Read the Conversation
Conversation highlights:
- Brazil's public health system requires efficiency-driven solutions due to limited per capita expenditure compared to European models, creating new partnership opportunities for pharmaceutical companies.
- The private health system serves 50 million people with an income ranging from $10,000-50,000, offering one of the world's highest quality care levels with virtually unlimited access.
- Payers are becoming increasingly influential in medication decisions, forcing pharmaceutical companies to understand payer business models beyond traditional physician relationships.
- Provider networks are implementing rigid clinical protocols and cost management strategies to maintain market share with payers.
- AI opportunities in Brazil focus primarily on back-office solutions and physician engagement rather than direct patient care transformation.
- Clinical trial opportunities in Brazil leverage a diverse genetic population of 200 million people with an established healthcare infrastructure.
EF: What are the key healthcare trends in Brazil today?
JS: We need to differentiate between the public and private systems. Focusing on the public side, there is a compelling data comparison that clearly illustrates the challenge.
If you look at disease burden versus healthcare expenditure per capita, typical European countries with universal systems have some of the lowest disease burdens while spending around $10,000 per capita. In contrast, Latin American countries face higher disease burdens but spend only $2,000 to $4,000 per capita. The United States, interestingly, has a disease burden closer to Latin America but with significantly higher spending. This creates a fundamental challenge for public health administrators in the region. We need to reduce the disease burden that is roughly three times higher than in Europe, but with far fewer resources. The solution, therefore, must come from efficiency. We cannot reduce disease burden simply by building more hospitals or relying on a traditional brick-and-mortar approach. At the same time, digital alone is not the answer. What is required is a broader rethinking of the system and wider engagement of all its members.
Pharmaceutical companies, for example, need to play a different role in this context. This is not about introducing more products or higher-priced innovations. It requires a new level of partnership, one that has not been necessary in the US or Europe. The rules of the game in Latin America are fundamentally different.
EF: How important is engagement versus digital solutions in achieving healthcare efficiency?
JS: There is a natural inclination to focus on what digital tools and AI can deliver, and rightly so, as they bring significant potential. However, there are still open questions around whether this is the only path forward. During COVID, digital health and telemedicine expanded rapidly, and adoption increased across the region. Yet, in many Latin American countries, patients have since returned to more traditional, non-digital care pathways. Interestingly, systems like the NHS have been adopting approaches that Brazil has long invested in, particularly through community health workers. These are not necessarily highly specialized clinicians, but individuals trained to stay closely connected with the population. The key concept here is engagement.
Achieving higher efficiency depends on reaching higher levels of engagement with patients, enabling prevention, early diagnosis, monitoring, and adherence to therapy. Importantly, engagement does not have to be digital. For example, in New Jersey, programs involving nurses visiting newborns and supporting new mothers have demonstrated measurable improvements in neonatal outcomes.
In the public health system, the emerging trend is clear: improving efficiency through stronger engagement and network redesign. This includes rethinking service delivery models, leveraging lower-complexity infrastructure for procedures, and using community-based networks to better support patients.
EF: What specific opportunities exist for pharmaceutical companies in Brazil's healthcare system redesign?
JS: Pharmaceutical companies have the opportunity to deliver significantly more value across two critical phases: diagnosis and therapy maintenance.
They play a fundamental role in enabling accurate diagnosis, particularly with the advancement of precision medicine. In therapy maintenance, they can support adherence and help develop new ways of delivering care.
In markets like Mexico, we are already seeing pharmaceutical companies partner with the public health system to support process redesign — helping register patients and guide them into the right care pathways with the appropriate providers. This is a direction we should expect to expand.
For Brazil’s public system specifically, if companies want to fully access a market of 150 million people, they need to define a clear and robust “menu” of partnerships they are willing to bring forward. This includes technology platforms, supply chain redesign, and process optimization. Strengthening this offering will be key.
At the same time, the system is clearly shifting toward cost-efficient solutions, including biosimilars and more structured pricing mechanisms. In this environment, the traditional approach of simply introducing more products at higher prices will no longer be sufficient.
EF: Why is Brazil an attractive investment destination for healthcare companies?
