Lifecycle regulation of private equity in healthcare: a transatlantic governance framework

Private equity (PE) investment in healthcare has expanded rapidly across the United States (US) and the European Union (EU), reshaping ownership structures in primary care, specialty services, and ancillary providers. This trend has generated both optimism about capital infusion and operational efficiencies and concern about financialization, short investment horizons, and risks to care quality and equity. In this Perspective, we argue that PE participation in healthcare constitutes a systemic governance risk requiring lifecycle regulation -from acquisition through ownership to exit- rather than regulation focused narrowly on ownership status. Building on current empirical evidence and policy debates, we advance a transatlantic governance framework with five core domains: transparency, financial safeguards, clinical autonomy, quality assurance, and workforce protection. We propose context-sensitive implementation tailored to US and EU institutional realities and discuss trade-offs between regulation and investment incentives, including gaps in ownership transitions and exit phases. Finally, we outline priority research and policy experimentation to support proportionate oversight balancing innovation with patient interests and public accountability.