In this short video, we’ll show you how our powerful platform can transform your approach to prospecting, enabling you to pinpoint the right hospitals in a fraction of the time it would take with traditional methods.

With SurgiScope, you can access detailed insights on over 9,000 hospitals across 4 countries. Whether you’re selling MRI machines, surgical instruments, or other medical devices, our service helps you find exactly who to target, without wasting time on unqualified leads.

Watch the video to discover how SurgiScope can streamline your lead generation, improve your sales targeting, and boost your success rate in the competitive medical equipment market. It’s fast, accurate, and tailored to your specific business needs.

Next Steps

Get in touch with us to schedule a demo of SurgiScope. We’ll walk you through how it can quickly connect you with the best prospects for your product across Latin America.

Let’s accelerate your lead generation so you can start closing deals faster.

SCHEDULE DEMO NOW

This quick reference resource features equipment counts and other key data for hospitals in 18 markets. Find key data points for each market, such as:

• Percentage of private and public hospitals
• Number of hospital beds
• Number of operating rooms
• Number of anesthesia machines
• Number of CT scanners
• Number of X-ray machines

And more.

Download your free copy of the 2024 Latin American Hospital Landscape here and get helpful data to understand the healthcare market in the region.

Click here to download the infographic.

Take it a step further

If you need more detailed information about surgical procedures, market size and share, market leaders in various medical equipment categories, or any other ad hoc research for hospitals in the region, please contact us. GHI provides comprehensive market insights and in-depth data that can help you benchmark opportunities and gain competitive intelligence.

Our goal is to capture what is happening in Latin American hospitals and share these updates with our audience. Currently, our team is in regular contact with thousands of hospitals as we update information for our HospiScope database and offer new data for our Latin America Hospital Monitoring service.

What we’ve done is take advantage of that ongoing contact to produce this resource for our readers. This Pulse Report issue spans Brazil, Mexico, Colombia, Argentina and Chile, and covers topics like:

• Electronic medical records in Latin America
• The challenges faced by IT during the patient journey
• The advantages of technology in healthcare services

And more!

Click here to download the report.

Deepen Your Insights

This report is just the beginning. If you’d like to have access to much more detailed data and monthly updates, subscribe to GHI’s Latin America Hospital Monitoring service. You access it using a Power BI platform with simple, efficient data displays. Click here to find out more about how you can subscribe to the Latin America Hospital Monitoring service.

Mexico’s current situation in the hospital sector

Mexico’s hospital sector is highlighted in HospiRank 2022, a ranking of the best equipped hospitals in Latin America, compiled annually by Global Health Intelligence (GHI). Hospital General de México is regarded as the best equipped hospital, with 1,110 beds and 50 operating rooms. “What is interesting to the private sector is that there are some [hospitals] such as Médica Sur, ABC, Ángeles, and Muguerza, that are very well equipped, specialized, and also offer fast treatment, which is one of the biggest problems in the public sector, where there is a lot of demand but long waiting times,” explains Mariana Romero, Director of Intelligence Services at GHI.

The same survey shows that Mexico has one of the highest operating-rooms-to-hospital ratios in Latin America. With an average of 2.2 operating rooms per hospital, it comes second behind Brazil (4.4), beating Colombia (1.2), Argentina (1.3), Central America (1.4), Chile (1.4), Peru (1,4), and the rest of Latin America (1.4).

Of the hospitals specializing in surgical procedures, Hospital Juárez de México, established 175 years ago, is considered the birthplace of Mexican surgery, and is one of the best equipped in the country. It is emblematic in the surgical sector as it has been a leader in certain treatment innovations,” says Dr. Gustavo Esteban Lugo Zamudio, CEO of Hospital Juárez de México, whom we interviewed for HospiRank. The hospital treats 54 specialties in the three levels of care and is constantly renewing its equipment to keep it up-to-date. “We are going to reinforce what we need here for tertiary care. We have resumed kidney and corneal transplants, and are exploring the possibility of performing liver transplants in 2023, so we are looking at the equipment we need to achieve that objective, as well as bone marrow transplants,” says the CEO regarding its purchasing plans.

The institution also develops surgical technology: “There are other relevant programs. Right now, few institutions offer a prosthetics program, especially for losses of lower limb segments. We are currently at the first stage, where we managed to reach an agreement with Mexican developers of this kind of technology. The agreement stipulates that the technology will be developed at Hospital Juárez de México so that the hospital will be the owner of the patent, to reduce the costs,” he told us.

Mexico is also among the countries that stand out for their hospital care infrastructure. It has more than 1.2 million hospital beds (1,224,837) and nearly 60,000 operating rooms, including those that were added after the survey was carried out (which counted 58,699 operating rooms). It also has 14,714 delivery rooms, and a still low ratio of 2 doctors per 1,000 inhabitants.

The Mexican health system

Mexico is the region’s second largest country after Brazil, with more than 3,000 hospitals. The Mexican health system is unique in the region, with a private system operated in parallel with a public system composed of more than 10 independent and isolated structures.

As GHI’s CEO, Guillaume Corpart, says, understanding the Mexican health system is a challenge because of the lack of communication among its units. “The private system has no obligation to report its procedures, or to use a consistent coding scheme, so it is a black hole that leaves a lot of questions unanswered,” Corpart says. The absence of standardization for clinical information is also a barrier. “The public system operates with independent structures that function without anything linking them to each other.  In addition, even though they are required to monitor the number of procedures performed, they do not use standardized codes, and in many cases they also fail to use the proper code. Some organizations use the international classification ICD-9, some use ICD-10, while others use their own or internal codes. This makes data management very complex. And also, because of this, the decision-making for initiatives such as increasing access to health becomes almost impossible, as it is very difficult to get a full picture of the system and the procedures performed,” says Copart.

