Skip to main content
The Keckley Report

U.S. Healthcare’s Existential Threat: Loss of Public Trust

By October 16, 2023No Comments

U.S. healthcare faces an existential threat: the loss of confidence and trust that the system is fair and more concerned about its profit than patient care.

It’s a sentiment that’s widely shared: Polls by Gallup and Pew show a steady decline in public confidence over the past 3 decades. A September, 2023 of 840 U.S. adults conducted by Jarrard showed only 15% trust the system “a great deal or a lot” vs. 69% who say they trust it “a little or not at all”.  And it lends to growing regulatory scrutiny by state and federal lawmakers who challenge the industry’s sincerity about reforms to lower costs, improve accessibility and demonstrate public accountability.

Studies show the erosion of public confidence and trust in the health system correlates to higher costs and suboptimal outcomes: when an individual thinks a clinician’s judgement might be clouded by a financial incentive, a hospital or drug price excessive and the provider prone to price gauging, or an insurer’s coverage determination arbitrary, doubt takes hold and trust plummets.

As public discontent has gained momentum against drug manufacturers and hospitals, lawmakers and regulators have widened their targets: health insurers and pharmacy benefits managers are now prime targets, and middlemen including information technology suppliers, device makers, brokers, wholesalers and distributors next in line.

It’s understandable: the industry does a good job touting itself. Examples from last week illustrate its proclivity to tout its successes (see Quotables and Industry Sections below for more):

  • Eye-popping 3Q 2023 earnings report from UnitedHealth
  • Resolution of the Kaiser workforce strike (at least temporarily)
  • Announcements by Walmart and Walgreens who are expanding their virtual & primary care offerings.
  • Investments by 10 leading not-for-profit health systems in Capital Rx (a PBM)
  • Release of a new study by the American Hospital Association showing hospital community benefits account for 15.5% of their total expenses
  • And numerous post HLTH news releases by early-stage companies that inked partnership/investment deals while in Vegas last week.

In response, state legislatures (including several in red states) are implementing price controls for drugs and hospitals. The US Department of Justice and Federal Trade Commission are reining in consolidation and revisiting consumer protections. And candidates for public office in 2024 face increased questions from media about their health reform agenda’s. That’s the lay of the land.

My take:

The U.S. the health industry is composed of good and bad actors in each of its sectors:  none owns the moral high ground exclusively though some believe and act as if they do. The health economy has been good to investors and entrepreneurs, especially those who sell products and services to hospitals, medical groups, and long-term care providers and the adjudicators of their transactions. Shareholder values for these increased 5.9% between 2013 and 2018 compared with 3.6% for the S&P 500 as a whole. Accolades, facility names and scholarships memorialize the financial successes of these while those who provide care—hospitals, nursing homes, public health providers—struggle as their operating costs soar and margins erode. But that’s noise to consumers: they see a system that’s big, profitable and self-serving. And, in popular media, they hear it has failed to improve life expectancy, imposed medical debt on 2 in 5 households and addicted a generation to harmful drugs.

The system issues are systemic and complicated. And no sector is capable of solving them alone: it requires all to collaborate based on a shared vision of its future but that vision does not exist. Until and unless a shared vision of the future of the U.S. health system is created, confidence and trust in the system will continue to erode and options for its future severely limited.


PS: The eyes of the world are on Gaza: the prospect of mass civilian casualties in the pending IDF-Hamas urban warfare its potential dwarfs the 4000 innocents in Israel and Gaza who’ve already died since last Saturday’s slaughter. The stress on the health systems in these countries is a staple of media coverage. That’s always the case in mass casualty events and unexpected carnage. For those of us privileged to serve in this industry, our prayers and support are for the caregivers there who will risk everything to help the dying and wounded. 


Re: FTC oversight of private equity role, non-compete agreements: “”Since taking office at the FTC, two major areas of focus for me have been promoting fair competition in labor markets, and promoting fair competition in healthcare markets. last January, we proposed a rule banning non-compete agreements and non-compete clauses from people’s employment contracts.

In such cases, there is such a huge asymmetry between what they’re investing and what they’re going to get back and it’s reasonable to ask, ‘Hey, it is really designed to function as a non-compete and also deter people from walking away because it is so coercive?”

