Telemedicine
Telemedicine
Business Model Description
Invest in the extension and implementation of telemedicine services such as online and / or telephone consultations, self-diagnosis, follow-ups, as well as services and technological solutions that allow the storage and access of medical information of patients with medical personnel throug mixed financing including private investment, subsidies from foundations and the co-payment system of the users.
Expected Impact
Increase access to health services and reduce inequality in rural and female population.
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
- Paraguay: Amambay
Sector Classification
Health Care
Development need
Difficulties of access to health care persist for the rural population, especially the rural poor. Additionally, there is a shortage of human resources, since in preventive health the gap amounts to 3,800 health professionals. Only 25.9% of the population has health insurance (I).
Policy priority
The Institutional Strategic Plan of the Ministry of Public Health and Social Welfare has been carried out for 2023. Among the objectives are: The protection and guarantee of universal access and coverage, strengthen the quality of health care, guarantee the care of the prevalent diseases and promote the rational use of medicines and other health technologies (II).
Gender inequalities and marginalization issues
Women often lack regarding fertility, contraceptive and reproductive health measures and rural areas have lower access to health (III).
The opportunity to rebuild the sector with business models that are more inclusive, help accelerate poverty reduction and close inequality gaps, is necessary. To do this, telemedicine and affordable health insurance were identified as opportunities (I).
Key bottlenecks introduction
Inadequate infrastructure, such as insufficient healthcare facilitie directly impacts the ability to deliver effective health services, especially in remote or underserved areas. Additionally, a lack of trained healthcare professionals exacerbates these challenges (IV).
Health Care Retail
Development need
Difficulties of access to health care persist for the rural population, especially the rural poor. Additionally, there is a shortage of human resources, since in preventive health the gap amounts to 3,800 health professionals. Only 25.9% of the population has health insurance (I).
Policy priority
The Institutional Strategic Plan of the Ministry of Public Health and Social Welfare has been carried out for 2023. Among the objectives are: The protection and guarantee of universal access and coverage, strengthen the quality of health care, guarantee the care of the prevalent diseases and promote the rational use of medicines and other health technologies (II).
Gender inequalities and marginalization issues
Women often lack regarding fertility, contraceptive and reproductive health measures and rural areas have lower access to health (III).
The opportunity to rebuild the sector with business models that are more inclusive, help accelerate poverty reduction and close inequality gaps, is necessary. To do this, telemedicine and affordable health insurance were identified as opportunities (I).
Key bottlenecks introduction
Inadequate infrastructure, such as insufficient healthcare facilitie directly impacts the ability to deliver effective health services, especially in remote or underserved areas. Additionally, a lack of trained healthcare professionals exacerbates these challenges (IV).
Pipeline Opportunity
Telemedicine
Invest in the extension and implementation of telemedicine services such as online and / or telephone consultations, self-diagnosis, follow-ups, as well as services and technological solutions that allow the storage and access of medical information of patients with medical personnel throug mixed financing including private investment, subsidies from foundations and the co-payment system of the users.
Business Case
Market Size and Environment
In 2019, 3,004,602 people were excluded from health insurance and health services
> According to statistical data for 2019, of the 7,152,703 inhabitants, 4,148,101 people had health insurance and / or accessed a health service (sick or injured who consulted), so 3,004,602 people were out of said groups (1).
> MediGet (a company that operates in Paraguay) offers a subscription for physicians of 15 USD (PYG 99,900) per month to access the platform and appear in the directory of specialists, regarding the cost of the consultations depends on the specialty of the doctor, it can range from 15 (PYG 99,900) to 25 USD (PYG 166,500) and the doctors receive 90% of the profits (2).
Indicative Return
> 25%
For an economic feasibility study of Telemedicine and its implementation in the department of Cordillera, Paraguay, in 2015, a positive NPV is obtained and results in an IRR of 43%, in a period of 10 years (3).
Investment Timeframe
Medium Term (5–10 years)
For an economic feasibility study of Telemedicine and its implementation in the department of Cordillera, Paraguay, in 2015, a positive NPV is obtained, with financing, in a horizon of 10 years (3).
Market Risks & Scale Obstacles
Business - Business Model Unproven
Impact Case
Sustainable Development Need
There are still great challenges in Paraguay to achieve SDG 3. The coverage index of essential health services in Paraguay in 2017 was 69.0 (on a scale of 0 to 100) (5).
40,000 people in Paraguay die each year and 30% die without any type of medical assistance, mainly the population in rural areas far from cities (4).
