Big picture” stuff – macroeconomic factors – hamstrung dealmaking across the healthcare sector. The global business environment for more than a decade has feasted on “free money” in the form of ultra-low interest rates. But in the past couple of years, central banks reacted with interest rate hikes, as the world struggled with supply chain woes and inflation. A lot of interest rate hikes. Wait, borrowing isn’t free? And at hospitals, profitable elective surgeries have been backlogged in the wake of COVID-19 pressures. A shortage of available trained medical personnel meant higher wages. In a flash, profitable health centers reported losing money. Rural and smaller hospitals especially began to suffer. Mergers and acquisitions slowed.