Linda Khan speaking to the annual meeting of the American College of Emergency Physicians Medpage October 11, 2023

Re: UNC-UnitedHealth dispute: “We must hold payors, including UnitedHealthcare, accountable for adequate reimbursement and voice our concerns when administrative burdens like improper denials and preauthorization barriers get in the way of care. UNC Health is urging UnitedHealthcare to mirror our own commitment, prioritizing patient welfare.”

Matthew G. Ewend, MD “UNC Health Publicly Threatens to Cancel UnitedHealthcare Contracts” MedPage October 13, 2023

Re: middlemen in healthcare: “In a country that spends as much on healthcare as the entire German economy produces in a year, American officials are right to want to bring prices down. But if Big Pharma isn’t earning excess profits, regulators looking to tackle the problems of healthcare would do better to pay more attention to the rest of the supply chain. The system is packed with opaque middlemen, such as pharmacy benefits managers, many of which are making big rents. A spate of consolidation means these intermediaries are only gaining more pricing power. Mergers of hospitals over the past 20 years, meanwhile, have been shown to lead to stagnation in the quality of care. American health care needs fixing. But price controls on drugs are not the way to do it. In 2022, the combined revenue of the nine biggest middlemen—call them “Big Health”—equated to around 45% of America’s health-care bill, up from 25% in 2013. Big Health accounts for eight of the top 25 companies by revenue in the S&P 500 index of America’s leading stocks, compared with four for Big Tech and none for Big Pharma…”

Who profits most from America’s baffling health-care system? Not Big Pharma the Economist October 8,

Re: role of consumers in healthcare: “Consumer engagement is the essential ingredient reshaping a complex healthcare ecosystem. Solving real consumer problems is the strategy required for market success. While health systems like Northwestern wait for Epic to deliver them to the digital promised land, they are losing the battle for consumers’ hearts and minds at the very time that consumers’ healthcare service choices are expanding. Engaging consumers requires “one app that covers the map” — a single-site, omnichannel platform that delights customers with comprehensive offerings, great service and ease of use…Promise and peril are the two sides of expanding healthcare consumerism. Engaging consumers is not rocket science, but it is rare in healthcare. Healthcare organizations that rise to the challenge can prosper. Those that don’t may perish.”

David Johnson “The Perils and Possibilities of Healthcare Apps” October 10, 2023

Re: sexism in the workplace: “The workplace is a mental minefield for many women, particularly those with traditionally marginalized identities. Women who experience microaggressions are much less likely to feel psychologically safe, which makes it harder to take risks, propose new ideas, or raise concerns.”

McKinsey Women in the Workplace Report 2023

Re: interoperability and Trusted Exchange Framework (TEFCA): “What ONC is developing is a glide path to interoperability. It’s a long path, and I’m very impressed with what they’re doing. We need to be careful and practical…. Some expect TEFCA and [HL7’s FHIR (Fast Healthcare Interoperability Resources) standard] to be automagical. They’re correct in that we want a world where one day everyone will be using [this technology]. But to get there takes a lot of cost. And a lot of people are going to have to retool their systems to get there. It’s going to take a while.”

Jim Jirjis, CHIO, HCA Healthcare. TEFCA Advocates Urge Patience—And Preparedness—As Interoperability Plan Moves Forward Health Leaders October 11, 2023

Re: U.S. medical device market: “After a couple of years of tremendous gains generated by the pandemic’s demand for medical equipment, the medical device industry has hit a slump. In its annual medtech report, EY reported a 30% decline in all industry financing, which includes a drop in initial public offerings, special-purpose acquisition company deals, and venture capital funding.

Medtech is certainly not the only industry facing a cash squeeze. But unlike biotechs seeing massive growth from obesity drugs, it has not spawned a billion-dollar market in a while despite investing heavily in research and development.”

“Lizzy Lawrence “Key takeaways from AdvaMed, the world’s largest medical device conference” October 11,2023

Re: health system transformation: Myriad challenges exist for today’s healthcare leaders: tight supply chains, high labor costs, payment reforms, growth in new technologies, artificial intelligence, disruptive competitors, and the prospect of a rising number of uninsured  Americans. But there’s a greater challenge than all of these: America’s declining health.

Even prior to the pandemic, America’s health rankings in areas such as life expectancy and infant mortality lagged in comparison to peer countries in the Organization for Economic Co-Operation and Development (OECD). Indeed, U.S. life expectancy began to stagnate a decade prior to COVID-19, and then fell remarkably during the 3-year period between 2014 and 2017.

The plateau in the decline of mortality rates from cardiovascular deaths, the obesity crisis, and the opioid and substance use epidemic have driven this trend, with disparities widening based on factors such as income, race, and geography.

