Most of private equity in health went to west & south: Study

Private equity, or PE, is capital invested in privately owned companies. Firms typically buy part or all of a business, help shape its growth, and seek a profitable exit later. In healthcare, this can mean investing in hospital groups, clinics, or other care providers. The study mapped 70 PE-backed acquisitions in India from January 2007 to May 2025.

PE investment can begin with a minority stake. The investor may then increase its ownership over time, as happened in several platform deals identified by the study. This staged approach lets firms build a larger position gradually. The investments covered 45 hospital groups and 16 outpatient care providers, including eye-care and fertility providers.

The main way PE investors seek returns is by selling their stake or the entire healthcare platform. Among 25 observed exits, secondary sales to other PE firms were most common, accounting for 64%. The study does not report investors’ profits. It does show that 45 hospital groups remained under their original PE ownership.

Private equity investment was concentrated in a small number of urban hospital platforms rather than spread across India’s healthcare system. The study identified 70 PE-backed acquisitions between January 2007 and May 2025. More than 73% of investment went to 45 hospital groups, which together included 187 multispecialty hospitals and several single hospitals.

The geographic pattern was equally uneven. Karnataka recorded the most deals, with 13. Maharashtra and Telangana followed with 10 each. Gujarat recorded six deals, while Keralam and Haryana recorded five each. Four hospital groups—Manipal Health Enterprises, Health Care Global Enterprises, CARE Hospitals, and ASG Eye Hospitals—accounted for one-third of all deals.

Northern and eastern states saw minimal or no investment. The study therefore describes a market focused on urbanised southern and western states. This matters because the areas receiving the most private capital are not evenly distributed across the country, leaving rural and underserved regions largely overlooked in the mapped investment.

Multispecialty hospitals attracted the largest share of private equity. More than 73% of investment went into 45 hospital groups, covering 187 multispecialty hospitals and several single hospitals. Among 16 outpatient providers, ophthalmology and fertility or reproductive care were the most common targets. These patterns show PE favouring organised provider platforms and selected specialties.

Four groups alone accounted for one-third of all deals: Manipal Health Enterprises, Health Care Global Enterprises, CARE Hospitals, and ASG Eye Hospitals. The article does not provide separate reasons why eye care and fertility services were chosen most often. It does establish that healthcare revenues were viewed as relatively stable during the pandemic, making the sector more attractive than others.

The concentration also reflects where PE activity actually occurred. Karnataka, Maharashtra, and Telangana recorded the most deals, while northern and eastern states saw minimal or no investment. Thus, the prominence of these providers describes investment behaviour, not proof that they delivered better care or produced higher returns.

Private equity activity in Indian healthcare accelerated after 2020 and reached its highest point in 2023, when 18 deals were recorded. The timing matched a broader global post-pandemic investment trend. Healthcare became an appealing destination as financial conditions made it easier and cheaper to fund acquisitions.

The study points to two key mechanisms. Low interest rates reduced the cost of borrowing and financing. At the same time, investors held large amounts of available capital, known as “dry powder.” Healthcare also offered relatively stable revenues compared with other economic sectors, which strengthened its appeal during uncertain conditions.

This increase was not evenly distributed across India. The mapped deals still centred on urban hospitals in southern and western states. Karnataka led with 13 deals, while Maharashtra and Telangana recorded 10 each. The post-2020 surge therefore increased activity without solving the study’s broader geographic imbalance, since rural, northern, eastern, and underserved regions attracted little investment.

When investment concentrates in urban hospitals, rural and underserved healthcare systems receive less private capital. That can mean fewer opportunities for new facilities, expanded services, updated equipment, or larger provider networks in places already facing limited access. The study directly documents the investment gap, but it does not measure changes in care quality, prices, staffing, or patient outcomes.

The contrast is clear in the study’s map. Karnataka recorded 13 deals, Maharashtra and Telangana 10 each, and Gujarat six. By comparison, northern and eastern states saw minimal or no investment. More than 73% of investment went to 45 hospital groups, many centred on multispecialty hospitals in urbanised regions.

The immediate reality is therefore uneven capital allocation, not evidence of equal healthcare development. Unless investment reaches underserved areas through other channels, the concentration may reinforce existing geographic differences in provider availability. The article does not identify a specific policy response or predict whether PE firms will expand into rural markets.

Private equity capital came from both foreign and Indian investors, but foreign firms supplied most of the mapped financing. Of the 70 acquisitions, 47, or 67.1%, were financed solely by foreign PE firms. These firms included investors based in the United States, Singapore, and Mauritius. Another 18 acquisitions were backed exclusively by Indian investors.

This difference describes who supplied the capital, rather than proving that one group controlled every deal in the same way. The study also reports that 45 hospital groups remained under their original PE ownership. Several platform deals began with minority stakes, followed by gradual increases in ownership. That pattern allowed investors to deepen their involvement over time.

Foreign participation was therefore the larger part of the market mapped by the researchers. Indian investors still represented a substantial share, with exclusive backing in 18 deals. The article does not provide a complete breakdown of shared foreign-Indian deals, nor does it identify the controlling investor in every acquisition.

Private equity firms make money by investing in a healthcare company or hospital platform and eventually selling their ownership at a higher value. The article does not report the profits from these transactions. It does show the ownership steps that can support a return: an initial stake, possible expansion of ownership, and a later exit.

Several platform deals began as minority investments. Ownership then expanded gradually, creating a staged approach to control and involvement. When investors exited, secondary sales to other PE firms were the most common route. They accounted for 64% of the 25 exits observed in the study. Hospital platforms made up more than half of those exits.

The average holding period among exited investments was 5.1 years. Meanwhile, 45 hospital groups, or 64.3%, remained under their original PE ownership. This means many investments had not yet reached an exit by the study’s end. The article identifies the transaction structure, but not the final financial returns or operational changes.