Overview and highlights of the Brazilian healthcare systems, by Eliane Kihara, Life Science Partner, PwC Brazil, for the mHealth Israel community, April 23, 2020.

1. Overview
and highlights
of the Brazilian
healthcare systems
mHealth Israel webinar
April 2020

2. PwC
• Population 211,4M
47,0 in the supplementary health system
• Life expectancy 75.5 years old in 2017 (General)
7.,8 (Male) | 79.2 (Female)
• Population 65+ 9.83%(2020) ► 21.88%(2050)
The health system in Brazil offers universal coverage for the whole population.
It is regulated nationally and funded by the three government levels.
SUS – the Brazilian public health system – is on its 30th anniversary. In the private health sector, 22.3% of the
population has insurance plans as private payers. This insurance sector is called Supplementary Health System.
2
April 2020Brazil's Healthcare Market
• Total spending in health BRL 637bn
(% of GDP) 9.3%
• Health spending per capita USD 1,357 (2014)
Private
363.7
(57%)
Public
273.3
(43%)
72.5
(11%)
110
(17%)
181.2
(28%)
118.1
(19%)
70.3
(11%)
84.9
(13%)
Total health spending breakdown 2018
(in BRL billion)
Out of Pocket Pharma retail Health plans
Federal gov State gov Municipal gov
2020 2050
Sources: IBGE, World Bank, ANS, Anahp, Sindusfarma, IQVIA, The Lancet and PwC analysis,
The aging population will drive a change on the volume,
type and cost of healthcare for a new generation of elders.

3. PwC
Growth projections for the health sector are optimistic* when compared to
other countries.
Regarding health expenditure per capital:
• Most emerging economies, specially from the BRICS or
MIST are expected to have growth in health spending per
capita of three digits together with an improvement in their
respective positions in the global ranking by 2040.
• It is projected a growth of 47% until 2030 and 104% until
2040 for health spending per capita in Brazil, although its
position in the ranking remains stable.
3
April 2020Bazil's Healthcare Market *Before Covid-19 pandemic,
Source: Artigo na revista The Lancet - Future and potential spending on health 2015–40: development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries;
Global Burden of Disease Health Financing Collaborator Network (financiado pela Bill and Melinda Gates Foundation); e análise PwC

4. PwC
The country's healthcare infrastructure and workforce shows a need and an
opportunity for expansion in both public and private systems when compared
to global standards. Equipment uneven distribution between these systems is
also an issue for the sector.
4
Sources: OCDE, Anahp, DATASUS and PwC analysis.
Primary Care Secondary Care
Tertiary
Care
Doctor's
Office
Health
Centre
Specialized
ambulatory
Policlinic Emergency
Rooms
Specialized
Hospital
Day
Hospital
General
Hospital
Private 161,405 324 40,298 7,405 227 677 632 2,903
City gov. 802 45,470 4,853 1,363 1,310 89 38 1,626
State gov. 84 727 325 112 115 137 18 453
Federal gov. 7 59 47 14 - 20 2 59
Gov.Others 3 - 84 53 - - 1 3
SUBTOTAL 162,301 46,580 45,607 8,947 1,652 923 691 5,044
TOTAL 208,881 57,820 5,044
Italy Spain Portugal Turkey Israel Avg
OCDE
Chile France Irland Switzer
land
Norway Nether
lands
Brazil
(2017)
Average number of health employees by hospitals
per 1,000 inhabitants (2015)
Healthcare facilities & (Selection of) Medical Devices by ownership
(Feb/2020)
Both the rate of bed (2.4), doctors (2.17) and the average number
of health professionals by hospitals (5.7) per 1,000 inhabitants in
Brazil are in similar levels when compared to other countries with
equivalent economic reality, but it is also below the OCDE
standards and the recommended by the WHO.
Although some rates of medical devices per 1M inhabitants are
similar to OCDE standards, the distribution of these equipments
between the public (40%) and private (60%) is uneven when
77.7% of the population is covered by SUS.
MRI CT X-Ray Mamo
grapher
Ultrasound
Scan
Endoscope
Private 2.097 3.455 12.299 5,432 25,351 10.901
Philanthropic 379 868 5.186 1,389 4,686 3.836
City gov. 33 194 4.613 869 5,785 1.681
State gov. 100 330 2.065 473 1,780 1.648
Federal gov 23 64 492 117 520 619
Gov. Others 8 21 123 35 197 252
TOTAL 2.640 4.932 24.778 8,315 38,319 18.937