Moreover, the system is evolving. Mexico’s present government is carrying out an ambitious policy to transform the health system, setting its sights on emulating the type of coverage system Denmark has for its population. While its political opponents view this plan as far from viable, the fact is that it has already implemented a series of changes aimed at providing the country’s health care institutions with more and better supplies, which means investment by the state administration in equipment, doctors’ offices, technology, and professional training.

On December 22 last, Mexico’s president, Andrés Manuel López Obrador, announced that Mexico will have one of the best health systems in the world in 2023. “To do this, the government is working on fixing its health centers, medical units, and hospitals, and making sure there are enough doctors,” he announced in a press conference held in Quintana Roo.

The health secretary, Jorge Alcocer Varela, said the new health system promoted by the government is seeking to provide universal, free coverage and access, even in the most remote parts of the country. “A health system focusing on humanist values and the inalienable principle of social justice,” he added. He also outlined the plan to transform the Mexican health system. He stressed that the fundamental objective of its transformation is to make Article 4 of the Constitution a reality, which means providing health care access to the nearly 70 million Mexicans who are currently without social security.

As the survey by GHI’s SurgiScope shows, in 2019, 2020, and 2021, there does not seem to have been complete coverage for the wide range of illnesses that are currently treatable with surgery. Most surgical practices were performed in the field of women’s health: obstetric procedures rank in first place, operations on female genital organs rank second, and operations on the digestive system rank third.

According to SurgiScope, the surgical procedures most often performed (sorted by field, without mentioning each specific procedure type) are:

1. Obstetric procedures
2. Operations on female genital organs
3. Operations on the digestive system
4. Operations on the musculoskeletal system
5. Operations on the integumentary system
6. Operations on the eye
7. Operations on male genital organs
8. Operations on the urinary system
9. Operations on the nervous system
10. Operations on the cardiovascular system
11. Operations on the nose, mouth, and pharynx
12. Operations on the respiratory system
13. Operations on the endocrine system
14. Operations on the blood and lymphatic system
15. Procedures and interventions not classified elsewhere
16. Operations on the ear
17. Miscellaneous diagnostic and therapeutic procedures

As a preliminary conclusion, Guillaume Corpart points out what an analysis of SurgiScope’s data tells us. “Most procedures are centered on women’s health, leaving aside other, more complex procedures. In Mexico, we can see that procedures are focused mainly on treating relatively basic cases, a reflection of the health system and the way it operates,” he says, adding, “There is an opportunity for growth in level of care and procedures by providing the population with medical education and access to health.

We can say that, looking forward, there is much to be done in Mexico in terms of surgery, surgical procedures, and providing these services to the country’s population. This makes surgery an opportunity sector for health providers. Surgical procedures broken down by practice can be looked up in the SurgiScope database, which shows the number of these performed in 2019, 2020, and 2021.

What the data tell us

Although Mexico’s public health system does not have a robust health information system with which to measure the state of surgical care, the surveys carried out by SurgiScope provide excellent quantitative information for detecting market niches that could benefit from the health products and services that the Mexican surgical sector needs to develop and grow over the coming years.

Other important inputs for understanding the situation of surgery in Mexico are the indicators proposed by The Lancet Commission on Global Surgery.^[1]

In the case of Mexico, these indicators show that the ratio of practicing surgical specialists is 40.2 per 100,000 inhabitants, double the target suggested by this commission and just above the average for high-income countries. This means that Mexico has enough surgeons, who are potentially eager to receive training in the latest technologies and devices that exist in order to significantly improve patient care and thus fulfill their goal: saving lives.

More facts about surgery in Mexico 

Rise of cosmetic surgery

Mexico is a regional leader in the field of cosmetic surgery, and is even regarded as a “medical tourist destination.” According to the president of the Association of Professionals with a Master’s Degree in Cosmetic Surgery of Mexico, Mauricio Casillas, the country ranks fifth in terms of highest demand for cosmetic surgery worldwide. In Mexico, demand is at a rate of 923,000 plastic surgery procedures per year, representing an average of more than 2,500 operations of this kind a day.

In an interview with the EFE news agency, Mauricio Casillas forecasted that within the next five or six years the market for cosmetic surgery will have grown by a factor of 10. The top three cosmetic surgery procedures performed in the country are: rhinoplasty, breast augmentation, and liposuction.

The ratio of cosmetic surgery among women and men in the Mexican population is 60/40. This means that for every 10 cosmetic surgery procedures performed in Mexico, four are on men. Why has the surgery market grown? For two key reasons: the low cost compared to the epicenters of this specialty (United States and Europe), and the quality of the services provided at Mexican clinics.

Equipment

• In health care systems, physical and material resources are necessary components for proper hospital care of the patients requesting the services.
• In 2021, a figure of 1,007 clinical analysis laboratories was reported in private health care establishments, distributed among general and specialty hospitals.
• Current data from HospiRank 2022 show that Mexico has 3,655 hospitals, 154,045 hospital beds, and 6,819 operating rooms.
• Of the hospitals analyzed in HospiRank, 63% are private and 37% are public. Those in the public sector have approximately 95 beds per hospital, while private hospitals have 16 beds per unit.

Areas of highest growth in surgical procedures

The areas where Mexico has experienced more growth in recent years are:

• Basic surgery: High- and low-temperature sterilization machines; operating tables.
• Advanced surgery: Catheterization laboratories, endoscopy towers; laparoscopic surgical equipment.
• Patient care: Patient-monitoring systems.
• Diagnostics: Echocardiogram machines.
• Advanced diagnostic imaging: Fluoroscopy systems.

