On-demand pay-as-you-go specialized clinics






Business Model Description
Scale-up small clinics / out-patient facilities that offer on-demand primary and secondary care services on a pay-as-you-go basis
Expected Impact
Provide broad healthcare access to underserved populations
How is this information gathered?
Investment opportunities with potential to contribute to sustainable development are based on country-level SDG Investor Maps.
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Country & Regions
- Brazil: Maranhão
- Brazil: Piauí
- Brazil: Ceará
- Brazil: Rio Grande do Norte
- Brazil: Pernambuco
- Brazil: Paráiba
- Brazil: Amapá
- Brazil: Alagoas
- Brazil: Sergipe
- Brazil: Bahia
- Brazil: Acre
- Brazil: Amazonas
- Brazil: Pará
- Brazil: Rondônia
- Brazil: Roraima
- Brazil: Tocantins
Sector Classification
Health Care
Development need
Healthcare deficiencies are cited as Brazil's largest development need by nearly half of the population. Some of the main challenges mentioned are a lack of resources, both human and technical, and lack of productivity, leading to extensive delays in healthcare delivery (2) Brazil has scored 76.9 on SDG 3 (Good Health and Well-being) (1)
Policy priority
The new administration is addressing the healthcare system's main challenges, by vowing to increase efficiency in the system by digitizing medical records and removing restrictions for health professionals to serve both the public and private health care systems; proposing legislation to simplify the transfer process for foreign doctors who wish to work in Brazil (5)
Gender inequalities and marginalization issues
Health-related issues, such as non-communicable diseases, lack of access to family planning services, and maternal health complications, greatly impede women’s ability to engage in the workforce. (6)
Investment opportunities introduction
High potential revenues by providing affordable healthcare to the uninsured population with high targeted returns ranging between 15 and 20%.(16)
Key bottlenecks introduction
Lack of resources and productivity leading to extensive delays
Health Care Providers
Development need
Brazil's new administration has cut healthcare expenditure by over US$ 2 billion in 2019, down to US$ 31 billion (4) putting a strain on the system which is characterized by poor quality factors. Patients in the public health system are twice as likely to die from infections than patients in the private health system (10) (13)
Policy priority
Public sector has repeatedly stressed the objective of making the public healthcare system more efficient and allow professionals to by allowing public and give flexibility to professionals to work in both public and private health care provision
Development need
Brazil's new administration has cut healthcare expenditure by over US$ 2 billion in 2019, down to US$ 31 billion (4) putting a strain on the system which is characterized by poor quality factors. Patients in the public health system are twice as likely to die from infections than patients in the private health system (10) (13)
Policy priority: Public sector has repeatedly stressed the objective of making the public healthcare system more efficient and allow professionals to by allowing public and give flexibility to professionals to work in both public and private health care provision
Gender inequalities and marginalization issues: Maternal mortality rates in Brazil are five to ten times higher than countries of comparable economic status. Two of the greatest challenges are the high prevalence of cesarean section (c-section) and unsafe abortions. (6)
Investment opportunities introduction
Since 2015, nearly 3M people have lost private health plan coverage, driven by the economic crisis (8), putting additional pressure on the public healthcare system, but also increasing the opportunity for non-plan coverage models (e.g., pay-as-you-go)
Health Care Delivery
Pipeline Opportunity
On-demand pay-as-you-go specialized clinics
Scale-up small clinics / out-patient facilities that offer on-demand primary and secondary care services on a pay-as-you-go basis
Business Case
Market Size and Environment
A target market of 42 million people requiring healthcare (16)
A benchmark investor estimated the potential revenue generated by serving 2/3 of the population in the North and Northeastern states (B, C1 and C2 segments) in these clinics at over US$ 2 billion (16)
This assumes a target market of 42 million people doing two consultations per year at an average price of US$ 25
Indicative Return
20% - 25%