What will it take to reverse these trends that were further exacerbated by the pandemic? To start, a re-commitment by healthcare leaders to three critical areas: primary care, public health, and prevention… Unfortunately, the primary care, public health, and preventive sectors received a small slice of the $4.3 trillion spent on health in the U.S. in 2021…only 6% to 7% of total spending goes to primary care (half as much as comparable OECD countries), only 5% goes to clinical preventive services, and only 4% goes to public health — and these categories are not mutually exclusive. If we’re to achieve a healthier nation, we must take steps to ensure our resources support this goal…”

Anand Parekh “Healthcare’s North Star Should Be Better Health: We must commit to primary care, public health, and prevention” MedPage October 13, 2023

The Economy

September CPI Report: Measures of U.S. inflation declined last month per the Labor Department report released last Thursday. Highlights:

  • Consumer prices (CPI) climbed 0.4% in September, below the prior month’s 0.6% pace. The year-over-year inflation (LTM) was unchanged last month from August’s 3.7% rise.
  • Food prices were up .2% and 3.7% in the LTM.
  • Energy prices were up 1.5% and down .5% in the LTM.
  • Shelter prices were up .6% and up 7.2% in the LTM.
  • Medical care commodities prices were down.3% but up 4.2% in the LTM.
  • Medical care services prices were up .3% but down 2.6% in the LTM.

“On a month-to-month basis, prices are continuing to rise faster than is consistent with the Federal Reserve’s 2% target,” notes the AP.

Bureau of Labor Statistics October 12, 2023

Earnings strong in 3Q: “The profit slump is over. Third-quarter earnings season is getting under way, and it will likely be much better than the second quarter’s for U.S. public companies. Industry estimates indicate that members of the S&P 500 will report earnings per share were 1.3% higher than a year earlier—a nice improvement from the second quarter’s decline of 2.8%.

The S&P third-quarter earnings estimate is also getting damped by an estimated 34.7% decline in energy-sector earnings—the consequence of fuel costs that were much lower than a year earlier… S&P 500 earnings excluding energy are expected to show a 6.2% gain after rising 3.6% in the second quarter. Finally, analysts reckon that profit growth in the fourth quarter will be substantially better, with estimates pointing to S&P 500 earnings up 10.8% from a year earlier.”

Justin Lahart “Despite challenges including rising labor costs and high interest rates, U.S. corporate earnings are on an upswing” WSJ October 11, 2023


Jarrard: women distrust system more than men: Per Jarrard’s survey of 840 U.S. adults, 15% say they trust the health system “a great deal or a lot” vs. 69% who say they trust it “a little or not at all”. Women are less trusting than men:

  • 57% of women say “hospitals, health systems and other organizations that provide medical care” don’t meet the needs of most Americans, compared to 40% of men. (51% overall)
  • 71% of women say hospitals are mostly focused on making money vs. caring for patients vs. 58% of men (65%overall)

“The people who use healthcare the most may trust it the least” Jarrard

Gallup: Gen Z anxious, optimistic: Gen Z are a more likely than other generations to report experiencing stress, loneliness, and anxiety, according to a recent survey of more than 3,000 people in the US between the ages of 12 and 26 conducted by the Walton Foundation and Gallup in May . 47% of Gen Zers believe they are thriving vs. 60% of millennials when they were at the same age., Gen Z is optimistic: more than 75% believe they have a bright future ahead, despite feeling unprepared for it.

“Does Gen Z struggle more with mental health than millennials? New polling shows signs of a shift” September14, 2023


AHA Study: hospital community benefit: :“… even as COVID-19 overwhelmed our entire health care system throughout 2020, tax-exempt hospitals increased their level of aid and support to communities.

Hospitals provided more than $129 billion in total benefits to their communities in 2020 alone (the most recent year data is available). This is about $20 billion more than the prior year and 15.5% of their total expenses.

