that own health care entities.
Meanwhile, in the last year, several congressional committees—including the Senate Budget Committee, the Senate Committee on Homeland Security and Governmental Affairs, and the House Committee on Ways & Means—have launched investigations into and held hearings on the role of private equity in health care. On a state level, legislation to regulate private equity in health care is pending in Massachusetts, New Jersey, New York, and Pennsylvania. California, Indiana, Minnesota, New Mexico, and Oregon already have programs that do so. (In September, California Governor Gavin Newsom vetoed a bill that would further intensify regulations.)
Protesters gather in front of the Massachusetts State House to advocate for keeping Nashoba Valley Medical Center and Carney Hospital open. (Steve LeBlanc / AP Photo)
Deeper changes
These regulations—if passed—could help protect physicians as well as patients. One of the significant changes from the corporatization of health care is that, increasingly, physicians are no longer working for themselves. In the 1980s, most doctors owned their own small clinics. Today, nearly 80% are employed by a hospital system or corporation—up from just over 60% in 2019, according to Avalere Health.
“If you’re a physician working in a hospital, chances are you don’t work for the hospital. You work for a corporation,” McDonough said. “And when you sign on with the corporation, you sign a non-compete clause. You can’t criticize anybody or raise your voice even as your workload keeps growing, even when you’re the only physician in the emergency department with multiple traumas, even when you’re seeing patients being put at risk and your colleagues being exploited.”
As this hypothetical proves reality for more and more physicians, many are banding together to advocate for some of the policies Song recommends. A physician advocacy group called Take Medicine Back, for instance, is working to garner support for corporate practice of medicine laws.
Burnt out, frustrated—and organizing
In November, primary care physicians employed by Massachusetts’ largest health system, non-profit Mass General Brigham, cited the “corporatization of medicine” among their reasons for pushing to unionize. Across the country, a small number of doctors—around 70,000, representing 8% of the profession—already belong to a union. But that number has been growing steadily, and will likely continue to do so with the arrival of a new generation of physicians. Currently, 20% of medical residents—more than 32,000—belong to a union, a number that has doubled since 2019.
But tighter regulations on private equity and corporations in health care can only achieve so much. Many experts believe deeper changes to health policy and investments in public health are equally needed. Examples include:
Higher reimbursements for public insurance, so that, in McGregor’s words, “small community hospitals that serve populations largely on Medicare or Medicaid can better meet their costs and remain in business without the private sector filling in”
Simplified health insurance systems, like those in the Netherlands and Switzerland, that use private insurance plans that are streamlined, with fewer choices, making them more transparent and easier to understand and regulate
Funding for non-medical social care, such as housing and food—in Rosenthal’s words, “social supports that make a big difference in people’s lives and that, when underinvested in, drive up our health care costs”
‘One of the biggest lies we’ve ever been told’
These additional policy levers could help diminish for-profit health care’s influence, but by how much is a matter for debate.
“At the end of the day, I think we’re always going to have this kind of mixed public and private system,” Rosenthal said. “Politically, it would be very challenging for us to go in a more government-focused direction. There’s just a lot of distrust. And the one big thing that’s quite different about our country is that we don’t consider health a right. It’s not in our constitution like it is for many of our peers.”
But significant change may be on the horizon, driven by public discontent around health care and growing visibility, brought by cases like Steward, into the consequences of a system where profits can come at the expense of patient care.
When health care follows the money, we get sicker and sicker.
Alecia McGregor, assistant professor of health policy and politics
“As a country, we’ve become desensitized to this notion that health care is the same as any ordinary commodity, and that the provision of health care can be run like any other business,” McGregor said. “I think this is one of the biggest lies we’ve ever been told, because we’ve seen health care costs skyrocket in a way that’s different from any of our wealthy country counterparts, yet our outcomes—life expectancy, maternal health, infant mortality—are abysmal. When health care follows the money, we get sicker and sicker.”
“Surrendering our health care system to the for-profit marketplace was a fundamental error that we’re paying the debts of right now,” McDonough added. “But I see people working on it, reassessing the role and value of for-profits and asking what a post-neoliberal health care system might look like.”
In the meantime, the story of Steward, now under new ownership and a new name, continues to unfold. Its physician network, made up of 5,000 doctors, was recently purchased by Rural Healthcare Group and rebranded as Revere Medical. Rural Healthcare Group is owned Kinderhook Industries, a private equity firm.
