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Conversation highlights:
MAC has grown from 15 to 25 hospitals since 2022, with 47% of its size coming from M&A and the remainder from organic growth.
The company focuses on secondary cities across 18 locations nationwide, targeting C+ and C-level populations — middle-income segments underserved by both public and traditional private providers — with competitive pricing and institutional-quality services.
Integrating hospitals with different IT platforms and processes into a true network is the central operational challenge as MAC transitions from standalone units to a national system.
Mexico’s private healthcare sector represents less than 6% of GDP compared to around 20% in the US, with 50% of expenditure coming from out-of-pocket payments — a significant structural opportunity for private providers.
MAC aims to operate more than 30 hospitals by 2030 and is building the financial and operational platform for a potential public offering.
The company is developing medical education programmes in Querétaro, Celaya, and Aguascalientes to build the next generation of healthcare professionals aligned with its model.
EF: You have an interesting background spanning different hospital organizations. What drew you to Hospitales MAC, and what mission have you set for yourself?
SURR: My entire career has been in hospitals. I started at one of the biggest hospitals in México when I was 22 as a financial analyst, and after 11 years, I became CFO after 16 years. I left that organization and joined H+, which was a struggling startup at the time, and we successfully turned it around. When MAC acquired H+ in August 2022, Miguel Khoury, MAC’s founder and CEO, asked me to join as CFO. MAC had achieved impressive growth, but was expanding so fast that processes and efficiencies became challenging. My job has been to complete that equation ever since: ensuring the company succeeds not only in growth but in profitability and long-term sustainability.
We have been working to standardize processes across our hospitals, so we operate as a true network rather than 25 standalone units. The goal is to consolidate our operational platform now so that we can grow even faster and more sustainably in the future.
EF: MAC has grown to 25 hospitals through both acquisitions and greenfield development. How do you manage the different financial risks of these growth strategies?
SURR: In 2022, before acquiring H+, MAC operated 15 hospitals. With that acquisition, we reached 17, and today we operate 25. If you measure MAC by size, 47% comes from M&A — nearly half the company’s footprint was acquired rather than built. In terms of the number of units, eight of our 25 hospitals come from acquisitions and 17 from organic growth. Each path brings different integration challenges.
Acquired hospitals arrive with their own IT systems, processes, and operating cultures. Organic units are built to our standards from day one. Bringing both into a single network requires standardizing platforms and workflows across operations that were never designed to work together. Our hospitals are also structurally different from traditional private facilities: we operate units ranging from 15 to 60 beds, well below the 100-plus beds typical of established private hospitals. Running efficient operations at that scale, while still offering the full range of necessary capabilities, requires strong centralized support.
To address this, we have built corporate offices in Mexico City that provide supply chain management, IT support, and standardized processes that all 25 hospitals can access. The network is an advantage — it allows each unit to operate with the efficiency of a small hospital while drawing on the capabilities of a large one.
EF: With Mexico's healthcare transformation and budget constraints in the public sector, how is MAC positioning itself to serve a broader population?
SURR: Mexico’s private health sector is structurally different from most comparable economies. While healthcare represents around 20% of GDP in the United States, in Mexico it is less than 6%. More striking still, 50% of all healthcare expenditure comes from out-of-pocket payments, and only 10% of the Mexican population has any insurance coverage. That gap is where the private sector’s opportunity lies.
MAC’s strategy is built around secondary cities rather than the major metropolitan areas. Mexico City and Guadalajara account for only 25% of our operations; the remaining 75% are distributed across medium-sized cities in 18 locations nationwide. We target C+ and C-level populations — middle-income groups that need quality healthcare but are not served by traditional private hospitals, which tend to concentrate in large cities and price themselves out of reach. We fill that gap by bringing institutional-quality services to cities where they did not previously exist, at pricing that works for patients and for insurance companies alike.
EF: As someone making investment decisions for hospital innovations, how do you balance bringing new technologies to smaller cities while keeping healthcare affordable?
SURR: Standardization is essential. The scale we have as a group should translate into greater access and more competitive pricing for the broader population. We are able to bring high-quality services to these cities while maintaining affordable prices, but doing so depends on highly efficient operations. Our objective is to keep price increases for our services below the overall inflation rate in healthcare. The strength of our network lies in avoiding the higher costs associated with standalone operations, allowing us to introduce advanced technologies and deliver consistent, high-quality care supported by the efficiencies and purchasing power of the group.
EF: Looking back over 10 years in Mexico’s private healthcare sector, what have been the key achievements and what’s on your agenda for the next decade?
SURR: Two major developments stand out. First, Mexican hospitals achieved the opportunity to reach international standards in healthcare services, making them attractive not only for Mexican patients but also for medical tourism. This pushed the entire industry toward standardization and quality improvements. Second, the process of integration has transformed the market. Ten years ago, there was mainly the Angeles network, but today, you see multiple hospital networks seeking the advantages of standardized quality services across the country. For the next 10 years, I expect the private sector to continue building networks that provide consistent, high-quality care nationwide while remaining accessible to broader populations.
EF: How is MAC investing in medical education to ensure adequate healthcare professionals for future growth?
SURR: We are at the beginning of this journey. We are currently training specialists in Querétaro and Puebla and launching programs in Aguascalientes. We understand this is important not only for MAC’s own pipeline but for Mexico’s healthcare system more broadly. Hospital-based schools are how you develop professionals who are trained within a specific operational philosophy from the start, rather than adapting them after the fact. We are participating on a small scale now, but it is a commitment we intend to expand significantly.
EF: As you approach your four-year anniversary at MAC and look toward the company's milestones, what would you most like to celebrate in 2028?
SURR: I want MAC's identity to be crystal clear for everyone — employees, physicians, and patients. Whether you walk into our hospital in Querétaro, Los Cabos, or Celaya, you should find the same standards of service, the same quality, the same safety culture. The size of the unit — 15 beds or 60 beds — should not change what the patient experiences.
The other milestone I am working toward is preparing MAC for a public offering. Much of that work happens behind the scenes: strengthening our financial position, advancing standardization, building the governance and reporting structures that a public company requires. Miguel Khoury has set a target of 30 hospitals by 2030, and we're confident we'll exceed that target. Getting there in a way that is financially sound and operationally consistent is what the next two years are about.
EF: What's your investment pitch for Mexico's healthcare sector and MAC specifically?
SURR: First of all, look at the market. Mexico’s private healthcare sector is still small relative to the size of the economy and the population; that is not a weakness, but an indicator of how much runway and opportunity remain for us. The demand is already there; what has been missing is the right model to reach it.
MAC has built that model. We have solved a genuinely hard problem: how to operate small-scale hospitals efficiently while maintaining quality, safety, and competitive pricing in cities where no viable private option previously existed.
