Key Takeaways
- • A study by researchers at Brown University's School of Public Health and the Johns Hopkins Bloomberg School of Public Health, published in BMC Health Services Research, analyzed 70 PE-backed healthcare acquisitions in India from January 2007 to May 2025.
- • Deal activity peaked in 2023 with 18 recorded deals, following a sharp acceleration after 2020.
- • Karnataka led with 13 deals, followed by Maharashtra and Telangana with 10 each; northern and eastern India were largely overlooked.
- • Foreign investors financed 47 of the 70 acquisitions entirely, while Indian investors were sole backers in 18.
- • Secondary sales to other PE firms accounted for 64% of 25 observed exits, with an average holding period of 5.1 years.
Summary
A comprehensive study of private equity activity in India's healthcare sector finds a pronounced geographic imbalance, with capital concentrated in multispecialty hospitals in the country's more urbanised southern and western regions. The research, conducted by investigators at Brown University's School of Public Health and the Johns Hopkins Bloomberg School of Public Health and published in BMC Health Services Research, examined 70 PE-backed acquisitions between January 2007 and May 2025.
According to the study, investment accelerated sharply after 2020 and peaked in 2023 with 18 recorded deals. The authors attribute the surge to post-pandemic conditions in which healthcare was viewed as a preferred sector for its stable revenue streams, alongside low interest rates and abundant available capital, often referred to as dry powder.
The geographic distribution is highly uneven. Karnataka led the country with 13 deals, while Maharashtra and Telangana each recorded 10. Gujarat, Kerala and Haryana also saw notable activity, whereas northern and eastern regions remained largely overlooked by PE investors. The study notes that this pattern leaves rural and underserved areas with limited access to private capital.
Ownership is concentrated among a small number of operators. Four hospital groups, Manipal Health Enterprises, Health Care Global Enterprises, CARE Hospitals and ASG Eye Hospitals, accounted for one-third of all deals observed. Outpatient care providers were also targeted, but the focus remained narrow, with ophthalmology and fertility services the most common areas of interest.
Foreign capital dominates the landscape. Of the 70 acquisitions, 47 were financed entirely by firms based in countries including the United States, Singapore and Mauritius, while Indian investors were sole backers in 18. On exits, secondary sales to other PE firms were the most prevalent route, representing 64% of the 25 exits observed, with an average holding period of 5.1 years. The study also found that many transactions were structured as minority stakes that gradually expanded, reflecting a cautious, multi-step market-entry approach often seen in BRICS economies.
According to the study, investment accelerated sharply after 2020 and peaked in 2023 with 18 recorded deals. The authors attribute the surge to post-pandemic conditions in which healthcare was viewed as a preferred sector for its stable revenue streams, alongside low interest rates and abundant available capital, often referred to as dry powder.
The geographic distribution is highly uneven. Karnataka led the country with 13 deals, while Maharashtra and Telangana each recorded 10. Gujarat, Kerala and Haryana also saw notable activity, whereas northern and eastern regions remained largely overlooked by PE investors. The study notes that this pattern leaves rural and underserved areas with limited access to private capital.
Ownership is concentrated among a small number of operators. Four hospital groups, Manipal Health Enterprises, Health Care Global Enterprises, CARE Hospitals and ASG Eye Hospitals, accounted for one-third of all deals observed. Outpatient care providers were also targeted, but the focus remained narrow, with ophthalmology and fertility services the most common areas of interest.
Foreign capital dominates the landscape. Of the 70 acquisitions, 47 were financed entirely by firms based in countries including the United States, Singapore and Mauritius, while Indian investors were sole backers in 18. On exits, secondary sales to other PE firms were the most prevalent route, representing 64% of the 25 exits observed, with an average holding period of 5.1 years. The study also found that many transactions were structured as minority stakes that gradually expanded, reflecting a cautious, multi-step market-entry approach often seen in BRICS economies.
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