Next steps

Contact us to learn more about GHI’s SurgiScope and HospiRank solutions. Both are resources for medical-equipment manufacturers, enabling them to see which hospitals in Latin America have specific types of equipment and in what quantities, as well as reference points for hospital administrators.

^[1] Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development, 2015, https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60160-X/fulltext

Since the start of the COVID-19 pandemic, each year has been marked by a key event that has shaped most of our lives in the West. For example:

• 2020 was the year that COVID lockdowns began, and uncertainty ensued.
• 2021 was marked by global vaccination campaigns, the race to 2+ doses and adapting to the “work from home” environment.
• 2022 was the year the world began enjoying vacations and outings again, while employers struggled to get their teams back in the office.

This year will pose its own set of challenges and opportunities. While some of the global driving forces will impact Latin America, the region poses unique characteristics in which opportunities are uncovered. Global Health Intelligence is exploring these driving forces and what they mean for healthcare manufacturers.

The Rise of China

The United States and Europe have long played a central role in shaping the offering of life sciences technologies within Latin America, whether this be in the pharma, consumables, medical device, or medical equipment sector. The COVID-19 pandemic brought about new and heightened demand for medical products, disrupting consumption patterns, and obliging clients to look at alternate suppliers and supply routes. Nimble Asian (specifically Chinese) suppliers took advantage of this opportunity to pave inroads into the region. And while 2022 was marked by a certain degree of “return to normalcy”, the region is now more open to Asian suppliers than it was before the pandemic, shaking the stability of established American and European manufacturers for the years to come.

Tensions between the United States and China are expected to continue throughout 2023 and beyond.  We can expect a rift in established relations as China will play a critical role in shaping trade in the region.  China will grow as a trading partner (especially given the pre-emptive lifting of the Zero-COVID policy) to the expense of all other economic blocks, gaining clients throughout Latin America, while the United States and Europe try to secure their allies in the region. The influx of economical healthcare products will put further strain on local R&D, manufacturing and competitiveness, critical factors to establishing long-term centers of expertise – a need that was made evident by the pandemic.

Implications for life science manufacturers

1. New entrants (mainly Asian) need to invest in understanding local markets and dynamics to grasp the nuances of healthcare sales and distribution in a region that they have not participated in historically.

2. Established manufacturers (mainly from the United States and Europe) need to closely monitor their markets for new entrants. A shift in paradigm will likely take place, seeking to redefine markets and competitors. Innovation and long-term contracts will be critical to maintain the client base. Historical relations become a key asset, whether to drive quality assurance programs (with associations, chambers, medical groups, patient groups, etc.) or to strengthen regulatory frameworks (with regulatory bodies, customs, tax authorities, public sector institutions, etc.).

3. Distribution channels will be reassessed, seeking to adapt the channel strategy to the market segmentation and further drive efficiencies based on client needs. We can expect disruptive channel strategies to appear, likely causing tensions between manufacturers and distributors.

The Impact of War in Ukraine

The Northern hemisphere is going through its first full winter while dealing with the effects of the ongoing war in Ukraine. While initial tensions of a global conflict and fears of nuclear escalation have ebbed (these cannot be ruled out entirely, however), the world is feeling the impact of the “long war” and the rise in cost that is generated.

Rising energy costs in Europe impact local household finances. Lower food production from Ukraine calls for greater demand of grains and other staples from global markets, contributing to a worldwide increase in food costs.

Food and energy represent over 40% of the consumption basket in most of Latin America’s middle-income countries, notably Brazil, Mexico, and Peru. Rising energy and food costs will be the main contributors to inflation across the region, putting pressure on household disposable incomes and contributing to a widening inequality gap. The region’s poorest and most vulnerable groups will suffer the most, with poverty rates expected to increase above 36% by year-end 2023 (from 30% in 2018 and 34% in 2020) and ensuing social tensions.

Looking forward to 2023, we can expect high energy and food costs to continue, fueling inflationary pressures that central banks will try to tame.

Implications for life science manufacturers

1. Manufacturing costs will rise. Efforts will be placed on resource-efficient product engineering, using less raw material and fewer components.

2. Distribution costs will rise.  With high energy prices, distribution costs will remain high. Manufacturers will seek to make their distribution chains more efficient, with better logistics and by redefining distribution channels.

3. Margin compression. Consumers will absorb some inflationary increases; manufacturers must become creative in their manufacturing and distribution strategies to increase their bottom line through operational savings.

4. Increased need for long-lasting corporate social responsibility. With vulnerable groups becoming even more marginalized, the need for quality healthcare will grow, particularly in the public sector. Governments throughout the region will welcome opportunities for increased public-private partnership (PPP) collaborations as a way to meet the increasing demand.

After three years of continued lifestyle disruptions, the feeling that we are in a permacrisis—an extended period of instability and insecurity—is evermore present, keeping consumers and corporations asking, “what next?”.

The abundance of cash, handouts and low interest loans fueled an already hot economy. Supply chain disruptions further exasperated the problem, resulting in product scarcity and a continued upward edging of prices. While supply chains are returning to standard behavior, high energy and food prices will keep inflation on the radar throughout 2023. While Ukraine fights Russia, the rest of the world fights inflation and economic stagnation.

Inflation in most global markets is expected to exceed 5% in 2023, with China remaining a wild card as it exits the Zero-COVID policy and looks to re-engage economically with the world.

Historically, whenever inflation in America has reached 5%, a recession has followed, with ensuing economic ripples across Latin America. While the probability of a recession hitting the U.S. in 2023 exceeds 70% (Source: Citibank, December 2022), it will likely be a short-lived event that will last less than one year.

