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Private equity firms are rapidly buying their way into the U.S. health care system, and as they do, new research finds they tend to increase costs and may also harm quality.

A new BMJ systematic review rounded up 55 studies on the effects of private equity buyouts in health care globally to flesh out an overarching conclusion. The team of researchers found that private equity ownership generally means higher costs for patients, insurance companies, and government programs. The effects on quality were mixed, with more evidence showing that such financial investors degrade quality.

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“This is really the first widespread snapshot of what the impacts of all these developments are,” said Alexander Borsa, a study author and doctoral candidate at Columbia University.

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