An average of 18,000 deaths are registered per year in the country, which represents about 6,000 people. (9). with more than 500 deaths annually. For this reason, active prevention and monitoring strategies for this type of disease are increasingly relevant in the country (6).
Gender & Marginalisation
There is a disparity around the distribution of health personnel, where 70% of health workers are concentrated in the area around Asunción, an area where only 30% of the population lives. This gap in health workers is due to the lack of infrastructure and incentives to work in rural areas (7).
Difficulties in access to health care persist for the rural population, especially the most vulnerable and low-income populations in rural areas (7).
Women often lack regarding fertility, contraceptive and reproductive health measures.
Expected Development Outcome
> Improve the provision and access to health services.
> Reduce the costs of access to care for diagnoses of different diseases (such as cardiovascular diseases and breast and cervical cancer), including waiting time and transportation cost.
Gender & Marginalisation
>Improve access to information for women regarding fertility, contraceptive and reproductive health measures.
> Reduce the inequality gap in obtaining health, improving access to health for rural areas.
Primary SDGs addressed
1.3.1 Proportion of population covered by social protection floors/systems, by sex, distinguishing children, unemployed persons, older persons, persons with disabilities, pregnant women, newborns, work-injury victims and the poor and the vulnerable
1.a.2 Proportion of total government spending on essential services (education, health and social protection)
3.1.1 Maternal mortality ratio
3.8.1 Coverage of essential health services
Secondary SDGs addressed
Directly impacted stakeholders
People
Public sector
Gender inequality and/or marginalization
Indirectly impacted stakeholders
Corporates
Outcome Risks
Due to its impersonal nature, the provision of health services online can reduce the responsibility between the doctor and the patient and decrease the overall quality (8).
Patients are exposed to cybersecurity problems, challenging the privacy of your information and personal data on telemedicine platforms (8).
Impact Risks
External risks: Lack of infrastructure and connectivity deployment could limit impact.
Drop off risks: lack of digital skills could limit population adoption of services.
Gender inequality and/or marginalization risk: digital training gaps could lead to lower adoption in rural areas and female population.
Impact Classification
What
Telemedicine has the potential to reduce inequalities in the accessibility of services between urban and rural communities and generate a positive result for the population of Paraguay.
Who
Communities living in remote areas, as well as society as a whole, the national health system and health employees
Risk
Although the model is proven, external factors such as limited connectivity and digital literacy of target populations can limit the extent of impact
Impact Thesis
Increase access to health services and reduce inequality in rural and female population.
Enabling Environment
Policy Environment
The National Development Plan 2030 - has as one of the objectives of axis I (Poverty reduction and social development) of the plan is to obtain quality social services: It combines poverty reduction, social development and efficient and transparent public management (9).
The Institutional Strategic Plan of the Ministry of Public Health and Social Welfare 2019 - establishes the objectives for the health sector in the medium term, which include increasing access and coverage and strengthen the quality of health care (10).
The National Telehealth Program - It is an example of the telemedicine effort in the public sector is in charge of the Ministry of Public Health and Social Welfare and its objective is to provide support to the Public Health System (11).
Financial Environment
Law 60-90 establishes that when the investment is financed with a foreign banking institution, no taxes are paid on the payments made by said banking institution (investments greater than US $ 5 million) (15).
Law 60-90 establishes that for investments greater than investments greater than US $ 5 million, no taxes are paid when the profits from the project are distributed (15).
Law 5,542 / 15 On guarantees for investments and promotion of job creation and economic and social development, grants the invariability of the income tax rate in force at the signing of the contract for up to ten years (16).
Regulatory Environment
Law No. 836 of the Health Code - Where the functions are regulated of the State in relation to the integral care of the health of the people and the rights and obligations of the people in the matter (12).
Law 2001/1936 - Creation of the Ministry of Public Health and the Organic Law for health custody and defence is established (13).
National Health Council - It is a body for coordination, consultation and inter-institutional participation between the public sector and the private health sector, within the limits established in Law No. 1032/96 that creates the National System of health (14).
