Trends in Healthcare Challenges and opportunities Seminário: Inovação na Saúde Brasil - Holanda Oportunidades para cooperação entre São Paulo e Amsterdam

Anahp | Representativeness

The health market in the world | Brazil is a key player 7th Largest Healthcare Market in the World 3rd Largest Healthcare Market for private healthcare in the World Total healthcare expenditures (2013) in Billion US dollars Private healthcare expenditures (2013) in Billion US dollars United States China Brazil Germany United States China Japan China Germany Japan France France Russia Canada United Kingdom Brazil Canada Italy India Others Others Fonte: Elaboração Anahp com base em dados da Organização Mundial da Saúde

Despite losses with the recession, the private system is larger than the national systems of many countries Insured population (millions) Source: ANS Data

Most of the expenses in health are from the private sector Health Expenditures 2015 (Estimates) Total health expenditures 9,5% of GDP R$563,1 B Private (55%) Public (45%) 5,2% of GDP R$308,3 B 4,3% of GDP R$254,8 B State (1,2% of GDP) R$72,5 B Private Insurance (2,4% of GDP) R$143,9 B Out-of-pocket (2,8% of GDP) R$164,5 B Federal (1,5% of GDP) R$91,7 B Municipal (1,5% of GDP) R$90,6 B Source: Data from Secretaria do Tesouro Nacional, IBGE and ANS | Estimate for 2015

Room for growth | fewer hospital beds per person than other countries Average number of hospital beds (per 1000 inhabitants) Netherlands 4,7 Fonte: OECD and WHO data (E) Estimate

Trends | Transitions Ageing Population Changes in the clinical and epidemiological profile Operational Management Long-term care Hospital Quality

Ageing | End of the demographic bonus by 2030, with an acceleration of the population ageing process Demographic pyramid (2015, and estimates for 2020 and 2030)

Changes in the clinical and epidemiological profile | Growth of Noncommunicable Chronic Diseases due to demographic, economic, cultural and environmental factors Percentage of the population affected by selected chronic diseases – by age (Brazil, 2013) Arterial Hypertension Diabetes Elevated Cholesterol

Management | Trend of growing investments in IT, in search of more accurate cost control, higher quality of care and better outcomes for patients Greater use of management tools (eg.: DRGs) Enhances control of resource availability, severity of cases, associated costs and pricing, allowing a better management of clinical teams, processes and results Measurement of outcomes Allows constant improvement of clinical and management practices, in search of better patient safety and higher quality of care More robust governance systems Professional management of the business and of the clinical staff (integrative governance) More widespread compliance systems

Long-term care | Reduction in the rate of long-term patients in hospitals indicate better de-hospitalization practices Rehabilitation Treatment Healthy Citizen Diagnosis Long term patients (>90 days) as % of hospital releases Prevention Primary Care Hospital Care Home Care

Quality | Rising number of accreditations indicates growing concern with inputs, processes and results Accreditations

Challenges to international cooperation “Brazil is not for beginners”*, but there are no insurmountable obstacles. The main barriers are: Commercial and Regulatory There is protection of the internal Market. Standards set by regulatory agencies often impose difficulties on innovation. Cultural Health professions in Brazil are well-establish and may resist the adoption of new models developed abroad Human Resources There are few professionals in the market capable of managing transnational health projects at a high level Institutional Not many health institutions are ready for an international relationship *Quote by Tom Jobim, Brazilian composer

Some of the opportunities for international cooperation Investment in a market with strong perspectives for growth Law nº13.097/2015 authorized foreign investment in healthcare. There are significant investment opportunities in healthcare infrastructure and technology, and in Public-private partnerships Management Brazil has much to learn from international experiences and models of excellence in management, and needs to develop good managers in greater numbers Technology, Research and Development Brazil has particular challenges in healthcare that require greater investment in developing solutions for local issues

Thank you! linkedin.com/in/franciscobalestrin @fbalestrin