JS: The fundamentals are already very compelling. Brazil offers a large-scale market, with around 150 million people in the public system and an additional 50 million in the private system. It is a growth economy that remains productive and globally connected, despite the uncertainties seen across markets.
However, the strongest argument lies within the private healthcare segment. This represents a population of roughly 50 million people with income ranging from $10,000 to $50,000, indicating substantial purchasing power. Few growth economies offer this combination at scale, outside of more mature markets like the US or parts of Europe.
In addition, the quality of care within the private system is among the highest globally. Access is extensive, and patients benefit from leading hospitals ranked among the top 100 worldwide, as well as access to advanced technologies and therapies.
What is particularly striking is the ease of access. Patients can obtain advanced procedures and treatments without substantial financial or administrative barriers, as there are rarely copays, and authorization processes are regulated to ensure broad access.
Overall, Brazil combines scale, purchasing power within a significant segment, and high-quality infrastructure and care delivery. This makes it a uniquely attractive market when compared to other growth economies.
EF: How is the competitive landscape evolving in Brazil's private healthcare system?
JS: The level of maturity and competitiveness in the private health system is increasing dramatically. Payers are becoming highly influential in determining what treatments are used, and their ability to negotiate, control access, and define which medication goes to which patient is evolving rapidly.
This shift is critical for pharmaceutical companies. It is no longer sufficient to focus primarily on physicians and aim to be top-of-mind. That model is changing. There may still be a premium segment — around 5 million people — who can access whatever a physician prescribes. However, for the remaining 45 million people, this dynamic no longer holds, largely due to affordability constraints. As a result, payers are now central decision-makers. Pharmaceutical companies need to understand their business models and speak their language. Today, many still lack a clear understanding of the differences between self-managed systems and fully insured models, despite the fact that these operate very differently and pursue distinct outcomes. For example, self-managed systems tend to retain beneficiaries throughout their lifetime, while others experience turnover every two years.
On the provider side, we are also seeing the rapid expansion of large, well-managed networks. This creates two clear strategic paths: either position as a premium provider, attracting volume through top-tier physicians, or align closely with payer-driven models, operating under strict clinical protocols and cost management to maintain competitiveness.
EF: Where are you seeing AI deployed effectively in Brazilian healthcare today?
JS: When it comes to the public health system, it might be difficult to see AI playing a meaningful role in the next five years. With healthcare expenditure at $2,000 to $3,000 per capita, there are many more immediate priorities that take precedence over AI adoption.
Across both public and private sectors, however, there is a clear opportunity for AI in back-office and decision-support functions; areas that can enhance administrative and some clinical capabilities without necessarily transforming the patient journey directly. This includes improving speed and quality of information, as well as supporting more precise treatment decisions, which is particularly relevant in the context of precision medicine.
We are also seeing increasing investment in better understanding populations and beneficiaries. One example is the deployment of digital twins at scale in Brazil. In industries such as oil and gas, where highly specialized professionals operate in costly environments, companies are developing digital twins to monitor health status more accurately and manage risk more effectively.
For pharmaceutical companies, the most immediate opportunity lies in strengthening engagement with physicians. There is significant room to evolve beyond traditional sales models — rethinking field force roles to include profiles that understand payers and provider networks, and enabling more tailored, scalable engagement based on physician needs and their relationship with specific therapies.
EF: What clinical trial opportunities does Brazil present for pharmaceutical companies?
JS: Brazil offers exceptional opportunities for clinical trials, primarily due to its scale, with a population of over 200 million people. Even within the private system, which can often facilitate faster partnerships, there are players with a significant volume of beneficiaries across the country operating with a verticalized model. In these systems, there is significant control over care delivery, as providers operate their own hospitals and retain all patient data internally. This creates a highly integrated environment that can be particularly attractive for clinical research.
Another key advantage is the genetic diversity of the Brazilian population, which adds important value for trial design and outcomes.
At the same time, current initiatives to attract clinical trial investment through CROs remain relatively limited. There is still considerable room to expand these efforts, including through the use of AI to support trial design, patient identification, and execution. Overall, this represents a highly compelling but still underleveraged opportunity, and one that should feature more prominently in discussions around pharmaceutical investment in Brazil.
