Pacific Alliance: Healthcare sector

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Pacific Alliance: Healthcare sector
a) Relevance
Global health estimations have determined that reductions in mortality account for
about 11% of recent economic growth in low-income and middle-income countries.
Between 2000-2011, 24% of the growth in “Full Income” in these two country
groups came from the value of life-years (VLYs) gained because of improved
health conditions.1 So , investment in healthcare makes a lot of economic sense.
The economic benefits of investment in healthcare are estimated to be more than
ten times greater than costs.2
Also, in Latin America, during the 1980s, health emerged as a fundamental human
right and it is now protected by specific laws or even national constitutions. That is
the case of the Pacific Alliance region, where the quest for effective universal
health coverage continues.
“A change in values has transformed health systems. Personal health care
was once regarded as the work of charity. It then became the prerogative of
one sector of the economy (a labour benefit), and now it is deemed by many
as a social right. Public health was initially about mitigating risks to trade,
then about the opening of new territories; today it is about investing in
people.”
Daniel Cotlear (World Bank), Octavio Gómez Dantés (National Institute of
Public Health of Mexico), et al3
Democratic national agendas now include universal health coverage, with equity
and quality as a central issue. Other important drivers have been the demographic
and epidemiological transitions of Latin American societies.
Due to the decline in the total fertility rate and the rise in life expectancy, the four
member countries of Pacific Alliance are experiencing a deep change in the
epidemiological and demographic profile of its population, consisting of an
increasing aging population and a rapid transition in disease burden, from
communicable to non-communicable and chronic illnesses.
1
“Global health 2035: a world converging within a generation”; Lawrence H. Summers, et al; The Lancet,
January 2014.
2
“Economists’ declaration on universal health coverage; Lawrence H. Summers, et al; September 2015; The
Lancet.
3
Coauthors of a series published in The Lancet, titled Universal health coverage in Latin America, part two:
overcoming social segregation in healthcare; published online on October 16, 2014.

2
SOURCE: Universal health coverage in Latin America; Octavio Gómez Dantés, et al; The Lancet,
series in three parts, October 2014.
Communicable diseases tend to afflict the very young more profoundly, so
mortality from communicable diseases has a larger cumulative effect on the years
of lives lost and hence on the overall human capital productivity of these countries.
Figure 7.F: Mortality by main WHO categories for Pacific Alliance member states in 2016, forecast
(Base Case)
Peru has been substantially more affected by communicable diseases, and in
particular, respiratory infections that cause mortality. Colombia has had a very high
death rate relative to intentional injuries, which are result of the guerrilla conflict.

3
One of the underlying reasons for the distinct disease burden in Colombia and
Peru is owing to a gap in urban-rural healthcare coverage in these countries. As
countries mature in their healthcare delivery system, the gap in urban-rural
healthcare access narrows.
Figure: Urban-rural divide in access to basic sanitation by country
These structural shifts required a different institutional design to attend with
increasing emphasis the life-cycle of long term illnesses over the traditional
episodic and acute care, characteristic of communicable diseases. Prevention and
primary care became the main elements of the new strategy. Financial
sustainability was a major concern, not only because treatment of new diseases
was more expensive than that of traditional illnesses, but also because of the
intents to achieve coverage of large social groups that had been left out of the
health system (unemployed and people working in the informal sector, and their
families).
From a per capita healthcare spending perspective, Pacific Alliance countries are
situated between countries with basic healthcare coverage and countries with
advanced healthcare.

4
Figure: Average healthcare spend per capita over the last decade by country type (Advanced,
Pacific Alliance and basic healthcare coverage)
Health systems in the Pacific Alliance region has been segmented, up to date, in
three categories: for the poor (subsidized social insurance); for salaried working
population (contributory regime); and for the rich, with private institutions and
private insurance. Although this segregation has been reduced (through intents to
equalize benefits between the two public segments, or even merge them; and
regulation for the health system as a whole, including public and private
components), differential access still exists and efficiency issues arise.4 Health
services’ quality became a great concern.
The organizational and financial efforts of the four countries have reflected in the
following indicators:
4
Within the OECD, administrative expenditure as percentage of total expenditure on health in the case of
Mexico is the highest, with almost 9%.
Pacific Alliance

