{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T17:56:13Z","timestamp":1793814973445,"version":"4.6.1"},"reference-count":80,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["HEPL"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Moral hazard is built into the structure of private equity investments, which incentivises debt-based extraction rather than value-adding investment. To craft effective regulation of private equity\u2019s participation in healthcare, and to cut through the industry\u2019s talking points, we must reframe and acknowledge private equity \u2018investment\u2019 as \u2018extraction\u2019. In the U.S. healthcare system, this debt-based extraction has produced higher risks of bankruptcy and financial distress and associated facility closures, cost-cutting that affects patient safety and care, rising healthcare costs, inefficient use of taxpayer dollars, erosion of clinician autonomy, and increased consolidation. Policies that address extractive behaviours are the most targeted and efficient means of safeguarding patient care and may discourage the worst actors from acquiring healthcare providers. As private equity invests in health systems beyond the U.S. where regulatory regimes differ, the fundamentals of its extractive business model remain the same. Regulations must be calibrated to country specifics, but they should address the debt-based extraction built into the very structure of private equity investments. As policy debates continue, it is worth asking why we need private equity\u2019s extractive business model in healthcare in the first place.<\/jats:p>","DOI":"10.1017\/s1744133126100759","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T07:55:18Z","timestamp":1791359718000},"page":"1-12","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":1,"title":["Investment or extraction? Reframing private equity in healthcare"],"prefix":"10.1017","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-4097-6925","authenticated-orcid":false,"given":"Mary","family":"Bugbee","sequence":"first","affiliation":[{"name":"Private Equity Stakeholder Project"},{"id":[{"id":"https:\/\/ror.org\/02der9h97","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"S1744133126100759_ref1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpubeco.2023.104821"},{"key":"S1744133126100759_ref19","first-page":"527","article-title":"Private equity and the corporatization of health care","volume":"76","author":"Brown","year":"2024","journal-title":"Stanford Law Review"},{"key":"S1744133126100759_ref54","unstructured":"O\u2019Grady, E (2021a) Money for Nothing: How Private Equity has Defrauded Medicare, Medicaid, and Other Government Health Programs, and How that might Change. 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