Marketplace Participants
Private Sector
Mediget (the platform charges 10% of the payment per consultation, the price of which depends on the medical professional), Dr. Click (family medicine, traumatology and orthopedics or psychology), E-Medicus (attention and primary diagnoses)
Government
Ministry of Public Health and Social Welfare (Diagnostic studies include tomography, ultrasound, electrocardiography and electroencephalography)
Target Locations
Paraguay: Amambay
References
- (I) Florencia Attademo-Hirt et al. 2019. Estrategia del grupo BID con el país 2019-2023. https://www.idbinvest.org/sites/default/files/2020-04/ESTRATEGIA%20DEL%20GRUPO%20BID%20CON%20PARAGUAY%20%282019-2023%29.pdf (II) Ministerio de Salud Pública y Bienestar Social. 2019. Plan Estratégico Institucional. https://www.mspbs.gov.py/dependencias/portal/adjunto/c5fbf6-PlanEstratgicoInstitucionalPEI20192023.pdf (III) Rural Health Information Hub. 2021. Barriers to Improving Rural Maternal Health. https://www.ruralhealthinfo.org/toolkits/maternal-health/1/barriers (IV) Ministerio de Salud Pública y Bienestar Social. 2014. Salud Pública apunta a desarrollo de servicios, pero espera recursos. https://www.mspbs.gov.py/portal/990/salud-publica-apunta-a-desarrollo-de-servicios-pero-espera-recursos.html
- (1) La Dirección General de Estadística, Encuestas y Censos. 2019. CONDICIONES DE VIDA. https://www.ine.gov.py/publicacion/28/salud
- (2) Mediget. s.f. About. https://www.linkedin.com/company/mediget/about/
- (3) Liduvina Marina Vega. 2015. Telemedicina en Paraguay: estudio de factibilidad económica para su implementación en el Departamento de Cordillera. https://www.eco.una.py/eco/postgrado/tesis/2016/Vega_Liduvina_Tesis_Maestria_Proyectos.pdf
- (4) Entrevistas. 2021.
- (5) Cambridge University Press. 2021. Launch of Sustainable Development Report for Paraguay 2021. https://www.unsdsn.org/launch-of-sustainable-development-report-for-paraguay-2021
- (6) Ministerio de Salud Pública y Bienestar Social. 2013. Al año, unos 6.000 paraguayos mueren por enfermedades cardiovasculares. https://portal.mspbs.gov.py/al-ano-unos-6-000-paraguayos-mueren-por-enfermedades-cardiovasculares/
- (7) The Borgen Project. 2020. The regional disparities of healthcare in Paraguay. https://borgenproject.org/healthcare-in-paraguay/
- (8) Iván Palacios, 2020. Ventajas y desventajas de las consultas por telemedicina. https://www.primicias.ec/noticias/tecnologia/consultas-telemedicina-ventajas-y-desventajas/
- (9) Gobierno del Paraguay. 2014. Plan Nacional de Desarrollo Paraguay 2030. https://www.stp.gov.py/pnd/wp-content/uploads/2014/12/pnd2030.pdf
- (10) Ministerio de Salud Pública y Bienestar Social. 2019. Plan Estratégico Institucional. https://www.mspbs.gov.py/dependencias/portal/adjunto/c5fbf6-PlanEstratgicoInstitucionalPEI20192023.pdf
- (11) Ministerio de Salud Pública y Bienestar Social. 2020. Gran avance en Salud Pública: Se crea “Programa Nacional de Telesalud”. https://portal.mspbs.gov.py/gran-avance-en-salud-publica-se-crea-programa-nacional-de-telesalud/#:~:text=La%20Ley%20N%C2%BA%205.482%20crea,calidad%20y%20los%20principios%20b%C3%A1sicos
- (12) Congreso de la nación paraguaya. 1980. Ley No. 836. https://www.bacn.gov.py/leyes-paraguayas/2399/ley-n-836-codigo-sanitario
- (13) Congreso de la nación paraguaya. 1936. Ley No. 2001. https://www.bacn.gov.py/leyes-paraguayas/2301/ley-n-2001-ministerio-de-salud-publica-msp
- (14) Congreso de la nación paraguaya. 1996. Ley No. 1032. https://www.mspbs.gov.py/dependencias/dnvs/adjunto/975a86-LEYN10321996QUECREAELSISTEMANACIONALDESALUD.pdf
- (15) Congreso de la Nación Paraguaya. 1991. LEY Nº: 60/90. https://www.mic.gov.py/mic/w/industria/ddi/pdf/Ley60-90.pdf
- (16) Congreso de la Nación Paraguaya. 2015. LEY Nº 5542. https://www.bacn.gov.py/leyes-paraguayas/4523/garantias-para-las-inversiones-y-fomento-a-la-generacion-de-empleo-y-el-desarrollo-economico-y-social