Working Papers
When Buy-and-Build Breaks: Serial Private Equity Acquisitions in the Hospital Industry [Draft] [SSRN]
Selected Presentations: AFA Poster Session 2026, MFA Annual Meeting 2026, EFA Annual Meeting 2026, University of North Carolina at Greensboro 2026, Federal Reserve Bank of Kansas City 2026, AKFA Joint Conference 2026, SWFA Annual Conference 2026, RCF-ECGI Conference 2025, Inter-Finance PhD Seminar 2025, WEFI PhD Conference 2025, Duke University 2024
Awarded: Best PhD Paper Award, 2026 Joint Conference with Allied Korean Finance Associations (AKFA)
Abstract: I study the operational heterogeneity of private equity buyouts in the U.S. hospital industry. Classifying targets into platforms and add-ons, I document that these acquisitions serve different structural roles within a consolidated buy-and-build network. Post-acquisition, platform hospitals experience significant and persistent profitability gains, whereas local add-ons exhibit severe contractions in patient volume and profitability. Rather than reflecting managerial failure, this localized deterioration is a mechanical friction of intentional reallocation: sponsors contract local add-ons to centralize advanced clinical intensity and drive further profitability at the platform. Finding no evidence of commercial price increases, I show that system-wide value creation is driven primarily by operational restructuring; crucially, system-level health outcomes remain stable. Because private equity operations are executed differently depending on whether a target is a buy or a build, capturing their complete economic impact requires expanding the unit of analysis to the integrated system.
Privatization, Financial Distress and Spillover Effects in Hospitals (with Rui Guo) [Draft]
Selected Presentations: Inter-Finance PhD Seminar 2026
Abstract: This paper examines how acquisitions affect hospital financial distress and its spillovers in the US. We first scrutinize the selection problem, and find limited evidence that financially distressed hospitals are significantly more/less likely to be acquired. Then, we find that acquisitions do raise distress for hospitals on average and in urban markets, while it declines for rural hospitals. We explore mechanisms behind the urban and rural differences, finding that private equity acquisitions are associated with a lower share of Medicare patients and a lower commercial to Medicare price ratio, especially in urban areas, suggesting that reductions in revenue from private insurers may explain higher distress among acquired hospitals. Finally, we investigate the spillover effects of acquisitions. Acquisitions within [0,10) miles raise distress among neighboring hospitals due to stronger competitive pressure, while acquisitions within [20,30) miles reduce it by greater efficiency gains at moderate distances. We find limited evidence of spillovers on profitability, operating costs, salaries, discharges, size, or efficiency. Overall, the results show that acquisitions generate heterogeneous consequences across markets and may increase distress for hospitals that rely heavily on private insurance revenue.