A Quiet Gap: Why Private Equity in Primary Care Remains Under-Researched in the Global South, and Why That Matters (Frontiers in Public Health)

Summary

• In the United States, private equity acquisitions of physician-practise sites rose more than six-fold between 2012 and 2021.p.1
• By 2024, an estimated 6.5% of US physicians worked in private equity-owned practices, up from 4.5% in 2022, exceeding 30% in certain specialties.p.1
• Aurelius acquired LloydsPharmacy in 2021 for £477 million, leading to liquidation in 2024 and the sale or closure of more than 1,300 NHS-contracted pharmacies.p.1
• A review of 55 studies across 8 high-income countries found predominantly mixed or adverse effects of private equity on healthcare quality and costs.p.2
• Out of approximately 20,000 healthcare private equity deals between 2000 and 2026 Q1, 90% targeted the Global North.p.2

Key insights

1. Private equity ownership of primary care facilities functions as a de facto public-private partnership operating largely within public reimbursement systems.p.1
2. In the US, private equity acquisitions of physician practice sites expanded over six-fold between 2012 and 2021.p.1
3. In the UK, investor Aurelius acquired LloydsPharmacy for £477 million in 2021 before entering liquidation in 2024.p.1
4. A review covering 55 studies in 8 high-income countries associated private equity ownership with market consolidation and higher healthcare prices.p.2
5. Between 2000 and 2026 Q1, 90% of roughly 20,000 healthcare private equity transactions were concentrated in the Global North.p.2
6. Healthcare private equity in the Global South relies more on growth equity, development finance, and greenfield clinic construction than on leveraged roll-ups.p.2
7. Policy interventions should mandate ex-ante capital structure transparency and change-of-control disclosures as conditions for public reimbursement.p.3