Telemedicine and Digitalization of the Health System
Telemedicine and Digitalization of the Health System
Business Model Description
Since the pandemic, telemedicine has expanded significantly. Companies that provide medical services in Uruguay could incorporate these services and equipment, or even extend it to Management Digitization processes. The foregoing will cause significant improvements in efficiency and quality in care for the population in general and especially for the most vulnerable.
Expected Impact
Access to telemedicine strengthens the Integrated National Health System, improving the coverage and efficiency of medical services with emphasis vulnerable 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
- Uruguay: Countrywide
Sector Classification
Health Care
Health in Uruguay is deployed through the National Integrated Health System, which ensures coverage for 95% of the national population. The main challenges raised in the 2021refer to: improving care for communicable and non-communicable diseases; prevention of causes of death and risk factors; decrease in suicide indicators.
Policy priority
The set of policies are defined in the document National Health Objectives 2020 that define 15 problems and define strategic actions and more than 300 specific lines of action.
Gender inequalities and marginalization issues
A not lesser group of health care is focused on populations of women and children and especially in relation to mortality in childbirth and prenatal care. In turn, Uruguay has moved towards a paradigm of Sexual and Reproductive Health that includes reproductive policies, teenage pregnancy, among others.
Investment opportunities introduction
The health sector requires significant investments to update the instruments, practices and buildings in which health services are provided. The COVID pandemic highlights the need for health systems with the capacity to respond to new types of emerging risks.
Key bottlenecks introduction
The SNIS poses continuous challenges associated with its financial sustainability, the ability to increase and ensure coverage, which in turn includes new challenges associated with improving the quality of care and health prevention of Uruguayans
Health Care Providers
Development need
There are 47 private health providers and ASSE (public) in Uruguay. These organizations require permanent investment policies to be able to improve their services and efficiency in the provision of services. Total spending on health is USD 5,000 million per year and USD 108 million is represented by spending on investments in infrastructure, machinery and equipment
Policy priority
The priority is a more efficient allocation of the capitations that FONASA makes per member, based on the type of treatment and the general state of health of the patient. Currently it is done by qualitative variables of age and sex.
Gender inequalities and marginalization issues
In the NSOs there is special attention to vulnerable populations. In addition, a better system ensures greater coverage of access to the entire population.
Investment opportunities introduction
The SNIS financed through a single "box" such as FONASA, allows the design of financial vehicles in order to make possible investments in digitalization of health that enable important improvements in the management and general monitoring of health providers, while improving levels of care and coverage.
Key bottlenecks introduction
There is significant heterogeneity within the different providers, which can make the system fragile and impose restrictions on ambitious infrastructure investment plans.
Health Care Distributors
Pipeline Opportunity
Telemedicine and Digitalization of the Health System
Since the pandemic, telemedicine has expanded significantly. Companies that provide medical services in Uruguay could incorporate these services and equipment, or even extend it to Management Digitization processes. The foregoing will cause significant improvements in efficiency and quality in care for the population in general and especially for the most vulnerable.
Business Case
Market Size and Environment
USD 100 million - USD 1 billion
< 5%
Health spending represents 10.5% of the national GDP. 2% of spending represents investments and of these 50% is in infrastructure and machinery and equipment. Total spending on health is USD 5,000 million per year and USD 108 million is represented by spending on investments in infrastructure, machinery and equipment, an amount that could be an estimate of the potential market.
Indicative Return
10% - 15%
The financial results of health providers are very heterogeneous. Differences persist in the management of the institutions. There are currently some short-term financial operations (trusts) with a rate of 20% in local currency or an equivalent of between 9% - 12% in USD.
The approximate value is extracted based on some issues of short-term and repayable debt for mutualists with high financial risk and with guarantees in transfers of per capita payments that are made by the National Health Fund (FONASA).
Investment Timeframe
Long Term (10+ years)
In the case of the financing of investments in equipment, the amortization periods should be accompanied, that is, 10 years.
Ticket Size
> USD 10 million
Market Risks & Scale Obstacles
Capital - Requires Subsidy
Capital - Requires Subsidy
Impact Case
Sustainable Development Need
Access to health, in remote territories such as the vulnerable population. Telemedicine techniques bring services closer to the population, while reducing their unit cost (consultation, diagnosis, etc.).
Improvement in the quality of medicine, based on the financial stability of health providers and the possibilities offered by telemedicine regarding consultations in medical conferences.
Improvement in the universal Uruguayan greeting system. The digitization of health management will allow better control of expenses and performance of each institution based on the services provided and results achieved.
