For more than two decades, I have worked in emergency departments across Chicago, and I have watched what happens when a hospital disappears from a neighborhood that depended upon it.

The ambulances have to drive farther, waiting rooms fill faster, and patients arrive sicker because the care they needed wasn’t there when they needed it. What I didn’t expect over the course of my career was to watch this happen not because a neighborhood couldn’t support the hospital, but because the hospital’s assets may be worth more extracted than operating.

In March 2026, West Suburban Medical Center, located in Oak Park, Ill., became the third hospital in Chicago’s safety net to abruptly close. Weiss Memorial Hospital also closed unexpectedly in 2025, and Westlake Hospital in Melrose Park in 2019. The common denominator is that all three were, at one point, owned by Pipeline Health, a private-equity-backed hospital chain that acquired them in 2019.

This is not just a Chicago story — it is happening all across the country. Approximately 447 hospitals are now under private-equity ownership, and about 25 percent serve rural populations. While private-equity-backed companies generate roughly 7 percent of U.S. GDP, they accounted for 21 percent of all health care bankruptcies in 2024, and seven of the eight largest health care bankruptcies that year.

Most notably, Steward Health Care, once the largest private for-profit hospital system in the country, was purchased by a private-equity firm in 2010 and sold in 2020. Four years later, the hospital system closed both their safety net hospitals and filed for bankruptcy, leaving a vulnerable patient population without access to health care and many miles away from potentially time-sensitive emergency care with prolonged emergency medical transport times.

Safety-net hospitals serve a patient population that is disproportionately low-income, publicly insured and racially and ethnically diverse. According to America’s Essential Hospitals, 75 percent of the patients are either uninsured or covered by Medicaid or Medicare. These hospitals are frequently the sole local source of high-acuity services for rural and urban communities. As the front door to acute care, these hospitals see twice as many emergency department visits on average.

Serving high volumes of low-income patients, most safety-net hospitals rely on targeted public financing to offset uncompensated and under-reimbursed care. The commitment to the mission of providing care for vulnerable populations, as opposed to targeting payer mix, contributes to their financially fragile existence. As a result, the thin-margin, public payer-dependent structure makes safety-net and rural hospitals targets for leveraged buyouts, sale-leasebacks and, unfortunately, closures.

The corporatization of the health care system by private equity has come with significant costs. While private equity’s ownership of hospitals may earn millions for their investors, they have put patients, communities and providers at risk.

A bipartisan U.S. Senate Budget Committee investigation, which reviewed more than a million internal documents, concluded that private-equity firms “extracted huge profits from hospitals, while increasing their debt and allowing patient care and safety to decline,” and that in some cases this directly forced closures.

A 2023 study in the Journal of the America Medical Association found a 25 percent increase in preventable adverse events at hospitals after private-equity acquisition, including a 38 percent rise in central-line bloodstream infections and a doubling of surgical-site infections.

A more recent study in the Annals of Internal Medicine linked private-equity ownership to cuts in staffing and a corresponding 13 percent increase in emergency room deaths.

And a July 2024 study found that hospital assets fell by 24 percent, on average, in the two years after a private-equity purchase, approximately $28 million per hospital in buildings, equipment and infrastructure that simply disappeared.

None of this is inevitable. It is the predictable result of a specific financing model, and policymakers are beginning to treat it that way. Lawmakers in 25 states, including Illinois, have introduced at least 79 bills, and enacted several addressing private-equity ownership of medical facilities.

And this is happening as a much larger threat looms. Federal Medicaid restructuring passed in 2025 is projected to reduce federal Medicaid spending by roughly $1 trillion over the next decade, with new provisions set to hit Illinois starting in January 2027.

Safety-net hospitals, which by definition serve the highest share of Medicaid patients, will absorb the brunt of that reduction. It is worth asking what happens to the remaining safety-net hospitals once their primary funding source shrinks even further.

Safety-net hospitals are not distressed assets waiting to be flipped. Instead, they often may be the difference between a stroke caught in time and one that isn’t, between a gunshot wound stabilized in minutes and one that isn’t, between a neighborhood that can care for its own and one that has to drive a considerable distance to do so.

Private-equity groups promise efficiency and turnaround, but as a physician, health care advocate and concerned citizen committed to health and well-being for all, the million-dollar question remains “Efficient for whom?” Heather Prendergast, MD, is a professor of emergency medicine, attending physician, and vice dean of clinical affairs at the University of Illinois College of Medicine, and a Public Voices Fellow of the OpED Project at the University of Illinois.

Private-equity groups promise efficiency and turnaround, but as a physician, health care advocate and concerned citizen committed to health and well-being for all, the million-dollar question remains “Efficient for whom?” Heather Prendergast, MD, is a professor of emergency medicine, attending physician, and vice dean of clinical affairs at the University of Illinois College of Medicine, and a Public Voices Fellow of the OpED Project at the University of Illinois.