Published Nov 05, 2026 | 7:00 AM ⚊ Updated Nov 05, 2026 | 7:00 AM
Foreign private equity firms accounted for 47 of the 70 acquisitions.
Synopsis: A new study maps 70 private equity acquisitions in India’s healthcare delivery sector between 2007 and 2025, revealing a strong concentration in hospitals in the southern and western states. Researchers say established healthcare infrastructure, rising incomes and medical tourism attract investors, while warning that underserved regions risk falling further behind.
South India’s established healthcare infrastructure, growing burden of non-communicable diseases, rising disposable incomes and reputation as a medical tourism destination are making the region an attractive market for private equity investors seeking predictable returns from India’s expanding healthcare sector.
A study by Brown University’s School of Public Health and Johns Hopkins Bloomberg School of Public Health published in BMC Health Services Research found that private equity (PE) investments in India’s healthcare delivery sector were concentrated in urbanised southern and western states, with Karnataka recording the highest number of acquisitions, followed by Telangana and Maharashtra.
The researchers attribute this geographical concentration partly to the region’s existing healthcare ecosystem.
“This pattern mirrors longstanding disparities in health care infrastructure and outcomes across India, where southern states have consistently outperformed on provider density, service utilization, and health indicators and hence may be seen as more favorable investment targets for PE firms looking for predictable returns,” the authors wrote.
The researchers –Megha Reddy, Cyrus Engineer and Yashaswini Singh– mapped 70 private equity-backed acquisitions between January 2007 and May 2025 and found that Karnataka accounted for 13 deals, the highest, while Telangana and Maharashtra recorded 10 each. Kerala had five acquisitions.
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Hospitals accounted for 45 of the 70 acquisitions, or 64.3% of all transactions. Of these, 33 acquisitions, representing 73.3%, involved multispecialty hospitals.
Clinics and outpatient services accounted for 16 acquisitions, followed by laboratory services with seven and elder care with two.
The preference for large hospital networks marks a difference between India’s private equity investment landscape and that of high-income countries such as the United States.
“In the United States and other high-income countries, PE has largely concentrated on high-margin outpatient specialties such as dermatology, gastroenterology, and ophthalmology, whereas in India PE has largely targeted large hospital platforms,” the authors noted.
They pointed to several factors behind this preference.
“Many factors can explain PE’s interest in multispecialty hospitals in India, including the burden of non-communicable diseases, growing disposable incomes, and India’s global reputation as a medical tourism hub,” they wrote.
Among outpatient services in India, ophthalmology recorded seven acquisitions and fertility and reproductive care five.
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The concentration of acquisitions in Karnataka and Telangana is also reflected in the expansion of major healthcare platforms headquartered or established in these states.
Manipal Health Enterprises and Health Care Global Enterprises (HCG), both headquartered in Karnataka, accounted for six and four acquisitions, respectively. CARE Hospitals and ASG Eye Hospitals recorded six acquisitions each.
Together, these four platforms accounted for nearly one-third of all acquisitions identified by the researchers.
The branch-level mapping, which examined the operational presence of PE-backed platforms as of May 2025, showed how these companies have expanded beyond their original markets.
Manipal Health Enterprises operated 38 locations, including 12 in Karnataka and five in Telangana. CARE Hospitals had 15 locations, seven of which were in Telangana and two in Andhra Pradesh.
HCG operated 23 locations, including eight in Karnataka and three in Andhra Pradesh.
Other major networks included Asia Healthcare Holdings, with 147 locations, and Indira IVF, with 171 locations.
Foreign private equity firms accounted for 47 of the 70 acquisitions, or 67.1%, while 23 deals involved at least one domestic PE firm.
The foreign investors included firms headquartered in the United States, Singapore and Mauritius.
The researchers attributed India’s attractiveness to its liberalised foreign investment framework, including the automatic route permitting 100% foreign direct investment in hospitals, alongside tax incentives and other policy incentives.
High domestic borrowing costs have also made private equity capital an attractive financing option for healthcare companies seeking funds for expansion.
According the study, investment activity accelerated after 2020, with 2023 recording the highest number of acquisitions at 18.
The authors linked the acceleration partly to favourable financial conditions during the pandemic, including low interest rates and large amounts of available investment capital. Healthcare’s relatively stable revenue streams also made it attractive compared with other sectors.
While investors concentrated on urbanised southern and western markets, rural and underserved regions have attracted little investment.
The researchers observed that Tier 2 and Tier 3 regions, which are home to more than 70% of India’s population, saw limited to no investment activity.
They cautioned that the concentration of private capital in already well-served regions could widen existing geographical inequalities in healthcare access.
They suggested that policy incentives and blended finance models could encourage private capital to flow towards regions with critical healthcare infrastructure gaps.
The implications of private equity ownership for patients, healthcare workers and affordability in India, however, remain uncertain.
Of the 70 platforms identified, 45, or 64.3%, remained under their original private equity ownership at the time of analysis. Among the 25 recorded exits, 16 involved sales to other private equity firms. The average holding period for exited investments was 5.1 years.
Drawing on international evidence, the authors noted that PE acquisitions in the United States have been associated with higher healthcare prices, workforce reductions and mixed outcomes in quality of care. However, they cautioned that these findings cannot automatically be applied to India.
“The long-term implications of PE ownership for quality, equity, and financial protection in India remain uncertain and an area for future research,” they wrote.
The researchers called for stronger ownership transparency, disclosure requirements and monitoring mechanisms to assess the effects of acquisitions on healthcare costs, patient care and workforce dynamics.
(Edited by Fayisa CA)