Nearly 7% of hospitals’ total expenses — amounting to $57 billion — was for financial assistance for patients in need, as well as transitioning patients to Medicaid or similar programs that offer regular and preventive care and then absorbing significant underpayments. Other benefits include a range of programs and services designed to meet the health needs of their communities…

These new data build on a report by the international accounting firm EY demonstrating that the return to taxpayers for hospitals’ federal tax exemption is $9-to-$1 (2019). That is, for every one dollar of tax exemption taxpayers receive $9 of community benefits — a remarkable return by any standard…

Let the record show that when we truly count all the ways that tax-exempt hospitals and health systems support communities, we find that every time we ask more of them, they step up and deliver. It’s time anyone stopped claiming otherwise. “

Rick Pollack “Hospitals and Health Systems Advance Health for Patients and Communities in Countless Ways”

Fitch: not-for-profit hospital margins: “Hospital volumes have largely recovered from the initial hit during the pandemic and are generally at, or even above, pre-pandemic levels for many in our rated portfolio. However, expenses, particularly salaries and wages, remain stubbornly high.

Median operating and operating EBITDA margins declined notably to 0.2% and 5.8%, respectively, in FY22 compared to 3.0% and 8.9% in FY21, according to Fitch’s latest median report. We expect weak margins to persist through 2023 and into 2024 due to an inelastic revenue model and higher labor costs due to still very tight labor conditions, even as operations broadly continue to gradually rebound.”

Controlling Labor Costs Will be Key to NFP Hospital Margin Improvement Fitch Ratings October 2, 2023

ND Rural Hospitals create network: 23 North Dakota rural hospitals have created the Rough Rider High-Value Network to share back-office services and coordinate primary and chronic care management programs.

Rural hospitals form clinically integrated network in North Dakota Modern Healthcare October 11, 2023

Study: Diversity in surgical leadership roles lacking: Researchers reviewed websites for U.S. medical schools and teaching hospitals to evaluate racial, ethnic, and gender diversity of surgical department chairs, vice chairs (VCs), and division chiefs (DCs). Findings:

  • Of 2,165 faculty across 146 medical schools in the U.S. and Puerto Rico, men occupied more leadership positions at all levels compared with women, including department chairs (85.9% vs 14.1%), vice chairs (68.4% vs 31.6%), and division chiefs (87.1% vs 12.9%), and only 8.9% were from racial or ethnic groups that are underrepresented in medicine, Notably, of the three leadership positions, 83.8% were men and 75% were white.
  • Individuals underrepresented in medicine were most commonly vice chairs of diversity, equity, and inclusion (DEI; 51.6%) or faculty development (17.9%). Vice chairs of faculty development were split evenly between men and women, while 64.5% of vice chairs for DEI were women.
  • Women also held more vice chair roles than chair or division chief roles, which was also true for women of color; Black women made up 4% of vice chair roles versus 1.5% of chair roles and 0.6% of division chief roles.

Iwai et al “Racial, Ethnic, and Gender Diversity Among Academic Surgical Leaders in the US” JAMA Surgery October 11, 2023. doi:10.1001/jamasurg.2023.4777

PBM attracts funding from health systems: Capital Rx, a pharmacy benefit manager technology company, received around $50 million in funding from multiple health systems including Phoenix-based Banner Health, New Jersey-based Atlantic Health System, Houston-based nonprofit Memorial Hermann Health System, New Orleans-based Ochsner Health and six others joined by growth equity firm Transformation Capital.

“Capital Rx Closes $50M+ Strategic Investment Round to Support Growth and Accelerate JUDI® Platform Development” October 11, 2023

Nursing Homes

Study: union representation in nursing homes associated with lower turnover: Researchers analyzed the association between the presence of a health care workers union and total nursing staff turnover rates in US nursing homes in 2021. Findings:

“We found that the presence of a union was associated with a 1.7 percentage point decrease in staff turnover. We also found that this association was significantly larger when the county-level proportion of nursing homes that were unionized was high: when more than 75% of nursing homes in a county were unionized, the facility-level presence of a union was associated with a 9.0 percentage point decrease in staff turnover. When 75% or fewer nursing homes in a county were unionized, a union was associated with a 1.2 percentage point decrease in staff turnover

Dean et al “Labor Unions and Staff Turnover in US Nursing Homes” JAMA Network Open October 13, 2023;6(10):e2337898. doi:10.1001/jamanetworkopen.2023.37898


GOP Doctors propose physician fee schedule change: The GOP Doctors Caucus released a policy proposal that would change the Physician Fee Schedule by offering more leeway in how much money CMS can spend, which is currently limited by a budget neutrality requirement. The key adjustment: Medicare’s calculation of how much it costs to run a practice.

