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Healthcare in Brazil
“Excellence and Innovation in health care in
Brazil - Private sector”
Healthcare in Brazil
Miguel Cendoroglo Neto
COO and Medical Director, Albert Einstein Jewish Hospital, Brazil
The healthcare sector in Brazil represents 8.9% of GDP
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 7th Largest Economy in the World - US$2.4 trillion (2012)
 5th Largest Population in the World - 201 million (July 2013)
- 84% of the population concentrated in urban areas
 5th Largest country in geographical area - 8,514,877 sq km
 1988 Constitution:
- Healthcare is an universal right of every citizen and a responsibility of the State.
Access is universal (Unified Health Care System – SUS), with no fees or copayments.
A Country of Contrasts:
– Some top quality institutions and
Market size(1)
Funding (1)
Population Coverage
(2)
Public:
45.7%
Contracting
Service Providers
Single Health
System (SUS)
Physicians
Self-management
75,3%
Insurers
Pharmaceutical and
healthcare industry
equipment
US$ 213 billion
Cooperatives
Private:
54.3%
MIGRATION
24,7%
Source: ANS, LAFIS, IBGE, WHO, Booz Allen & Hamilton; 2011 – WHO; 2012 - ANS, IBGE
Hospitals
Managed Care
Organization (MCO)
Private
Medical
Diagnostics
Healthcare in Brazil
– Very poor income distribution, though improving
In 2011
Health Care in Brazil
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 90% of population use SUS:
Fortaleza
 29% use exclusively SUS services
 62% uses SUS and private
services
Brasilia
Recife
Salvador
 9% of population use only private
services
Hospitals: 6,756 (Private/Public)
 Beds: 448,954 (2.2/1000 hab)
(Private/Public)
São Paulo
Physicians: 388,015 (2.0/1000 hab)
11.7 million hospital
admissions/year
Healthcare in Brazil
Rio de Janeiro
Healthcare Facts:
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
Good coverage of Primary
Health Care: Vaccines, Basic
Care, Infant Mortality Rate
decreasing

Brazil is the 1st country in
public transplantations in the
world; 2nd in total
transplantations

Unequal access to acuity care

Unequal access to high
complexity procedures
Infant mortality rate
(probability of dying between birth
and age 1 per 1000 live births)
Solid organs: heart, liver,
pancreas, lung, kidney

Unequal access to
healthcare as a whole
across regions
Physicians per
1,000 people
Amapá
Pará
52
7,300
0.84
0.95
Maranhão
6,827
41
0.71
6,422
29
21
15
13
5,999
+75%
in 9
years
4,718
4,584
4,447
4,374
4,194 4,293
Distrito Federal
RJ
4.09
3.62
2012
2011
2010
2009
2008
2007
2006
2005
2004
1990 1995 2000 2005 2010 2012
2003
São Paulo
2.64
Rio Grande do Sul
2.37
Source: WHO, National System of Transplants, Brazil Federal Council of Medicine
Healthcare in Brazil
-74%
in 22
years
Stroke incidence is higher in less affluent areas of the city of Sao Paulo (green,
yellow and red areas of the upper right graph), where the distribution of hospitals
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Healthcare in Brazil
with CT-scan devices is lower than in the more affluent areas.
Albert Einstein is a private, non profit network, with activities in 5 main areas (hospital, diagnostics
and preventive medicine, social responsibility, education and research) carried out through its
units distributed around the city of São Paulo
Morumbi
Perdizes/Higienópolis
Alphaville
Ibirapuera
M’Boi Mirim
Jardins
Francisco Morato
Paulista
Vila Mariana
CONSULTORIA
E GESTÃO
Healthcare in Brazil
Paraisópolis
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1.
Joint Commission Accredited since 1999. Only Stroke
Center accredited in Latin America
2.
AméricaEconomía - Best hospital in Latin America for the
5th consecutive year
3.
Planetree Designation
4.
1460 liver transplants, 2579 solid organ transplants
5.
Leadership in Robotic Surgery
6.
Centers of Excellence with published outcomes in
orthopedics, cardiology, neurology and oncology
7.
Reference Spine Center for top health insurance in Brazil
8.
First Hybrid Cardiac Operating Room in Latin America
9.
Physician-Hospital Relationship Program – Model in Brazil
(meritocracy)
10.
Comprehensive Patient Flow Program - first in Brazil
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Healthcare in Brazil
Albert Einstein Hospital is a reference in Latin America
Projects to Support the Institutional Development of Public Health
System (PROADI-SUS)
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 Application of 100% tax exemptions for Projects to Support the
Development Institutional of Public Health System (PROADISUS), divided into:
Studies of Technology Acquisition
Researches of Public Interest in
Health
Human Resources Training
Development of Technical and
Operation Management in Health
Services
 Services: maximum of 30% of the resources in partnerships
with the State or Municipal Health Departments
Healthcare in Brazil
 Projects: minimum of 70% of the resources in partnerships
with the Ministry of Health
The activities of the Public Sector already represent a significant
share of the activities of the Institution
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30% - Services
Hospitals
Private
%
Public
%
Total
2
67%
1
33%
3
647
68%
300
32%
947
34
77%
10
23%
44
194.4
67%
94.9
33%
289,3
Discharges (1,000)
48.9
76%
15.2
24%
64,1
Surgeries (1,000)
37.0
92%
3.2
8%
40,2
3,871
49%
4,043
51%
7.914
4
17%
19
83%
23
262
56%
203
44%
465
4,068
88%
544
12%
4.613
264
25%
786
75%
1.050
Beds
Surgery rooms
Patient Days (1,000)
Births
Outpatient units
ER Patients (1,000)
Exams (1,000)
Consultations (1,000)
Healthcare in Brazil
2012
Einstein performed 26% of the liver transplants in the state of SP, with
survival rates 18p.p. higher than the best centers in the country and
similar to the US. Leader in adult liver transplant performed in the
world in 2010
Cost per MELD
quartile por Quartil de MELD
Custos
Número
de Transplantes
Total
Liver Transplants
de Fígado
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(Average cost per transplant = R$ 85,147 or USD 43,000)
Global Survival Results
62%
+18p.p.
in 3 years
70% - Projects
Healthcare in Brazil
80%
Healthcare in Brazil
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Can we do more?
Healthcare in Brazil
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Can we do more?
X
Healthcare in Brazil
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Can we do better?
Support for ICU patients in public hospitals (PROADI-SUS)
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> 300 pacientes already
seen
Partner
Videoconferencing and
telepresence
Ministry
of Health
Bench
mark
VISICU
(Phillips)
Healthcare in Brazil
1st opinion program (decision support) for critically ill patients at 24 hospitals - 2012-2014.
Program already in operation in four hospitals
Reduction in mortality rates after implementation of a telemedicine
program (specialist telepresence) for Stroke, MI and Sepsis at
Hospital Moyses Deutsch (Jardim Angela, Sao Paulo)
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Myocardial Infarction
Ischemic Stroke
75,6%
43,8%
43,8%
Sepsis or septic shock
16,2%
Healthcare in Brazil
16,2%