The Case for Owning vs. Leasing in Healthcare Real Estate

It’s a question that comes up in almost every strategy meeting:

Should we buy the building, or just lease it?

And in 2025, the answer isn’t as straightforward as it used to be.

Owning gives you control. Leasing gives you flexibility. But in healthcare real estate, the real decision comes down to how central the facility is to your long-term operations—and how much capital you’re willing to tie up.

If you’re running a high-performing behavioral health or outpatient surgery center, owning can make sense. You’re already investing heavily in the buildout, licensing, and staff. Having control of the real estate means you’re not at the mercy of a landlord when renewal time comes around.

But ownership also means responsibility—repairs, taxes, deferred maintenance. And in a rising-rate environment, the cost of capital can make even a solid investment feel tight.

Leasing, on the other hand, allows operators to test markets, scale faster, and stay nimble. It can be especially useful for multi-location groups or PE-backed rollups trying to move quickly and preserve cash for growth.

From a valuation standpoint, owned real estate gives healthcare groups a real asset on their books—but it also complicates things during M&A or restructuring. Sometimes, separating the opco and propco is the smarter long-term play.

What I’m seeing is this:

→ Groups that are stable, local, and focused on a single market are leaning toward ownership.

→ National groups and rapid-scale operators are leasing.

→ Everyone else is looking for the right hybrid.

There’s no perfect answer. But there is a right answer for your model.

📅 Book a call if you’re weighing the decision between leasing and ownership for a healthcare facility.

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