For concerned patients, Rosenthal offered some concrete advice. “Find a provider you trust and be skeptical. Always ask about the benefits of an intervention. Because more services, more tests, more treatments are not always beneficial—but they’re always profitable.”
“Put in stark terms, CVD [cardiovascular disease] claims 1 American life every 39 seconds and is responsible for more deaths annually than cancer, chronic lower respiratory disease, and accidents combined.” For most heart attack deaths, you just keel over. Sudden cardiac death “is the first manifestation of CHD [coronary heart disease] for the majority of individuals, particularly among women.” So, “for many of these sudden death victims, their demise was the first indication of the presence of coronary heart disease.” They didn’t even know they had heart disease. That’s why an ounce of prevention is worth way more than a pound of cure—because there is no cure for death.
That’s also why the prevention of sudden cardiac death “remains a major public health challenge” because most people don’t even know they’re at risk. However, we’ve known for more than half a century, when we first started autopsying young servicemen who died during the Korean War, that coronary artery disease begins in our youth, even among young children. So, “business as usual…simply is not going to yield the improvements necessary to radically improve the CV [cardiovascular] health of the United States” and around the world.
There is good news, though. A “low-risk lifestyle (not smoking, exercising regularly, having a prudent diet, and maintaining a healthy weight)” may be able to eliminate the vast majority of the risk for sudden cardiac death. “The time is now long overdue to start aggressive preventive cardiovascular disease programs in our schools, our homes, and our worksites.” How about starting in our hospitals?
As I discuss in my video Hospitals Profit on Junk Food, a significant percentage of hospitals surveyed had fast-food restaurants inside them, with Krispy Kreme topping the list. Brilliant marketing, given that “families surveyed at the hospital with McDonald’s were…twice as likely to think McDonald’s was healthy, as compared to families at the hospitals without McDonald’s.” After all, McDonald’s was in the hospital.
What about food served in hospital cafeterias? Any better? Researchers analyzed 384 entrees from 14 children’s hospitals in California, and only 7 percent “were classified as healthy.” And, just in case someone chose the rare healthy option, 81 percent of eating venues in children’s hospitals had junky “high-calorie impulse items, such as ice cream freezers, cookies, and candy, at or near the checkout register” and 38 percent “had signs encouraging unhealthy eating.” Why would they do that?
If you ask hospital cafeteria managers, “less than a quarter (4 of 17) of respondents reported that the hospital followed nutrition standards for food offered in the cafeteria.” “Nutrition is not a top priority.” It’s the same reason unhealthy food is sold anywhere else: “pressure on food service departments for cafeterias to generate profit.”
“Increased emphasis…[is] placed on running a hospital foodservice department as a profit center”—a bigger and “bigger profit center,” that is. It’s such a metaphor for our sickness-care system in general, where healthy, treat-the-cause approaches are eclipsed by the pills and procedures that bring in the most money.
What do you expect from the private sector? Public hospitals don’t seem to be much better. A 2019 analysis of veterans’ hospitals found that “all VA Hospitals contain vending machines providing a majority of soda, candy, and junk foods that directly conflict with healthy food choice recommendations from US governing health bodies,” such that, ironically, “hospital visits could theoretically promote worse health….An important question that should be posed is why are any soda or candy machines available at our VA hospitals? Are we trading the health of our veterans for profits?”
Maybe it’s time to ban junk food on hospital premises. “On daily rounds, it is appalling to see patients…gorging on crisps [potato chips], confectionery [candy], sports drinks, and cola—the very food items that may have contributed to their admission in the first place…It is obscene that many hospitals continue to have…fast food franchises on site, as well as corridors littered with vending machines selling junk food. Such practice legitimizes the acceptability and consumption of such foods in the daily diet…The obesity epidemic represents a public health crisis, but it is a public health scandal that by legitimizing junk food hospitals have themselves become a risk factor for diet-related disease by perpetuating the revolving door of healthcare…It’s time to stop selling sickness on the hospital grounds.”
What message do residents receive when they are fed pizza and soda at grand rounds? We need a healthcare system with “more Hippocrates, less hypocrisy.”
For more on how the profit motive is degrading our health, see related posts below.