“A BILL To provide for certain adjustments to the physician fee schedule under the Medicare program” October 4, 2023

Health insurers

Study: infant mortality rates by insurance status: Researchers compared the infant mortality rates (IMR) for infants born in the US with maternal private insurance vs. public Medicaid insurance from 2017-2020. Finding:

“Infants born to mothers with private insurance had a lower IMR compared with infants born to those with Medicaid (2.75 vs 5.30 deaths per 1000 live births; adjusted relative risk. Those with private insurance had a significantly lower risk of post neonatal mortality (0.81 vs 2.41 deaths per 1000 births; low birth weight, vaginal breech delivery and preterm birth and a higher probability of first trimester prenatal care compared with those with Medicaid.”

Johnson et al “Health Insurance and Differences in Infant Mortality Rates in the USJAMA Network Open October13,.2023;6(10):e2337690. doi:10.1001/jamanetworkopen.2023.37690

UnitedHealth Group 3Q earnings: the strong earnings surprised analysts:

UnitedHealth Group

  • Total revenues in the third quarter were $92.4 billion, up 14% year over year.
  • Total net earnings in the third quarter were $5.8 billion, up 11% year over year.
  • The company’s operating margin was 6.3% in the third quarter.


  • Total revenues in the third quarter were $69.9 billion, up 13% year over year.
  • Total earnings from operations in the third quarter were $4.6 billion, up 21% year over year.
  • UnitedHealthcare’s operating margin was 6.6% in the third quarter.
  • As of Sept. 30, total U.S. membership is 47.3 million, with commercial membership at 27.3 million. There are 8.1 million Medicaid members, 7.6 million Medicare Advantage members, and 4.3 million members with Medicare supplement plans. Part D plan membership is 3.3 million.


  • Total revenues in the third quarter were $56.7 billion, up 22 percent year over year and led by Optum Rx
  • Earnings from operations in the third quarter were $3.9 billion, up 7% year over year.
  • Optum’s operating margin was 6.9% in the third quarter.
  • In 3Q, Optum Rx revenues were $28.9 billion, Optum Health revenues were $23.9 billion and Optum Insight revenues were nearly $5 billion.
  • Optum Health revenue per consumer increased 27% year over year, driven by the growth in patients served under value-based care arrangements and the continued expansion of services offered.

“UnitedHealth Group Reports Third Quarter Results” October 13, 2023

Prescription Drugs

Quotable: state Prescription Drug Affordability Boards: “Anticipation may be high that Medicare can wring lower prices out of drugmakers, but a handful of states are moving aggressively to slash costs for their residents, a clear sign the battle over affordable medicines in the U.S. is only going to escalate further. These efforts involve Prescription Drug Affordability Boards, which are designed to function like a rate-setting authority…The concept is not new. It was, in fact, floated several years ago and gradually explored by lawmakers in several states that chafed at the lack of progress in Washington to address rising prescription drug costs. Since then, seven states created such boards, but in recent months, there has been a flurry of activity reflecting what supporters say is an increasingly pressing need to lower prescription drug costs.”

Ed Silverman Medicare may plan to negotiate drug prices, but some states are taking their own steps to lower costs Stat Oct. 11, 2023

Re: U.S. Prescription drug market: “America is the world’s largest pharmaceutical market, with 630B in sales in 2022, or 42% of the world wide total. Its contribution to its profits—65%of the global haul—is greater still. American patients have long born the burden of these juicy returns, Prescription medicines in America cost 2-3 times more than in other rich countries. Patients out of pocket expenses, the slice of drug costs not covered by insurance, are also among the world’s highest.”

“A Bitter Pricing Pill” The Economist September 2, 2023

Re: PBM legislation: “I think that PBMs—my characterization—are the train that drives the healthcare agenda in Congress in both the House and the Senate. There’s enormous interest…There are few concerns that connect more with people at the kitchen table than healthcare. Within that frame of how strongly people feel about healthcare is prescription drugs at the top of every list.”

Senate Finance Chair Ron Wyden (D-Ore.) Modern Healthcare October 11, 2023

OTC contraceptive: access, pricing: “In July 2023, the Food and Drug Administration (FDA) approved Opill (norgestrel), the first over-the-counter (OTC) daily oral contraceptive pill in the United States, a move that could dramatically improve practical access to family planning. Opill’s price, however, hasn’t been made public and may not be revealed until the drug enters the market in early 2024. Although contraceptive pills generally cost between $10 and $50 per month without insurance, there’s no indication that Opill’s price will fall within this range. In addition, although the manufacturer (Perrigo) has expressed interest in a consumer-assistance program, it hasn’t released details regarding eligibility for such a program.

