Healthcare in Brazil 1 “Excellence and Innovation in health care in Brazil - Private sector” Miguel Cendoroglo Neto COO and Medical Director, Albert Einstein Jewish Hospital, Brazil Healthcare in Brazil “Excellence and Innovation in health care in Brazil - Private sector” Miguel Cendoroglo Neto COO and Medical Director, Albert Einstein Jewish Hospital, Brazil

Healthcare in Brazil 2 Source: ANS, LAFIS, IBGE, WHO, Booz Allen & Hamilton; 2011 – WHO; ANS, IBGE The healthcare sector in Brazil represents 8.9% of GDP  7 th Largest Economy in the World - US$2.4 trillion (2012)  5 th Largest Population in the World million (July 2013) - 84% of the population concentrated in urban areas  5 th Largest country in geographical area - 8,514,877 sq km  1988 Constitution: - Healthcare is an universal right of every citizen and a responsibility of the State. Access is universal (Unified Health Care System – SUS), with no fees or copayments.  A Country of Contrasts: – Some top quality institutions and – Very poor income distribution, though improving In 2011 Market size(1) Funding (1) Population Coverage (2) Service Providers US$ 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

Healthcare in Brazil 3 São Paulo Rio 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

Healthcare in Brazil 4 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

Healthcare in Brazil 5 Stroke 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.

Healthcare in Brazil 6 Albert 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 ParaisópolisMorumbiPerdizes/HigienópolisM’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 MoratoPaulista

Healthcare in Brazil 7 Albert Einstein Hospital is a reference in Latin America 1.Joint Commission Accredited since Only Stroke Center accredited in Latin America 2.AméricaEconomía - Best hospital in Latin America for the 5th consecutive year 3.Planetree Designation 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

Healthcare in Brazil 8 Projects 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 Training Development of Technical and Operation Management in Health Services

Healthcare in Brazil Private%Public%Total Hospitals2 67% 1 33% 3 Beds647 68% % 947 Surgery rooms34 77% 10 23% 44 Patient Days (1,000) % % 289,3 Discharges (1,000) % % 64,1 Surgeries (1,000) % 3.2 8% 40,2 Births3,871 49% 4,043 51% Outpatient units4 17% 19 83% 23 ER Patients (1,000)262 56% % 465 Exams (1,000)4,068 88% % Consultations (1,000)264 25% % The activities of the Public Sector already represent a significant share of the activities of the Institution 30% - Services

Healthcare in Brazil 10 Einstein 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 Cost 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

Healthcare in Brazil 11 Can we do more?

Healthcare in Brazil 12 Can we do more? X

Healthcare in Brazil 13 Can we do better?

Healthcare in Brazil 14 1st opinion program (decision support) for critically ill patients at 24 hospitals 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 Partner VISICU (Phillips) Bench mark

Healthcare in Brazil 15 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)