Read the Conversation

EF: From your perspective and that of Deloitte's life sciences and healthcare division, do you see 2023 as a challenge or an opportunity in Latin America? 

AG: Challenges always present an opportunity to do things differently. 2023 is an opportunity for companies to make a difference. Pharma companies, especially those focused on life sciences, are driving innovation. Their strides toward innovation are having a significant impact on the systems. Innovation is expensive, and our systems are not ready to receive it. 

Companies have been thinking about different ways to bring innovation to the system. They have been re-inventing themselves in the process. This is good because they are no longer just focused on ticking boxes. They are now focused on understanding the patient's journey, getting there, finding ways to make the patient more engaged, and helping them financially to have access to the medicines.

Companies need to solve issues related to financial resources, engagement, and early detection. Once these issues are solved, it will pave the way for doing things differently. Life sciences companies are currently engaged in all three parts of the process. Pharma companies view Latin America as an opportunity and feel reassured about their investments here. Medtech companies are mostly found in Costa Rica and Mexico. Distribution hubs are located in Panama. Pharmaceutical companies are building strong capabilities in different Latin American countries. We have come to realize that every country in Latin America needs to be independent when it comes to accessing vaccines and medicines. There are initiatives from different governments to own their vaccine production capacities.

Healthcare providers are also finding ways to do things differently. In the Mexican system, patients were paying for a significant amount of their healthcare needs out of their pockets. This amount was around 48 percent. Providers sought to determine how they would create certainty in the system and how much it would cost for patients to be treated for certain diseases over a certain period. This was helpful as it led to the creation of packages where patients have certainty of how much they are going to pay.

There are also more institutions coming into the system. We are seeing investments from Spain and Peru coming in to build more capabilities around healthcare providers. We have innovative companies that are providing specific treatments for ailments such as diabetes, cancer, and cardiovascular diseases. This is changing the approach of healthcare providers, who now have a challenge in the form of digital transformation. They need to embrace digital change and learn to digest all the data that they have. Currently, they are only receiving information and giving it to the payers, but at some point in time, they are going to have to share that information with the patient, and they are not ready to do that. Healthcare providers also need to learn how to consume information that is not related to the system but comes from other places. 

We also have payers who can be identified as government and private payers. Governments have to understand that they have limited resources and that they have to use them wisely. Prevention should be the main priority of governments. They also have to build different models to attend to their patients. We have to learn from other countries, such as the UK, where a person is connected to the system and can easily access all the information. We can use notching to make people change their behaviors.

We have to use different financial sources because government budgets are limited. They need to consider other sources, such as the World Bank. They can use these funds to develop programs centered on prevention. There is going to be a transition in the way they offer healthcare. This will be based on the results gathered from the use of new technologies and improvement of engagement. 

Private health providers consist of insurance companies and their plans. Insurance companies need to learn that we are in a complex situation. Our health is important, and this was highlighted during and after the COVID-19 pandemic. They have to build different capabilities to assess the different behaviors of people and help the customers be more active in the way they approach their health.

Health plans usually cover everything, but they are too expensive for most people to access. Building well-being plans is very important. Every company is now focused on health, and after COVID-19, most of them started working on well-being programs. The problem with well-being programs is how you measure the results financially. Companies need to be open and build a two-way communication channel with their employees to see if the things that they are doing are the ones that their employees need. They also need to build a case around well-being. This is a challenge in the system because we have to learn how to measure the well-being of our employees.

The patient is another aspect we need to look at. Empowerment allows us to learn about the importance of health in our lives. We never really thought about it until COVID came around. When we measure health, we have to think about it physically, financially, mentally, and socially. When we see health from that perspective, we will have an integrated approach to our health, meaning that we have to take care of our finances, relationships, and physical health.

EF: The traditional system in Latin America is more geared towards treatment than prevention. How is Deloitte supporting companies to shift towards a preventative approach?

AG: Prevention is very important, but it can be difficult to implement. For example, when you get into a company with a well-being program and get diagnostics, normally, the people who are approached for that program are healthy. This is because people who know that they are sick are scared of being diagnosed. Companies need to do things differently and show them the value of diagnostics. 

Diseases like cancer and diabetes kill us. These diseases are silent killers. We do not see them until they physically manifest. We need to work on being conscious of those things that are happening but that we do not see. These are the first things we need to be aware of. Companies have a great deal of responsibility for how they help employees become aware of their health. Everyone in the system must be involved when focusing on prevention measures. 

COVID encouraged us to develop a "testing culture." People who feel sick are now more likely to go and get tested to get a diagnosis. Testing is something that has to continue happening. The most popular tests right now are those for glucose and lipids. These tests are fast and simple. Testing needs to become an integral part of the system.

We need to become aware of our responsibility to society. For example, someone came to our floor wearing a mask. I asked him why he was wearing a mask. He responded that he felt sick and was responsible for everyone. It was his duty to make sure that he did not spread his illness. We also need to be aware of our cleaning habits. Washing hands during COVID-19 lowered the infection rates of other diseases because we followed those very basic rules of washing our hands constantly.