Implications for life science manufacturers

1. Nearshoring is a real long-term strategy. While nearshoring is a way for the United States to strengthen its supply chain by relying less on Chinese manufacturing, the approach also has merit to combat inflation during high energy cost periods and becomes a long-term strategy for manufacturers. Due to the proximity to the U.S. market, Mexico has the largest opportunity for nearshoring in Latin America estimated at US$ 35 B, followed by Brazil (US$ 7.8 B), Argentina (US$ 3.9 B) and Colombia (US$ 2.6 B). Source: The Inter-American Development Bank.

2. Online sales will gain a growing share of the market. Online sales represented 10% of all sales in 2019 and 14% of all sales in 2022. Due to highly regulated products, life science manufacturers have been reluctant to significantly invest in this channel. Regulatory changes (growing presence of online prescriptions), combined with increased online purchases (spurred during the pandemic), as well as inflationary pressures, are a perfect combination of factors to drive online sales in the life science space, compressing the distribution chain, increasing margins for manufacturers, and possibly placing downward pressure on consumer pricing.

3. Medical tourism is rebounding. Hospitals and health systems across Latin America recovered in 2022, regaining their pre-pandemic operational levels. With inflation on the rise in the U.S. and general increase of medical costs, we can expect additional bolstering of medical tourism in Latin America.  Mexico, Central America, and Colombia will benefit the most from this trend, due to their geographic and cultural proximity, as well as being historic centers of expertise.  The types of medical tourism services offered in Mexico are evolving, going from predominantly elective surgeries in the 2000s (such as plastic surgery and IVF) to more complex procedures today (including bariatric and cardiovascular).

Additional Factors at Play

Additional trends will likely appear across Latin America’s healthcare market, guided by operational efficiencies and innovative leadership. As important as these may be, they will likely remain factors in isolation rather than macro drivers.

Operational efficiencies (select examples)

• Increase in ambulatory / short stay surgeries
• Reduction of patient stays within hospitals
• Telehealth incremental increase
• Interoperability
• Homecare

Innovative leadership (select examples)

• Robotic surgery systems
• Adoption of international best practices
• Metaverse reality check – limited in functionality and implementation

Lastly, government stakeholders will maintain a reactionary stance to healthcare, viewing systems as a cost rather than an investment in economic productivity and workforce wellness. As long as this is the case, only limited incremental changes driven by individual initiatives will be seen, as opposed to transformative changes that adopt a long-term view of healthcare.

Next Steps

GHI will continue to study the aforementioned trends throughout the year and their effect on the medical equipment market and healthcare manufacturers. If you would like to discuss these trends further or see how they will impact your business and operations, please contact GHI for more information.

Interview with Leonardo Semprun

Leonardo Semprun, Senior Director of Global Regulatory Policy at MSD, reveals the changes implemented among drug and medical-device regulatory agencies, and how this experience helped accelerate approval processes for innovations while guaranteeing safety in Latin America.

By Daniela Chueke Perles

American pharmaceutical company MSD (Merck, Sharp & Dohme), a global leader in health care, held its 19th Latin American Science and Health Journalism Seminar in Buenos Aires. Global Health Intelligence (GHI) spoke to Leonardo Semprun, head of global regulatory policies at MSD, who revealed the transformations in drug and medical-device approval processes that are game changers in terms of access to scientific innovations.

The need to provide rapid responses to the emergency meant that, during the pandemic, regulatory agencies adapted by speeding up their processes. The lesson learned is that, in many cases, the skills the agencies acquired could be sustained over time.

GHI: You have mentioned that there are various circumstances or mechanisms that expedited the way drugs were approved during the pandemic. Is there any drug in particular, besides the COVID-19 vaccines, that may have benefited from this new regulatory approach? Which drugs do you think are best suited to benefit from expedited regulatory approval? And which ones are not?  

Leonardo Semprun: During the pandemic we saw these expedited pathways come into effect. The expedited regulatory pathway as such is a practice that did not exist before COVID. Accordingly, product approvals issued in that time window were primarily the result of public health needs in the context of the pandemic: mainly diagnostic and testing mechanisms. As for the developers’ vaccines that were approved at that time, many companies in Latin America were given emergency usage authorization. Emergency usage is a special authorization. It is not a registration license per se, but rather a means provided for regulatory decision making. Obviously, all of this was done based on risk analysis, ensuring the safety, quality, and efficacy of the products at all times.

GHI: Was there any regulatory progress in terms of cancer treatments?

Leonardo Semprun: It was also known that cancer was an illness that needed to be covered and given a level of care during the pandemic. I don’t know about any specific procedure during the pandemic, but I do know that, as a result of this international collaboration, there are global initiatives aimed at giving access to cancer products. The initiative is known as Orbis. It is a joint evaluation mechanism among global regulatory agencies with a high level of health vigilance, and in the region we have some very positive experience with Brazil forming part of these initiatives. It is not a mechanism that comes as a response to the pandemic—it came before that—but I mention it because it is an expedited mechanism that has proven to have many benefits. So, to answer the question: yes, the expedited regulatory pathway was focused on COVID-related treatments. Over the course of the pandemic, we could see how regulatory agencies were issuing communiqués, circulars, and guidelines that were opening up their spectrum of action.

GHI: Did regulatory agencies work harder than usual during the pandemic?

Leonardo Semprun: With the challenge also that in Latin America many of these interactions between the manufacturer or the company used to be face-to-face meetings. In other words, there was nothing in the practice that told us how things were supposed to be done, and obviously there was a period of adaptation. Regulatory formalities before the pandemic were usually begun by submitting all the physical documentation, and the big change that happened during the pandemic was that digital electronic mechanisms had to be set up to deliver files and certificates.

