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Healthcare in Brazil

“Excellence and Innovation in health care in Brazil - Private sector”

Miguel Cendoroglo NetoCOO and Medical Director, Albert Einstein Jewish Hospital, Brazil

Healthcare in Brazil

“Excellence and Innovation in health care in Brazil - Private sector”

Miguel Cendoroglo NetoCOO and Medical Director, Albert Einstein Jewish Hospital, Brazil

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Source: ANS, LAFIS, IBGE, WHO, Booz Allen & Hamilton; 2011 – WHO; 2012 - ANS, IBGE

The healthcare sector in Brazil represents 8.9% of GDP

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

– Very poor income distribution, though improvingIn 2011

Market size(1) Funding (1)Population

Coverage (2) Service Providers

US$ 213 billion

Public:45.7%

75,3%

24,7%

Single Health System (SUS)

Self-management

Insurers

Managed Care Organization

(MCO)

Cooperatives

Physicians

Pharmaceutical and healthcare

industry equipment

Hospitals

Medical Diagnostics

Contracting

Private:54.3%

Private

MIGRATION

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São PauloSão PauloRio de JaneiroRio de Janeiro

SalvadorSalvador

RecifeRecife

FortalezaFortaleza

BrasiliaBrasilia

Health Care in Brazil

90% of population use SUS:

29% use exclusively SUS services

62% uses SUS and private services

9% of population use only private services

Hospitals: 6,756 (Private/Public)

Beds: 448,954 (2.2/1000 hab) (Private/Public)

Physicians: 388,015 (2.0/1000 hab)

11.7 million hospital admissions/year

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4,194

4,584

7,300

6,827

6,422

5,999

4,3744,447

4,718

4,293

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

52

41

29

1315

21

1990 1995 2000 2005 2010 2012

Healthcare Facts:

Good coverage of Primary Health Care: Vaccines, Basic Care, Infant Mortality Rate decreasing

Unequal access to acuity care

Brazil is the 1st country in public transplantations in the world; 2nd in total transplantations

Unequal access to high complexity procedures

Unequal access to healthcare as a whole across regions

Source: WHO, National System of Transplants, Brazil Federal Council of Medicine

Maranhão

0.71

Pará

0.84

Amapá

0.95

São Paulo

2.64

Rio Grande do Sul

2.37

Physicians per 1,000 people

RJ

3.62

Distrito Federal

4.09

Infant mortality rate (probability of dying between birth

and age 1 per 1000 live births)

Solid organs: heart, liver, pancreas, lung, kidney

-74% in 22 years

+75% in 9

years

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5Stroke 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

with CT-scan devices is lower than in the more affluent areas.

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6Albert 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

Paraisópolis Morumbi Perdizes/Higienópolis M’Boi Mirim

Alphaville

Ibirapuera

Jardins

Vila Mariana

C O N S U L T O R I A E G E S T Ã O

Francisco Morato Paulista

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7Albert Einstein Hospital is a reference in Latin America

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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8Projects to Support the Institutional Development of Public Health System (PROADI-SUS)

Application of 100% tax exemptions for Projects to Support the Development Institutional of Public Health System (PROADI-SUS), divided into:

Projects: minimum of 70% of the resources in partnerships with the Ministry of Health

Services: maximum of 30% of the resources in partnerships with the State or Municipal Health Departments

Studies of Technology Acquisition

Researches of Public Interest in Health

Human Resources TrainingDevelopment of Technical and

Operation Management in Health Services

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2012 Private % Public % Total

Hospitals 2 67% 1 33% 3

Beds 647 68% 300 32% 947

Surgery rooms 34 77% 10 23% 44

Patient Days (1,000) 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

Births 3,871 49% 4,043 51% 7.914

Outpatient units 4 17% 19 83% 23

ER Patients (1,000) 262 56% 203 44% 465

Exams (1,000) 4,068 88% 544 12% 4.613

Consultations (1,000) 264 25% 786 75% 1.050

The activities of the Public Sector already represent a significant share of the activities of the Institution

30% - Services

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10Einstein 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

Número de Transplantes de FígadoCustos por Quartil de MELDCost per MELD quartile

(Average cost per transplant = R$ 85,147 or USD 43,000)Total Liver Transplants

Global Survival Results

80%

62%

+18p.p. in 3 years

70% - Projects

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Can we do more?

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Can we do more?X

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Can we do better?

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1st opinion program (decision support) for critically ill patients at 24 hospitals - 2012-2014. Program already in operation in four hospitals

> 300 pacientes already seen

Videoconferencing and telepresence

Support for ICU patients in public hospitals (PROADI-SUS)

Ministry of Health

PartnerVISICU (Phillips)

Benchmark

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43,8%

16,2%

43,8%75,6%

16,2%

Ischemic Stroke Myocardial Infarction

Sepsis or septic shock

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)