For decades, consolidation in frontline care delivery has reshaped healthcare markets across the US. More recently, growing ownership of healthcare delivery organizations by retail companies, insurers, and investor-based firms has accelerated this transformation. In a viewpoint for JAMA, Dr. Mark Unruh, associate professor of population health sciences, Dr. Zirui Song, associate professor of healthcare policy and medicine at Harvard Medical School, and Dr. Jane Zhu, associate professor of medicine at the Oregon Health & Science University, explain that, amid shifting healthcare ownership, science that advances patient outcomes and clinician well-being while avoiding harm is a critical public good.
In the fall of 2025, the National Institute on Aging (NIA) convened a two-day workshop to discuss this new area of scientific inquiry, which has typically relied on broad ownership categories to estimate average effects on economic and clinical outcomes. As the field expands, the authors explain that it can be used to examine certain phenomena in greater depth. For example, there is a difference between ownership and resulting business strategies, as downstream management of consolidated healthcare entities is often made distinct by investor-driven incentives or operational changes at the point of care. These distinctions are yet to be explored. Additionally, ownership models evolve rapidly, and empirical evidence is needed on what owners actually do for clinicians and patients after taking control.
Authors note that the NIA is uniquely positioned to lead the next phase of research by supporting longitudinal, data-intensive, and interdisciplinary work linking ownership structures and strategies to patient outcomes, workforce dynamics, and system-level performance. This will require investments in data infrastructure and shared best practices, such as clear definitions of the treatment of interest and consistent outcome measures. With this new era in research, scientific evidence can support a nuanced understanding of ownership changes, providing insights that clinicians and patients can use to make their healthcare decisions.
- Highlights