title: Private capital investments in health care provision through mergers and acquisitions: from long-term to acute care.
abstract: OBJECTIVE
  This work aims to test whether different segments of healthcare provision differentially attract private capital and thus offer heterogeneous opportunities for private investors' diversification strategies.
  
  
  METHODS
  Thomson Reuter's SDC Platinum database provided data on 2563 merger and acquisition (M&A) deals targeting healthcare providers in Western Europe between 1990 and 2010. Longitudinal trends of industrial and geographical characteristics of M&As' targets and acquirers are examined.
  
  
  RESULTS
  Our analyses highlight: (i) a relative decrease of long-term care facilities as targets of M&As, replaced by an increasing prominence of general hospitals, (ii) a shrinking share of long-term care facilities as targets of financial service organizations' acquisitions, in favor of general hospitals, and (iii) an absolute and relative decrease of long-term care facilities' role as target of cross-border M&As.
  
  
  CONCLUSIONS
  We explain the decreasing interest of private investors towards long-term care facilities along three lines of reasoning, which take into account the saturation of the long-term care market and the liberalization of acute care provision across Western European countries, regulatory interventions aimed at reducing private ownership to ensure resident outcomes and new cultural developments in favor of small-sized facilities, which strengthen the fragmentation of the sector. These findings advance the literature investigating the effect of private ownership on health outcomes in long-term facilities. Market, policy and cultural forces have emerged over two decades to jointly regulate the presence of privately owned, large-sized long-term care providers, seemingly contributing to safeguard residents' well-being. Copyright © 2016 John Wiley & Sons, Ltd.
authors.affiliation: Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
authors.forename: Federica
authors.initials: F
authors.lastname: Angeli
authors.forename: Hans
authors.initials: H
authors.lastname: Maarse
mesh_terms: D002202:Capital Financing / Q000191:economics / Q000458:organization & administration*; D003422:Critical Care / Q000191:economics / Q000458:organization & administration; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration*; D005060:Europe; D006273:Health Facility Merger / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D007449:Investments / Q000458:organization & administration*; D008134:Long-Term Care / Q000191:economics / Q000458:organization & administration
keywords: Mergers and acquisitions; financial service organizations; long-term care providers; western Europe