GHI: But not all Latin American countries were prepared…

Leonardo Semprun: There is a quite interesting case we can talk about in this context: certificates of pharmaceutical product. Certificates of pharmaceutical product are used to demonstrate the approval given by a country that has high levels of health vigilance. The FDA and the EMA issue certificates of pharmaceutical product, and those certificates are adopted by national agencies. That is, an agreement from the WHO exists. There is a whole arrangement in place. Those certificates bear an apostille. During the pandemic, the European Medicines Agency issued electronic certificates. This was a breakthrough, as these certificates usually arrived by FedEx with an apostille, but from that point on it was agreed they would be sent electronically. That was a big step forward.

GHI: Now that the exceptional nature of the pandemic has passed, will these new electronic approval procedures continue in effect?

Leonardo Semprun: We are now pushing for this as associations. I am in a network, the International Conference [sic] for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (better known as ICH), which works with the European Medicines Agency, and we are pushing for the adoption of electronic certificates.

GHI: To sum up, what changes or lessons learned in the regulatory processes has the pandemic left us with? 

Leonardo Semprun: There are many practices in the expedited regulatory pathways, but the main one is reliance (collaboration). Emergency usages are criteria based on reliance because they are based on recognizing the decisions of others, although it is not a health registration as such. We have to make the distinction here: emergency usage is a temporary thing. In fact, as the pandemic progressed and some countries declared that the situation has been improving, they have therefore removed the emergency usage because it is understood that this usage is for health emergencies only.

What does reliance mean and how can it strengthen Latin American regulatory systems?

The Latin American Federation of the Pharmaceutical Industry defines reliance as an action whereby national regulatory agencies can consider and give significant weight to assessments performed by another regulatory agency, another trusted institution, or any other authorized source of information, in order to make its own decisions. The authority using this information is still independent, and is solely responsible for the decisions taken, even when they are based on the decisions and information of others. Reliance is a practice based on good regulatory practices to contribute to a process of solid and efficient regulation of medical products. In recent years, regulators in Latin America and the Caribbean began adopting different means of reliance, particularly in the context of the COVID-19 pandemic.

According to Leonardo Semprun, Latin America adopted reliance well over the last few years. “Awareness has been raised about the importance of reliance—something that comes with the backing of the WHO, which has issued good regulatory practices. The Pan American Health Organization has also worked on technical committees with various regulatory agencies.” These include Mexico’s COFEPRIS. 

Mexico’s admission to the ICH

The International Conference [sic] for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use is a network that brings together regulatory authorities from different countries with the pharmaceutical industry, to discuss scientific and technical issues regarding pharmaceutical products, and develop guidelines for action. The entity was formed in 1990 to ensure that safe, effective, and high-quality drugs are being developed, registered, and maintained in the most efficient way possible. In November 2021, Mexico became the only Spanish-speaking country member of this regulatory maxi-forum, and is only the fourth country from the Americas region to have joined (along with Canada, the United States, and Brazil).

Interview with William Krinickas
Vice President for Latin America
MicroPort

In a chat with William Krinickas, MicroPort’s Latin America chief, we discussed the impact of the pandemic on the health sector and the new opportunities that have appeared in the market.

Latin America is a long way from achieving a health system comparable to other regions. What do you think the causes might be?

The issue continues to be limited patient access to therapies for a variety of reasons. One of the main obstacles to better health systems and the efficient use of resources in some countries of the region has been corruption, which generates instability and profound economic crises within each ecosystem.

On the other hand, we live in a context where there is a constant lack of legal certainty, affecting the ability to plan for the long term. This generates mistrust and low predictability throughout the region as it is very hard to achieve economic stability without political stability.  Add to this the negative growth rates in recent years.

The pandemic has highlighted the strengths and weaknesses of health systems in the region, as well as the consequences of corruption that we have lived through in several of the region’s markets. This is Latin America’s cancer.

Conversely, our pricing is shifting more and more toward greater transparency, which will allow us to improve access by democratizing the scope of devices and equipment that used to be unfeasible for our region. This is possible because of the collaboration between the industry’s businesses and associations and our governments, with a view to moving forward.

The pandemic is not over yet, although it appears to be in its final stage. How do you think this has affected the health sector, and what lessons has the industry learned in this regard?

The pandemic has caused chaos in our societies and created long-term disruptions to our health systems. All the procedures or checks that used to be done but have stopped being done will be reflected in clinical cases over the next few years, and this situation will have a big impact within the health system. We are experiencing something that is unprecedented, a phenomenon that is beyond our grasp. 

Personally, I don’t think it has only had a negative impact. COVID-19 has also changed our approach and has opened the door to new opportunities: for example, among the most prominent [events] is the fact that telemedicine has assumed a leading role, [there has been] a redistribution of budgets, and a rearrangement of the system to achieve better patient care or greater coverage. I believe these should be what our interests are as an industry, as governments, and as a medical community. We have a duty to take care of the population’s health, and currently many companies are participating in green or sustainable economy programs, which is the future of health.

The last few years have been a time of crisis for some companies, and of opportunities for others. How did MicroPort fare?

The pressures of the pandemic have been enormous for all countries and their respective industries. The crisis brought about by COVID-19 has considerably depleted the budgets. These structural changes have given new developers the chance to enter the medical-device market, offering quality products at more affordable prices for healthcare systems whose budgets have been significantly affected.

The capacities of healthcare systems have changed completely to be able to continue providing coverage in terms of both quantity and quality. This situation has given rise to new offers of value, technology, and quality, such as minimally invasive procedures.

