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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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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