Private Equity Ownership in Hospice Care: A Systematic Review (2012-2026)

Area of Science:

• Health Services Research
• Health Economics
• Gerontology

Background:

• Hospice care utilization is shifting, with Alzheimer's disease and related dementias (ADRD) becoming the leading diagnosis.
• Hospice industry ownership has transitioned from nonprofit to for-profit, with significant growth in private equity (PE) ownership.
• Limited synthesized evidence exists on the impact of private equity ownership in hospice care.

Purpose of the Study:

• To systematically review and synthesize existing evidence on private equity ownership in the hospice care industry.
• To identify trends in PE ownership and its association with care experiences and financial outcomes.
• To highlight gaps in the evidence base regarding PE ownership and hospice quality.

Main Methods:

• Systematic review of English-language, peer-reviewed studies published between 2012 and 2026.
• Adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
• Inclusion of studies using national data, with sample sizes ranging from 80 to 536 PE-owned hospices.

Main Results:

• Private equity ownership is increasingly prevalent in hospice markets.
• Two studies consistently found worse caregiver-reported care experiences at PE-owned hospices compared to nonprofit hospices.
• Emotional and religious support experiences were similar across ownership types.
• Evidence suggests PE ownership is linked to complex, often negative patterns in market structure, care experiences, and financial allocation.

Conclusions:

• The current evidence base on private equity ownership in hospice care is limited but indicates potential negative impacts on care experiences.
• The findings underscore the need for further research into the associations between PE ownership and hospice quality, particularly for vulnerable populations.
• Additional research is required to clarify modifiable factors influencing hospice quality and to better characterize evolving ownership structures to inform policy development.