For MicroPort, the pandemic has been a moment of opportunity; we have been able to add our portfolio of medical and robotic devices to most areas of minimally invasive therapy. These types of surgery have significant benefits over traditional surgery. Physicians have greater control of the procedure [by] making small, precise incisions without trembling hands, as they can operate with mechanical movements, made by the robot. [This means] they can easily get to hard-to-reach areas, with significantly better vision thanks to the equipment’s built-in cameras. For the patient, this means faster recovery times than in traditional operations, with less blood loss, fewer complications, and smaller scars. In all cases, these types of surgery are more beneficial.

————————

MicroPort is a multinational that has been developing and manufacturing medical devices for the whole world for more than 20 years. It is one of the top 100 medical-device companies.

Interview with Dr. Alejandro Mauro
Head of the Biomedical Informatics Department
Clinica Alemana

After the pandemic, which forced us to make traditional channels of communication with patients more flexible, Latin American health systems are now facing the challenge of managing institutional treatment by incorporating the technological adoption that grew rapidly over the last two years. One example of this is the development being carried out by Clinica Alemana in Santiago de Chile to solve the problem and avoid the associated risks.

Dr. Alejandro Mauro —Head of the Biomedical Informatics Department at Clinica Alemana in Santiago de Chile— says the outbreak of the COVID-19 pandemic spurred the legislative changes needed for the adoption of technology in medicine. According to the innovation expert, that process was generally at a standstill in Latin America because of two main factors: legal obstacles and pushback from healthcare professionals.

He also, however, points to a scenario that was not anticipated: the COVID-19 pandemic has positioned Meta’s instant messaging app as an unexpected channel of communication between doctors and patients. Accordingly, Mauro says health systems are faced with the challenge of maintaining the management of medicine within the institutions.  Here we share his detailed answers to our questions.

Why did the pandemic speed up the adoption of telemedicine or virtual consultations, solutions that were already developed in Latin America?

Because of the legal obstacles and because there was no funding to make the technological changes; and if something isn’t funded, it doesn’t exist. Telemedicine had been adopted in places where it was the only option. The history of telemedicine is closely tied, for example, to the world of shipping. Not all ships have a doctor aboard, and there are thousands of ships. Telemedicine measures have been used on ships for more than a century. But those circumstances aside, society was failing to take advantage of innovations in the field of telemedicine. They went no further than being pilots to the production and implementation stage, because there was no funding for them and because the legislation made it really difficult.

What barriers were there to the adoption of telemedicine?

There were old regulations that meant prescriptions and a lot of medical documents could not be generated digitally at the source. Electronic prescriptions, for example, were not implemented because of legal obstacles. All Latin American countries said that prescriptions had to be written out by hand. Then along came COVID and it upended everything. Doctors had no way of getting to patients. Patients had no way of getting to hospitals, so then countries had to completely change their whole philosophy of trying to avoid this, which in a way is what had been happening. Even in countries that already had payment policies in place, like the United States, there was a lot of opposition. For example, they would say, “How can we hold video consultations via Zoom? No, there has to be a special system hosted on a secure server.”  As if video were a problem. Then, there were numerous limitations. For example, there were limitations that were built into the HIPPA Act on personal data protection: medical consultations couldn’t be done via Google Meet or Zoom, or any of the traditional video conferencing platforms. It meant having to get a specific company to make a dedicated video component for the institution’s medical informatics solution. When COVID arrived, all those obstacles were lifted. Even using WhatsApp was allowed, and the use of technology went from being within a very restrictive context to a very permissive one.

So is there now a context of risk in terms of data being shared?

Yes, because all this use of informal channels has several implications. When medical information is delivered on certain networks with automatic reading mechanisms that are shared with users, these users need to be aware that they are ultimately providing Google, Facebook, or Apple with their personal information. And they will use that information to then sell us something. It’s a dilemma that is still quite open because today, effectively, the largest digital health system in the world is WhatsApp. That’s why it is currently the platform that knows the most about health.

What a revelation!

WhatsApp has the greatest amount of health information today because doctors are currently communicating with patients through that app, and because doctors are communicating with each other through WhatsApp; they interact with things about the patient. It’s an app that everyone has, and that is used more than email—there are loads of email providers besides Google—but WhatsApp is Meta’s alone. That sort of set the stage for what, to me, is a problem that we’re in and that we still don’t know how to get out of. As I see it, a lot of people’s information is going through that network.

Do we know if there is any kind of policy or pronouncement from Meta, the company that owns WhatsApp, about this issue?

No, not at the moment. But the issue of Facebook sharing patients’ mental health information is being looked at. A paper by JAMA (Journal of the American Medical Association) looked at apps for smoking cessation and depression. These apps that are in the stores for anyone to download, they take the data or health information of their users, for their clients. The study found that Facebook was sharing that mental health information with third parties. What does that mean? It means a person who, for example, is depressed may get offers of all kinds that will supposedly cure their depression: a course on how to be positive, drops, whatever, that are based on dubious scientific evidence. We start getting into a gray area that is difficult to work out.

Algorithms don’t differentiate

It’s not even done by a human; it’s done by a machine. This means the machine could make the decision to start sending out advertising about the topic related to your data. It isn’t a question of somebody programming it maliciously, it’s just the way e-commerce works: it’s guided by machine learning algorithms. A machine learning algorithm will correctly identify that this user needs to be sold some therapy.

Could we say that the borders between health and pseudo-health are being expanded or blurred, that it is more about providing a health service as an excuse to sell something? Do you think that is the danger?