Companies are now using sequencing processes to personalize cancer treatment, but this process is still very expensive. Companies are investing a lot in sequencing and the technology needed to have access to that specific type of treatment. Companies with well-being programs are also bringing in fast testing so that we can test for everything. Deloitte is working on different diseases. For example, we are working on contraception, diabetes, and cardiovascular disease. We are working on designing early interventions.

Regarding contraception, the rate of pregnancy in girls between 10 and 18 years old is very high. This is also a sign of sexual abuse. Girls between 12 and 16 need education and empowerment. We partnered with pharma companies, Naciones Unidas, and the government to create a model with three different interventions. The first one is in education. You have to teach girls the implications of pregnancy and tell them that they have access to the system if they want and do not need their parents to do so.

The second intervention is around health. We have to teach the girls about contraception processes, including the traditional ones such as rhythm. The third intervention is empowerment. We are thinking about building a coding school. Programming is a very attractive field because the salaries of programmers are high, and they are appealing to the current market. Software companies see the empowerment of girls as a two-way benefit for them. The first one is that they have labor, and the second one is because it touches on an inclusion point.

A girl who already has access to a competitive salary and is empowered can say no. This intervention is financed by the software company, and its results can be measured by how many girls access education and health services. This will enable us to bring different sources of funding into the system and scale it. We are scaling it to other countries, such as Colombia, where our partner is interested in teaching the girls about new energy resources.

EF: What is the potential of the Latin American region to position itself as an innovation hub on a global level?

AG: I think innovation is not only about how you develop a science. Innovation also comes from how you deliver it. From a scientific perspective, I think we can become a hub because if you want to launch any medicine in one of the Latin American countries, it's easier and faster to get approval for the medicine if a part of the population that got tested is from a Latin American country. Getting into clinical trials is very important. For example, Sora in Colombia is investing a lot in testing. 

On the innovation side, we learned about the importance of collaboration during COVID. We need to collaborate with different centers. Life Sciences companies are collaborating with different centers in Asia, and they are also thinking of how to develop their own capabilities in other countries. On the delivery side, we have cutting-edge institutions that are transforming the way diabetes is treated.

The Institut Nacional de Nutrition has a clinic with a different approach that focuses on education and engagement. You have to bring a partner to the clinic. When you bring a partner, they follow a process that ensures that the patient is supported. At the Institut Nacional de Nutrition Mexico, they found that a lot of partners also have diabetes. This adds to the process of prevention and detection in the early stages.

Healthcare providers have different approaches, and we once worked in a program where we took women on a journey that started with pregnancy. For example, we start with pregnancy, and when they have a baby girl, we identify if there are biomarkers that will lead to disease later in life. After three years, we have the papilloma vaccine, and later in life, we have periods and the education around that. When they get pregnant, they also get an education because they have to understand their role and what is going to happen to their body. 

During menopause, they need to be tested for cancer and other diseases. Women get connected to their healthcare provider, and based on what they got at the very beginning with the data analysis, they get a journey specifically for their girl child. These innovative models are valuable. We did a nutrition project in India using 5G, interventions with education, and interventions with different companies to build a program around nutrition and reduce the impact of malnutrition. Innovation is going to change the system not only for Mexico but globally. 

EF: How do you assess the potential impact of the latest technologies, their receptiveness, and their adoption in Latin America?

AG: I think those technologies are helping the system accelerate some processes. Physicians have to be trained to embrace technology and realize that it will not do their work. It's going to be an accelerator. Regulation in healthcare is very complex. We have to be very careful with the technologies that we adopt. At some point in time, innovation will be faster than regulation. The most widely used diagnosis tool globally is the search engine. Patients Google their symptoms and are given death notices every week. We have to be very careful to curate the content and technology. Governments and companies related to health should be the ambassadors curating this information, and eventually, the regulatory process will catch up. In the meantime, patients are going to continue using that technology. This is a challenge that we have, but we are prepared to face it.

We have the technology and infrastructure, but not everyone has access. Not everyone understands a smartphone, and some don't even have a network connection. Literacy is another problem. You have to understand the results. For example, If you use a patch to track your glucose and don't know how to read it, you will not understand the different things that are happening in your body. Education is an important issue for consumers because you have to tell them, for example, what happens if they have high blood pressure and whether they are at risk.

EF: If you had to design a road map to sustainable healthcare for Latin America as a whole, what would your three base pillars be?

AG: My pillars would be an integrated care approach that includes prevention, engagement, and financial health. The way we deliver help needs to change. We have to understand that we have patients who pass through the system because they have an infection. We also need to be aware that in our different countries, we have chronic diseases that need to be treated completely differently. Prevention requires education and early diagnostics. We need everyone to be financially involved. We pay a lot for our healthcare, but if we make some decisions on the way we invest our money, we can have a greater impact. Companies can play a role in managing certain aspects of people's health.

EF: Do you have a final message for our readers?

AG: We have to transform the system and give access to everyone. System transformation and health equity are very important. If we don't achieve these two things, we are not going to have an impact on the way we deliver health to Latin America. We recently signed a pledge at the World Economic Forum that we are going to do everything in our power to reduce health inequities to zero. Everyone needs to have access to healthcare. We are approaching health in a different, holistic way. Socially, mentally, physically, financially, and emotionally. Interoperability is another important topic because the system has to be interoperable. It means that everything must be digitalized, translated, and connected.

August 2023