Gender & Marginalisation
Health problems in any member of the family affects the income possibilities of the whole. Especially in women who are in charge of care.
Lower costs in vulnerable low-income populations.
Improvement in the treatment of health conditions that can affect household income and especially women in charge of care.
Expected Development Outcome
Decrease in costs and improvement in access to health services that can be derived in the Telemedicine modality.
Improvement in the profitability of institutions that provide health services by incorporating specialized management technologies.
Increase in the level and total investment at the level of the integrated health system as a result of access to impact financing. Incorporation of specific impact metrics in the health services provided based on the requirements of the impact financing schemes offered.
Gender & Marginalisation
Telemedicine services aimed at vulnerable populations and specialties in women and children (gynecological and prenatal) as well as pre and postpartum, as well as early childhood.
Care services for people living in remote territories.
Increase in the quality of care in cases that require specializations or medical meetings.
Primary SDGs addressed
3.8.1 Coverage of essential health services
3.b.3 Proportion of health facilities that have a core set of relevant essential medicines available and affordable on a sustainable basis
They are defined based on the National Health Objectives 2020: 4: Build an Institutional Culture of Quality and Safety in Health Care. 4.2: Implementation of the National Policy on Safe Behavior. 4.3: Implementation of Quality Measurement and Assessment Strategies. Care that allows continuous improvement. 4.5: Surveillance of HAIs with audited data.
Likewise, objective 3 Improve access and health care in the course of life, has a set of actions and goals that will need to be prioritized based on the scope and direction of the telemedicine teams to be implemented.
In the case of objectives 4, 4.2 and 4.3 define as a Goal to reach 80% of the institutions providing the SNIS with an implemented behavior agreement and a self-assessment carried out. The baseline was 15% and 66% for 4.2 and 4.3 and the evaluation report indicates an advance of 42%.
In objective 3 of the 2020 NSOs, the Results will be selected and will continue based on the established and updated goals.
Secondary SDGs addressed
Directly impacted stakeholders
People
Gender inequality and/or marginalization
Planet
Corporates
Public sector
Indirectly impacted stakeholders
People
Corporates
Public sector
Outcome Risks
Risk factors associated with the decline in the number of affiliations.
Increase in drug costs due to exchange rate effects.
Pandemics and other unexpected events that destabilize system coverage planning.
Fragility in the system due to the existence of institutions with significant financial problems.
Impact Risks
Unexpected effects of the pandemic on the prevalence of neglected noncommunicable diseases.
Financial destabilization of the system as a whole that implies postponing planned investments.
Worsening of the budget items assigned to ASSE that attends to the lower-income populations.
Increase in unestimated proportions in ASSE affiliations as a transfer from private providers, causing the collapse of the public system.
Impact Classification
What
Facilitate financial access to accelerate investments in Telemedicine and digitalization of the management of health service providers.
Risk
Existence of actors that present significant financial weaknesses and that can destabilize the system
Impact Thesis
Access to telemedicine strengthens the Integrated National Health System, improving the coverage and efficiency of medical services with emphasis vulnerable populations.
Enabling Environment
Policy Environment
Law on Telemedicine, which still needs to be regulated.
National Health Objectives that determine priorities in health policies and establish objective indicators. In addition, their monitoring is carried out in the Ministry of Public Health.
Voluntary National Report (UN).
Priorities in mental health, drug abuse, gender violence, teen pregnancy prevention, nutritional information on products with a high sugar and sodium content, universal access to sexual and reproductive health services, as the most notable.
Financial Environment
Financial incentives: Important presence of public policy that provides concessional funds, retention mechanisms and can eventually provide guarantees.
There is a special tax treatment of exemptions for investments in innovations.
It is possible to identify financial vehicles that combine investment from multilateral credit organizations. Health is a high-impact sector with a high level of indicators and metrics already developed and regularly monitored.
Regulatory Environment
Law 19,689 of General Guidelines for Telemedicine.
National Integrated Health System that centralizes and manages funds between the population and the different providers, ensuring universal coverage and good quality.
National Health Fund (FONASA), individual collection system based on personal and family income, also discriminating by age of the contributors.
Marketplace Participants
Private Sector
SNIS health providers; suppliers of telemedicine equipment at the intl level as well as TOCs applied to management.
Government
Through the MSP and SNIS as central management of the health system.
Multilaterals
IDB, CAF, World Bank and other institutions can provide funds or collateral.
Medical union, Mutual associations, PAHO-WHO
Target Locations
Uruguay: Countrywide
References
- (1) National Voluntary System Uruguay 2021 - Presidency, OPP AUCI
- (2) Health Health Objectives 2020. MSP