It’s unclear whether health insurers or federal health programs will cover OTC versions of contraceptive pills…Some states have already taken steps to facilitate access to oral contraception. Nationwide, 29 states and the District of Columbia permit oral contraceptives to be dispensed without an order from a physician. Twelve states and the District of Columbia require OTC oral contraceptives to be covered by insurance. But this requirement applies only to health plans regulated by the state and doesn’t cover many of the largest employer-based plans….”

Christopher Robertson., Anna Braman. ” Perspective The New Over-the-Counter Oral Contraceptive Pill — Assessing Financial Barriers to Access”  October 12, 2023N Engl J Med 2023; 389:1352-1354

OTC access: drug pricing, generic unavailable : In June the U.S. FDA approved colchicine (Lodoco) as the first anti-inflammatory drug for the prevention of heart attacks and strokes among people with established heart disease or multiple risk factors…Colchicine is not a new drug. It has been used for centuries. But here is the rub. Although colchicine has been used successfully for centuries, it had not been patented until relatively recently. Back in 2006, the FDA created the “unapproved drugs initiative” for older generic drugs, like colchicine, that had never been carefully evaluated by the FDA for safety and efficacy…With these new approvals, the cost of colchicine accelerated from pennies to about $5 per pill… While there are now 17 patents for Colcrys, until last June there was only one FDA approved form of colchicine.

Agepha Pharma now holds eight patents  on Lodoco (simply 0.5 mg of colchicine) for preventing heart disease or stroke. Now that the periods for exclusive marketing of Colcrys have expired, the price has come back down. Although the retail price  remains around $5 per pill, large chain pharmacies sell it for less than $1/pill. Colcrys still remains FDA-approved for the treatment of gout at a dose of 0.6 mg per pill and generics remain unavailable.

Meanwhile, Agepha just released a retail price for Lodoco of $621 for a 30-day supply — nearly $21/pill. It will be available with a coupon at Walgreens  for $170/month or about $5.66/pill. Using either the retail or coupon price, Lodoco can cost as much as four to six times more than Colcrys . Yet, Colcrys and Lodoco are essentially the same drug. Both have only one active ingredient — colchicine… “

Robert M Kaplan, Michael H Weisman “A Price Jump From Pennies to $20/Pill for the Same Drug: Drug pricing should be subject to stricter regulation” MedPage October 12, 2023

Regulatory Actions, Announcements

CMS: Medicare Part B Premiums To Rise By 6% in 2024: The Centers for Medicare and Medicaid Services (CMS) announced the monthly Medicare Part A and B premiums for 2024 last Thursday, with the costs set to go up by 6% next year. The premiums would increase by $9.80 from $164.90 to $174.70 in 2024 and the annual deductible for Medicare Part B beneficiaries will go up from $226 to $240 as well. This price increase comes after Medicare Part B premiums went down for the first time in more than 10 years in 2023. (Choi, 10/12

CMS 2024 star ratings: Friday, CMS announced 42% of Medicare Advantage with drug coverage and at least 4 stars out of 5 will receive bonuses ($12.8 billion) from the quality ratings program, down from 51% this year. Nonprofit insurers outperformed for-profit companies: 56% of nonprofit Medicare Advantage carriers will earn bonuses compared with 36% of for-profit companies.

CMS developed the star ratings program to measure the quality of care Medicare Advantage members receive. The program pits insurers against one another by grading scores for 40 clinical, member experience, administrative and quality services measures on a curve, and awarding 5% bonuses to plans that earn at least four stars.

Private Capital

Pitchbook: 3Q deal value: The value of exit deals in the U.S. during the third quarter tumbled to the second-lowest amount since the same period in 2010, excepting the pandemic-ridden second quarter of 2020, according to PitchBook. Related findings:

  • The value of exits in the third quarter fell almost 41% to $44.1 billion from the second quarter and was more than 80% lower than the peak reached in the second quarter of 2021..
  • The number of U.S. exit deals fell about 46% in the third quarter from the comparable period a year earlier after showing some signs of life in the previous quarter.
  • The aggregate value of deals dropped 18% compared with the second quarter. The total value of U.S. private-equity deals was almost 55% lower than the peak reached in the 2021 fourth quarter. The value of platform deals dropped 21% from the second quarter.
  • With entry deals and exits declining, the gap between the levels of both has narrowed by $104.2 billion totaling $475.1 billion at the end of September