It is a danger that the medical world is aware of, but the problem is that there is so much ignorance around how the technologies work. We don’t know how Facebook’s data center functions. I have no way of knowing the risks, except when a complaint occurs. There is a JAMA article highlighting this problem of data privacy in the use of health apps. I think there was a boom in the use of social media by doctors during the pandemic, and we don’t know how that will impact health management. All we know is that the pandemic led many more people to use digital channels to talk to healthcare professionals, and it got the most reluctant healthcare professionals to finally come around to using those channels for communication. Digital channels, meaning the social media channels, set to work on solving health issues. I believe that is a big problem because the institutions are not thinking about putting a solution forward.

Doctor–patient contact shifted to informal channels.

Now what needs to be done is to move the conversation that is happening today on public channels over to institutional channels, which will enable us to not only guarantee the security of the information being shared, but also help ensure that this won’t fuel a problem that is impossible to solve. Healthcare professionals, in addition to caring for patients, have families. I get video calls at three in the morning telling me that José has a fever. At three in the morning, I’m asleep. You start to see a certain level of abuse that normally occurs with this kind of thing, and it creates conflict. Everybody has my phone number now. What do I do? Change my number? Do I need two phones? There are some doctors with two phones, some with three. In the end, telemedicine actions start to get blurred, or sometimes lines are crossed, which is a problem. One of the pending topics we have as institutions is to put forward alternatives. At Clinica Alemana, we’re building a formal channel for communication with patients.

What does the solution entail?

We are looking at building a formal channel that will somehow be able to manage and govern all the information that gets exchanged. If you, as a patient, write to a doctor, a healthcare professional that attended to you, what we expect first of all is that they will answer you, answer the patient. And that response to the patient may be that that professional is travelling or somewhere else, meaning another would have to respond to you. It means you can manage the “I’m not here, someone else will answer my messages,” to be able to refer and provide a service with the appropriate timing. Ultimately, a kind of logic begins to prevail where we can first track the communications, and know how long that takes. Today, it is something we can redimension. At present, we don’t know how many hours professionals spend in informal channels of communication with patients.

That leads to billing issues because we don’t know how many hours of their personal time doctors spend answering patient inquiries; and also legal issues, in cases of malpractice suits: there are medical decisions left out of the clinical record. That is why the institutional solution must be integrated with patients’ electronic medical records.

Are you considering implementing bots?

There are various health robots, but they are still very limited. The bot does what it was programmed and designed to do. Broadly speaking, no one is designing bots to make medical decisions because it is still not that easy for them to diagnose and prescribe treatments.

If you look at the big developments, like Ada Health or Babylon, they still don’t give medical indications, only recommendations. Their responses to health inquiries are still at that level. I believe the institutionalization of doctor–patient communication technology tools is the issue that needs to be looked at. We have a plan for that and we are now sure that it is something we have to take care of, and that the management is looking to develop.

Are you developing it yourselves or through external providers?

The development is being done partly by the Clinic and partly by the providers; we’re doing it jointly.

About Clinica Alemana of Santiago de Chile and its Department of Biomedical Informatics

Clinica Alemana in Chile is a leading private clinic for diagnostics and treatment in all medicine and health specialties, seeking to contribute to the development of medical knowledge for the benefit of the community. The mission of Clinica Alemana’s Department of Biomedical Informatics is to generate evidence and develop innovative solutions that will help maximize the impact of information technologies in the field of health and promote telemedicine and telehealth in Chile.

Learn more about the adoption of telemedicine in Latin America
Contact us to find out how we can offer you a study on telemedicine in Latin America. Our team—in addition to recording in our HospiScope database the hospitals in over 15 Latin American countries that have telemedicine systems—can put together a telemedicine market study based on your needs.

Mauricio Ortiz
President
Boston Scientific Latin America

What impact did the pandemic have on the health sector?  

The pandemic has heavily impacted all industries, and has generated enormous structural changes and much mobility, particularly in our sector, where primary care has demonstrated a clear need for more solid systems to promote and protect the health of all patients.

Personally, I think the main issue we have in Latin America is access, both to medical devices and to health in general. It’s a major problem that has existed for a long time, before the pandemic even began. For the last two or three years, we haven’t focused on access, and COVID-19 has just made it clear that the procedures we have in Latin America are not comparable to the level and quality of those in the rest of the world.

This information is supported by concrete data: the World Bank’s 2021 reports show that 14.5% of Latin America’s population has to allocate 10% of the family budget to health.

We are living through a time of constant changes, and COVID-19 sped up those changes. What did the industry learn during the pandemic?

I think the biggest lesson we learned, as an industry and as humans, was the capacity for people to work together. For example, in our sector, we have released the plans so that everyone has the possibility of building a mechanical respirator in their home; vaccines have been shipped around the world; telemedicine came to be part of daily life; we have all worked together to get ahead, and we had never had the opportunity to do that before.

It may sound strong, but for the first time the patient was center stage, regardless of their condition—rich or poor, black or white. In spite of the differences, there was something that we could all agree on, which is that the “focus is on the patient.”

Those of us in decision-making positions have a duty to think about what the patient really needs. This is why we have to cultivate a broader approach and stop naval gazing.

Companies within the health industry look out for themselves instead of seeking the common good. When a hospital wants to buy a medical device, what really matters is the price and mix of products that may be offered to them, as the hospitals’ objective is to negotiate a patient-care package that will be the most cost-effective. The interest of healthcare businesses is based on protecting their own budgets and obtaining the greatest possible cost-effectiveness.

Yet the pandemic got many people joining together to save others, and I think we, as an institution, should take that example to completely rethink our structure and find a way to bring as many patients into the system as possible, without being so concerned with profit margins.

We have overcome the contagion outbreak. What are the next steps for the sector?

Today I think the answer to the problems we have in the sector lies in the diversity of groups. We are going to find the best results in difference. It means no longer looking within and stepping outside our structures to learn new ways of working, with digital or even hybrid methods.

