JAMA Study Reveals $2.6 Trillion in Healthcare Shareholder Payouts: A Crisis of Priorities?

New research published in JAMA Internal Medicine highlights a growing disconnect between U.S. healthcare spending and patient outcomes. The study finds that from 2001 to 2022, publicly traded healthcare companies paid out a staggering $2.6 trillion to shareholders through dividends and stock buybacks—representing 95% of their net income across the sector.

In some subsectors, including pharmaceuticals, healthcare distributors, and facilities, shareholder payouts actually exceeded total net income, suggesting companies are prioritizing financial engineering over reinvestment in research, access, or affordability.

Escalating Payouts, Lagging Access

The analysis, led by researchers at Yale and the University of Pennsylvania, examined stock performance and financial statements for companies in the S&P 500 Healthcare Index. The authors argue that this trend undermines claims from pharmaceutical and hospital leaders that high prices are necessary to fund innovation or expand access.

“Increasing capital distributions to shareholders may be associated with higher prices and may not be reinvested in improving access, delivery, or research,” said lead author Dr. Victor Roy, a physician and researcher at the University of Pennsylvania (JAMA, 2025).

Healthcare spending in the U.S. reached $4.9 trillion in 2023—more than $14,500 per person—yet affordability remains a top concern for Americans, many of whom struggle with surprise bills, medication costs, and high-deductible plans.

Shareholder First, Patient Second?

Dividends and share repurchases are standard practices in public markets, but the degree to which healthcare firms funnel profits back to investors raises questions about their social responsibility—especially given that much of their revenue comes from taxpayer-funded programs like Medicare and Medicaid.

Some of the most aggressive payout strategies came from pharmaceutical firms with high-profile pricing controversies and from hospital operators receiving government subsidies during the pandemic.

“The findings challenge the narrative that rising costs are solely driven by medical inflation or labor shortages,” said Dr. Roy. “They’re also driven by choices about how profits are allocated.”

Reform on the Horizon?

Policy proposals have begun to emerge in Congress to restrict buybacks in certain sectors or condition government reimbursement on reinvestment metrics. Critics argue that publicly funded healthcare dollars should be tied to accountability measures—particularly around R&D spending, pricing behavior, and care delivery expansion.

While healthcare companies defend these payouts as necessary to attract capital and reward innovation, the new data could strengthen calls for structural reforms aimed at realigning financial priorities with public health goals.

Implications for Digital Health and Health IT

For digital health companies and vendors, the broader spotlight on profit allocation may accelerate trends toward outcome-based pricing, social impact investing, and ESG-aligned reporting. As hospital systems and payers reevaluate vendor partnerships under growing scrutiny, firms that can demonstrate clear alignment with care access, equity, and reinvestment may gain a competitive edge.

In the meantime, JAMA’s data offer a sobering reminder that financial returns and patient outcomes are not always aligned—and that the future of U.S. healthcare may hinge as much on how dollars are used as how many are spent.