5. PwC
The Brazilian health sector value chain
5agosto 2018
PayersHealthcare Providers Financial
intermediation
Products and
technologies
suppliers
Governments
Employers
Individuals
SUS
Supplementary Health
(Health insurance companies,
HMOs, Medical Coops, Self-
administered and Philanthropic
Institutions)
Brokers, TPAs and PBMs
Health promotion
Health protection &
disease prevention
Diagnostics
Treatments (eg. hospitals etc).
Chronic disease
monitoring & management
Pharmas
Medical devices
Orthoses and Prostheses
Medical materials
Biological products
Information tecnology
Products and
Technologies distributors
Support and complementary services
General services
Health products
distribution
Health services sales
Generic and
specialied retails
Financial
Accounting
Legal
Logistics
IT
Clinical research
Clinical engenering and
maintainance
Management
ConsumerHealth
knowledgement
promotion and
development
Basic research
Applied research
Education
Knowledge bases
Patient
Healthy indivitual
Integrators | transactional corps.
Rehabilitation
Regulators Ministry of Health
ANVISA ANS Federal Medical Council
Pesquisa de mercado
Atuarial e/ou regulatória
Acreditação
Incubators /Accelerators
Events’ companies
Sectorial entities
Market research
Actuarial and regulatory
Accreditation
Source: Ana Maria Malik e Marcelo Caldeira Pedroso - Cadeia de valor da saúde: um modelo para o sistema de saúde brasileiro. http://www.scielo.br/pdf/csc/v17n10/24.pdf adapted by PwC
Other healthcare
professional councils
Doctor
Other HC professionals
In a highly regulated sector, the heathcare provider segment is supervised by the Ministry of Health but NOT
regulated on its products and services, prices or technological innovation strategy. New technologies are
adopted by SUS when approved by CONITEC – a technical committee that supports the Ministry of Health.
CONITEC

6. PwC 6
142.4
78,7%
38.6
21.3%
Supplementary Health System revenue
distribution among healthcare providers
in 2018 (in BRL billions)
Other provider Top 109 private hospitals
Private
363.7
(57%)
Public
273.3
(43%)
72.5
(11%)
110
(17%)
181.2
(28%)
118.1
(19%)
70.3
(11%)
84.9
(13%)
Total health spending 2018
(in BRL billion)
Out of Pocket Pharma retail Health plans
Federal gov State gov Municipal gov
Among the 4,212 private hospitals in Brazil (63% of total), 109 leading
private hospitals concentrate ~ 21% of all revenue from the
Supplementary Health System.
Distribution of Total Expenses
by type of expense
2018
Cost with Personnel 37.32%
Technical and operational contracts 13.72%
Medicines 10.79%
OPSM and special materials 7.18%
Other expenses 8.18%
Materials 6.37%
Logistics and support contracts 4.27%
Other inputs 2.77%
Depreciation 2.87%
Financial expenses 2.06%
Utilities 2.24%
Maintance and technical assistance 1.91%
Medical gases 0.32%
Distribution of Gross Revenue
by nature
2018
Medicines 24.66%
Materials 20.36%
Admission rates and fees 21.65%
Other operational revenues 19.01%
OPSM and special materials 8.30%
Medical gases 2.30%
Other service revenues 3.39%
Donations 0.34%
Top 109 private hospitals Gross Revenue and Total Expenses breakdown
Source: Observatório Anahp 2019.

7. PwC
Health sector agenda and challenges
Digitalize the public health
system and integrate patient
data from all three state levels
healthcare facilities.
It is a BRL 6bn project on hold in the
Ministry of Health since 2018 due to
Government Fiscal Audit.
Reformulate and expand health
programs with Primary Care as
a priority.
• “Doctors all over Brazil” is a program that
intends to replace the dismissed foreign
medical workforce (allocated in distant
sites) of a similar program from the
previous government for Brazilian doctors.
• “Family health program” aims to expand
its population coverage up to 75%
(64.2%), and increase the quality of care.
It currently has 42,975 health teams.
Hierarchization of access and
optimization of the public health
system budget.
Challenges – A new federal law from 2016
that limits the increase in the Federal
Government Budget to the inflation rate of
the previous year will lead to a progressive
reduction in the Health Spending per
capita in the next 8 years as the health
budget will not grow at the same rate as
the population.
7
Sector consolidation (health
providers and health plans).
Challenges – Find “attractive” targets and to
replicate their winning care models in
acquired organizations with such different IT,
accreditation and quality levels.
Corporate verticalization
Staying competitive in price and innovation
when managing many different stages in
the continuum of care and their complex
cost structures.and “against” it
Negotiate new payment models
Challenges – Equalizing Total Cost of Care
through data integration and sharing of
data to evaluate new value-based payment
models that enable the incorporation of
new technologies in a substantiable way.
Paperless health
Although several big providers are in late
stages of HIMSS certification, a recent law
(13.787/18) was enacte to accelerate the
implementation of EMR by all healthcare
providers. This is still a big effort for small
health organizations.
Non exhaustive
Public Health
Private Health
Telemedicine
Previous lack of regulatory background for
this type of solution before the covid-19
pandemic was an issue for the sector,
which delayed the adoption of this service.
A recent law in 2020 regulates a few
practices for telemedicine, but President
Bolsonaro still left out an important concept
for this digital transformation: digital doctor
prescription.
Source: Ministry of Health (Relatório de Gestão 2018) and PwC Analysis

8. pwc,com,br
Thank you
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