A benchmark business operating in the subsector is targeting returns of 20-30% (16)
Investment Timeframe
Short Term (0–5 years)
Capital intensive, requiring permissions and real estate. (e.g., securing locations, acclimating them for medical purposes)
However, technology used in these vertically-integrated clinics is readily available and produced domestically. Established companies in the vertical are able to roll out new clinics in under a year (16)
Ticket Size
USD 1 million - USD 10 million
Market Risks & Scale Obstacles
Capital - Requires Subsidy
Market - Highly Regulated
Business - Supply Chain Constraints
Market - Volatile
Impact Case
Sustainable Development Need
Public health expenditure per capita has been declining in real terms since 2015, putting a strain on the system (9) The Brazilian public healthcare system is decreasingly able to subsidize medical procedures, having dropped from 60 to 30% in the past nine years (12)
The public health system is characterized by poor quality factors: Booking an appointment can take as long as six months, 60 people have died while waiting for necessary surgery in 2016 (11); patients in the public health system are twice as likely to die from infections (10)
Since 2015, nearly 3M people have lost private health plan coverage, driven by the economic crisis (8), putting additional pressure on the public healthcare system, but also increasing the opportunity for non-plan coverage models (e.g., pay-as-you-go)
Gender & Marginalisation
Maternal mortality rates in Brazil are five to ten times higher than countries of comparable economic status. Two of the greatest challenges are the high prevalence of cesarean section (c-section) and unsafe abortions. (6)
Northern and Northeastern states like Maranhão, Amapá, and Piauí have some of Brazil's highest maternal mortality ratios, 116.5, 110.8 and 103.6 maternal deaths for every 100,000 births, vs. 30.9 in Santa Catarina (17)
Expected Development Outcome
Broaden access to affordable primary and secondary healthcare to the bottom of the pyramid. Consultations with benchmarked investors start at approximately US$ 10 for a simple orthopedic or other primary consultation, often lower cost than the public healthcare system (14) (15)
Make efficient and quality healthcare available to the bottom of the pyramid by reducing waiting times and providing flexible scheduling
Alleviate pressure on the public healthcare system by absorbing patients that would otherwise use public healthcare
Gender & Marginalisation
Increase women's access to affordable healthcare services, reducing maternal mortality ratios
Resolving health-related issues, such as non-communicable diseases, lack of access to family planning services, and maternal health complications, greatly impeding women’s ability to engage in the workforce
Primary SDGs addressed

3.1.1 Maternal mortality ratio
3.2.2 Neonatal mortality rate
3.8.2 Proportion of population with large household expenditures on health as a share of total household expenditure or income
Maternal mortality ratio 60 per 100,000 live births (2017) (22)
7.9 neonatal deaths per 1,000 live births (2019) (22)
25.56% (2008) (23)
Target to reduce the global maternal mortality ratio to less than 70 per 100,000 live births. (23)
All countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births. (23)
N/A
Secondary SDGs addressed





Directly impacted stakeholders
People
Indirectly impacted stakeholders
Public sector
Outcome Risks
Expansion of this model will require healthcare professionals, currently in shortage, which can strain the public healthcare system of professionals, who will opt for private practice
Healthcare professionals remaining in the public healthcare system are likely to be the less competitive professionals who are unable to enter the private practice
Impact Risks
Unexpected impact risk: increased demand in healthcare professionals diverting supply from the public sector, rendering it less competitive.
Evidence risk: Unit economics are not proven and this may affect breadth of impact
Impact Classification
What
The outcome is likely to be positive, important and intended because a broader healthcare offering could benefit millions of underserved populations in Brazil
Who
Uninsured patients or patients in remote areas are underserved due to lack of healthcare coverage
Risk
The model is based on good evidence and it is being deployed large cities, but unit economics are not proven and this may affect breadth of impact
Impact Thesis
Provide broad healthcare access to underserved populations
Enabling Environment
