ESG and Firm Performance in Global Healthcare Real Estate Investment Trusts: Evidence From Efficiency and Financial Outcomes

Healthcare real estate investment trusts (REITs) play a critical role in financing essential healthcare infrastructure, but the performance implications of their Environmental, Social and Governance (ESG) engagements remain under-researched. Drawing on the resource-based theory, this study examines the ESG-firm performance relationship in the global healthcare REIT industry. We apply a two-step approach combining data envelopment analysis and regression models. Specifically, ESG performance is measured via firm-level ESG scores, while firm performance is assessed through corporate efficiency scores and well-known financial metrics, using data from the London Stock Exchange Group database (2016–2023). The results show that overall ESG performance is positively associated with corporate efficiency. However, individual ESG dimensions exhibit varying effects on the performance indicators. These findings contribute to the ESG literature in niche real estate sectors and provide policy insights for sustainable investment strategies in healthcare real estate.