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• Chile, only 3% of population was reported as non-insured in 2011, although
out-of –pocket expenses5 were estimated to be 32% of total health
expenses in 2012
• Colombia, had 12% of population non-insured in 2012, and out-of-pocket
expenses reached 14% of total health expenses
• Mexico, 21.4% of the population reported having no insurance coverage,
and out-of-pocket expenses were 44% of total health expenses in 2012.
• Peru, approximately 38% of the population remained uninsured in 2012 and
out-of-pocket expenses were estimated in 36% of total health expenses.
Out-of-pocket expenses have remained high, due to people dissatisfaction with
their health service as well as lack of insurance. Other organizational and financial
changes have been promoted to increase efficiency and enhance quality
throughout the whole health system.
Chile, Colombia, and Peru have separated the purchaser and provider functions of
health care, introducing contracts with which insurers incentivize health providers
to improve performance. Chile, Colombia and Mexico have expanded the package
of minimum health services guaranteed to poorer population. At the same time,
the four countries have introduced reforms to strengthen the system’s financial
base through pooling funds from many sources. Although specially Peru and
Mexico have a biger challenge to reform their Health Systems
5
Out-of-pocket expenses are those monetary expenditures that the patient has to do in order to receive
medical attention when he needs it, whether he has or not health insurance. Basically, this kind of expense
is done when the patient is not insured or is not satisfied with the quality of service he has.

6
SOURCE: The quest for universal health coverage: achieving social protection for all in Mexico;
Felicia Marie Knaul (Harvard Global Equity Initiative), Octavio Gómez Dantés (National Institute of
Public Health), et al; The Lancet, August 16, 2012.

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In this context, new elements appear: development of e-health6; increasing
importance of detailed information and patient data for health system planning,
monitoring and evaluation; innovation in models of care, particularly in rural and
remote areas, through ITC platforms and community-led delivery pilots.
Electronic Health Records (EHRs) are a critical element in the health system, since
they gather the patients’ information and should be capable of sharing it with any
health institution where the patient is treated, and even with the patient himself.
But several technical issues like interoperability are still unsolved. Patients’
information is the cornerstone for a better individual treatment, and also for the
health system planning and evaluation, and for the analysis of drug prescription
outcomes.
Also new models can be found in distinct areas as:
• Pharmacies with medical services attached next door
• Telemedicine strategies to make the most of scarce specialists available
and also to help out medics in remote places
• Wider range of activities performed by nurses and other health para-
professional.
In Mexico, pharmacies with medical services attached have multiplied by more
than 9 in the period 2003-2013, reaching around 13 thousand units. Their impact
has been very relevant: they attend 450 thousand people each day, compared
with the 500 thousand attended by the main institutional social security service (the
IMSS).7
Having said the above, universal health care has three dimensions: one is the
percentage of total population coverage, another is the percentage of the financial
expense that is prepaid (and reduces out-of-pocket expenditures), and the third is
the benefit package (number and type of treatments) that is included. All three
dimensions have been influenced by each country public policy.
6
Which includes: electronic health records (EHRs), telemedicine, e-learning, mobile health (m-health) and
standardization and interoperability issues. M-health has to do with surveillance, monitoring and distance
medical care.
7
Article in the newspaper El Financiero, “Consultorios de farmacias acechan servicios del IMSS”, 27 de julio
de 2014.

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SOURCE: “Global health 2035: a world converging within a generation”; Lawrence H. Summers, et
al; The Lancet, January 2014.
Private participation is a key component in the region’s health systems;
representing 51% of total expenditure on health in the case of Chile, 48% in the
case of Mexico, 41% in the case of Peru, and 24% in the case of Colombia.8
And it will be increasingly important in a context where healthcare service needs
are growing and fiscal resources will continue to be scarce, Competition among
health purchasers (insurance companies) and among health providers (networks of
healthcare facilities) is required in order to incentivize efficiency and quality
upgrading and a more balanced risk management approach to treat health.
Compared to other health systems, those of the Pacific Alliance region are still
lagging behind in several key areas. In an aggregate measure, healthcare
services as percentage of countries’ GDPs are smaller than the OECD average9.
The same can be said regarding certain key operational indicators.
Indicator OECD Chile Colombia Mexico Peru
Physicians
per 1,000
inhabitants
3.2 1.6 1.5 2.2 1.1
Hospital beds
per 1,000
inhabitants
4.9 2.2 1.5 1.6 1.5
8
Lessons from Latin America: The early landscape of healthcare public-private partnerships. Healthcare
public-private partnership series, No. 2; Llumpo, A., Downs, S., Montagu, D., Foong, S., Brashers, E.,
Feachem, R.; San Francisco: The Global Health Group, Global Health Sciences, University of California, San
Francisco and PwC.-United States. First edition, November 2015.
9
OECD average of healthcare share in GDP is around 10%, while in Chile it is 7.7%, in Colombia 6.8%, in
Mexico 6.2%, and in Peru 5.3%, according to ECLAC’s database CEPALSTAT, in 2013.