Policy Environment
(SUS (Unified Health System)): Public health in Brazil is organized through the SUS characterized by universality, free service and responsibility to enforce the Constitution, which states that health is a right of everyone and duty of the state through public policies financed by taxes (21)
(Brazil’s Federal Medical Council (CFM)): which is in charge of medical licensing and ethics, recognized the insufficiency of health professionals and made it easier for foreign doctors to serve in Brazil, hoping these will reach segments of the population in the North and Northeast regions (7)
Financial Environment
Financial incentives: ProFarma, a BNDES program, provides credit to health-related R&D projects (18)
Other incentives: Similar credit provision programs such as Finep, MCTIC and FNDCT exist
Regulatory Environment
(Child Mortality Emergency Plan): launched in Teresina to support births with more resources, human and technical assistance
(National Health Technological Innovation Policy (PNITS)): offers some risk off-setting arrangements (21)
Marketplace Participants
Government
Conselho Federal de Medicina (CFM) (20)
Target Locations

Brazil: Maranhão
Brazil: Piauí
Brazil: Ceará
Brazil: Rio Grande do Norte
Brazil: Pernambuco
Brazil: Paráiba
Brazil: Amapá
Brazil: Alagoas
Brazil: Sergipe
Brazil: Bahia
Brazil: Acre
Brazil: Amazonas
Brazil: Pará
Brazil: Rondônia
Brazil: Roraima
Brazil: Tocantins
References
- (1) Bertelsmann Stiftung, 2019, https://dashboards.sdgindex.org/#/BRA
- (2) Pardee Center, 2017, https://pardee.du.edu/sites/default/files/BRAZILReportPardeeCenter%20%281%29.pdf
- (3) Estado de São Paulo, 2019, https://politica.estadao.com.br/noticias/geral,analise-o-que-esperar-do-governo-bolsonaro-na-area-da-saude,70002662565
- (4) Núcleo de Acompanhamento de Políticas Públicas, 2019, https://fpabramo.org.br/wp-content/uploads/2019/04/napp-saude-100-dias.pdf
- (5) Poder 360, 2019, https://www.poder360.com.br/governo/cfm-pede-que-bolsonaro-crie-carreira-de-medico-de-estado/
- (6) Sarah B. Barnes & Elizabeth Wang. "Healthy Women, Healthy Economies: A Look at Brazil" https://www.wilsoncenter.org/sites/default/files/media/documents/publication/healthy_women_healthy_economies_a_look_at_brazil.pdf
- (7) Business Insider, 2018, https://www.businessinsider.com/heres-why-brazil-is-poised-for-a-health-tech-boom-2018-10
- (8) BMJ Glob Health, 2018, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6035510/
- (9) BMJ Global Health, 2018, https://gh.bmj.com/content/3/4/e000829
- (10) Diario de Pernambuco, 2018, https://www.diariodepernambuco.com.br/app/noticia/brasil/2018/10/09/interna_brasil,765039/morte-por-infeccao-e-duas-vezes-maior-na-rede-publica-do-que-na-privad.shtml
- (11) Sydharta Seguros, 2019, https://sydhartaseguros.com.br/qual-o-tempo-medio-na-fila-de-espera-de-cirurgia-do-sus/
- (12) Correio Braziliense, 2019, https://www.correiobraziliense.com.br/app/noticia/economia/2019/02/13/internas_economia,737126/henrique-prata-saude-privada-avanca-por-culpa-do-governo.shtml
- (13) Globo, 2017, https://g1.globo.com/bemestar/noticia/em-um-ano-falhas-em-hospitais-causaram-a-morte-de-3-brasileiros-a-cada-5-minutos.ghtml
- (14) Catraca Livre, 2012, https://catracalivre.com.br/saude-bem-estar/dr-consulta-clinica-particular-com-preco-acessivel/
- (15) Gazeta Online, 2016, https://www.gazetaonline.com.br/noticias/cidades/2016/07/clinicas-oferecem-consultas-a-partir-de-r-40-em-mais-de-20-especialidades-1013958721.html
- (16) Dalberg interviews, 2019
- (17) IBGE ODS, 2019, https://indicadoresods.ibge.gov.br/objetivo6/indicador611
- (18) Ciência and Saúde Coletiva, 2018, http://www.scielo.br/scielo.php?pid=S1413-81232018000602035&script=sci_arttext&tlng=en
- (19) BNDES, 2004, https://www.bndes.gov.br/wps/portal/site/home/imprensa/noticias/conteudo/20040401_not764
- (20) Financiadora de Inovação e Pesquisa, 2019, http://www.finep.gov.br/
- (21) BNDES, 2018, https://web.bndes.gov.br/bib/jspui/bitstream/1408/16040/3/PRLiv214078_Visao_2035_compl_P.pdf
- (22) United Nations Global SDG Database. “SDG Indicators.” https://unstats.un.org/sdgs/indicators/database/.
- (23) Civil Society Working Group for the 2030 Agenda. 2020. "Spotlight Repor on the 2030 Agenda in Brazil" https://gtagenda2030.org.br/relatorio-luz/relatorio-luz-2020/
- (24) Lemos, Manoel. “Brazil’s Healthtech Sector Is New Hot Spot.” TechCrunch (blog). https://social.techcrunch.com/2018/10/09/brazils-healthtech-sector-is-new-hot-spot/.
- (25) Health Market Innovation. “Clinica SiM.” https://healthmarketinnovations.org/program/clinica-sim.