The pandemic has taught us a lot, and we have a duty to evolve. The term “out of office,” meaning the treatment of patients outside hospitals, is something that was implemented primarily when COVID-19 began, but it opened up new doors for the future of the healthcare sector, generating greater fluidity of patients and, therefore, greater access and better care for patients.

In my experience, hospitals whose management has a modern, digital mentality have achieved better results than traditional hospitals, and that’s why I say that the key to change lies with those of us who can make the decisions. We need to be surrounded by people who can get on board with us and implement these changes.

————————

Boston Scientific is one of the industry’s most senior multinationals, developing, making, and selling medical devices worldwide. One third of its operations are in Latin America, and it is among the top investors in R&D.

In this latest installment, we look at two issues about which the conversation has deepened and taken on more significance because of the pandemic: collaboration between companies and the role of employees in the new business models.

LESSON 5: COLLABORATION BETWEEN COMPANIES IS KEY TO ACHIEVING DEVELOPMENT IN THE SECTOR

The health-care industry—and particularly the medical-device industry—has undergone major changes. For some years we have seen how the collaboration among companies, the interaction of various industries, and the incorporation of technology have developed the enormous advances that we find in the market today. Instagram, for example, has gone from a recreational social network to an e-commerce platform where you can find any kind of content, product, or service—medical devices among them.

Accounts like @buscare give us the opportunity to have a professional medical consultation from the comfort of our own living rooms, which brings us a new type of care associated with a new concept in health: the healthy experience. This has been developed by businesses and entrepreneurs that have identified the needs of users and turned them into a profitable business.

Clearly these experiences have been understood by larger companies, which are the ones that make the difference in terms of volume and the ability to bring large-scale change to the market. For example, Boston Scientific is about to launch a pilot with a company engaging in remote monitoring and patient tracking from home. The leaders that are characterized by their level of adaptation are the ones that usually take the biggest risks, which in cases such as this one, are good decisions. Collaborating among competitors opens new doors for the development of any market. Losing the fear of the “enemy” and joining them so that both can benefit is the way of the future. This kind of collaborator has been referred to as a “frenemy” (a portmanteau of friend and enemy). This is why it is important to continue to build collaborative work spaces between industries that focus on the same users or customers with complementary approaches.

As we mentioned previously, this trend grew stronger still with the pandemic, which put us in situations of stress and extreme need. There were times when no matter how many resources we had, if we did not work together it was impossible to get ahead.

The situation we have lived through has forced us to change the way we think about business, and to understand that collaboration generates more benefits than competition. Companies are taking the first steps along a path that will enable us to have products and services that are more aligned with consumers’ new needs.

Collaborating with competitors is the new trend. Toyota and General Motors assembling motor vehicles, and Cannon supplying Kodak with photocopiers, are examples of large companies that are renowned for being fierce competitors. The advantage that the industry of medical devices—fundamental in health systems—has is that many of them present opportunities for collaboration in relation to their technologies, which would help lower R&D costs, allow more mass production, and consequently democratize access.

It is possible that much of what we are proposing in this article may be seen as utopian, but we are convinced that the future has come to the sector and that real transformation is just a matter of making decisions with an impact beyond the profits of each individual company.

Are we ready for this change?

LESSON 6: BUSINESS IS STRENGTHENED BY EMPLOYEE ENGAGEMENT

Very much in line with the previous lesson, as the days went by and we were unable to leave the house, companies began to see all their investment plans being called into question. This situation forced us to rethink the paradigms we felt comfortable with to make way for new forms of collaboration and more efficient interactions.

This change fueled the wave of new working relationships, for both for companies and employees, and we now understand that we are part of the same team, which has to be flexible, open to change, capable of working both from home and in person, and above all, empathetic. Soft skills during the pandemic have been among those most sought after, often more so than the skills inherent to the job, and this situation has generated great opportunities in interpersonal relationships on all levels. The ability to adapt, lead and be creative were key during the pandemic.

We have seen how it is possible to reconvert in just a few days, to be efficient and effective on any schedule, attend to several things at once, and help those who suffered most. We have now emerged from the crisis, and are beginning to return to what is termed the “new normal”—hybrid or combined schemes that have existed for those who have been in freelance work or have generated customized working relationships, the most widely known being part time, fixed term, and remote.

Hybrid work is a redesign of communications. The challenge we have today is getting the masses to adapt to all these schemes while keeping the corporate culture present, because employee commitment has been shown to be the factor that can make or break businesses.

The sector cannot take a step back and return to the old ways of doing things. The pandemic underpinned an evolution toward interactions that are more efficient in terms of the time they take up in our lives, and more enjoyable in terms of what they generate for us emotionally. It is time to redefine ways of working and collaborating with the needs of companies, customers, and employees.

At GHI, we always approach subjects from a constructive angle in an attempt to generate productive debate. The objective of this series has been to go back and look at issues that have become trending topics over the last two years: digitalization in the industry, the role of the patient, the need to think about health systems in a preventive rather than a reactive way, approaching crises as a moment of opportunity, working hand in hand with competing companies, and joining with collaborators as an indispensable way to achieving success in organizations.

We are clearly facing major challenges in the health sector, and critical changes throughout its structures. The best lessons are learned through mistakes, and it is up to us to adapt or to stagnate in our comfort zone.

Next steps

Contact us if you are interested in exploring further how these lessons are being applied, perhaps through a personalized study that will help you outline new strategies for your business or create new initiatives. We can also provide you with subscriptions to our data services, such as HospiScope, SurgiScope, El Monitoreo de Hospitales Latinoamericanos, and others.