9
SOURCE: Lessons from Latin America: The early landscape of healthcare public-private partnerships.
Healthcare public-private partnership series, No. 2; Llumpo, A., Downs, S., Montagu, D., Foong, S., Brashers,
E., Feachem, R.; San Francisco: The Global Health Group, Global Health Sciences, University of California,
San Francisco and PwC.-United States. First edition, November 2015.
Public-private partnerships (PPPs) have been seriously explored as one of the
main instruments to promote private investment in the sector. Mainly Mexico, and
at some extent Chile and Peru have already experienced with it. In addition some
innovative ways to leverage the PPPs philosophy have taken place; for example, in
the case of the Mexican social insurance for workers at private companies
(IMSS)10, PPPs have focused in certain kind of facilities and treatments (through
“service integrators”11). In the period 2008-2015, annual average contracting has
been of almost 800 million dollars, with a compound average growth rate of 15.7%.
An evaluation of the PPP environment within the four member countries of Pacific
Alliance is presented in the following chart:
10
Instituto Mexicano del Seguro Social
11
Integration refers to products and services offered to a particular entity, where technological and human
components, as well as consumables and distribution-storage-dispensing processes are performed by a
professional third party at an established price according to the type of service or procedure.

10
SOURCE: Lessons from Latin America: The early landscape of healthcare public-private
partnerships. Healthcare public-private partnership series, No. 2; Llumpo, A., Downs, S., Montagu,
D., Foong, S., Brashers, E., Feachem, R.; San Francisco: The Global Health Group, Global Health
Sciences, University of California, San Francisco and PwC.-United States. First edition, November
2015.
Pharmaceutical industry, as well as medical devices12 industry, are functionally part
of the health sector. Pharmaceutical industry includes patent drugs and generic
drugs13. Both need a testing period with a representative sample of the population
where it is pretended to be sold. With more complex chronic diseases, drug testing
is also more demanding. And evidence is increasingly necessary to prove that a
drug has the desired outcome. This long and expensive process can now be
12
According to the International Medical Device Regulators Forum (IMDRF), `medical device' means any
instrument, apparatus, implement, machine, appliance, implant, in vitro reagent or calibrator, software,
material or other similar or related article:
a) intended by the manufacturer to be used, alone or in combination, for human beings for one or more of
the specific purpose(s) of:
· diagnosis, prevention, monitoring, treatment or alleviation of disease,
· diagnosis, monitoring, treatment, alleviation of or compensation for an injury,
· investigation, replacement, modification, or support of the anatomy or of a physiological process,
· supporting or sustaining life,
· control of conception,
· disinfection of medical devices,
· providing information for medical or diagnostic purposes by means of in vitro examination of
specimens derived from the human body; and
b) which does not achieve its primary intended action in or on the human body by pharmacological,
immunological or metabolic means, but which may be assisted in its intended function by such means.
13
According to the FDA, a generic drug is a drug product that is comparable to a brand/reference listed drug
product in dosage form, strength, quality and performance characteristics, and intended use. It can be
marketed after the brand drug’s patent has expired.

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facilitated by access to quality consumer data, through technology, like biometric
sensors.
Medicines are a big part of household health expenses. Health public institutions
are consolidating their purchases in order to bring prices down.
b) Challenges
Universal health coverage is a moving target. As soon as a certain stage is
reached with a certain percentage of population and financial coverage, and a
certain benefits package, then a superior stage can be imagined, until every
inhabitant is fully financially covered for all illnesses and treatments. The rhythm at
which targets can be accomplished depend on financial constraints and
institutional capabilities for change. Realistically, no country has reached full
effective coverage , nor it has assumed this ideal as its goal.
Before that, there is a lot of room for improvement in the quality front, to assure
every individual the same level of service in the same benefits package, regardless
of its employment status. Also, co-financing is reasonable in certain cases of
higher risk, and out-of-pocket expenses can be minimized through adequate
supplementary insurance products.
The whole health system can gain in efficiency putting prevention and primary care
at the center. Prevention would focus on promoting healthy lifestyles while primary
care would make an early detection of population at risk and of chronic diseases.
Besides, the role of primary care would be not as an entrance door to specialist
treatment, but as a real diagnostic and first treatment area, where a high
percentage of visits would end satisfactorily, without going to the next level. These
elements would impact meaningful cost reductions in the long term, and would be
focused on outcomes, rather than on the volume of services.
“…prevention will be the deciding factor in containing costs.”
Carlos Abelleyra, Managing Director for Latin America at Aspen Labs.
A well-developed institutional framework is needed to foster competition between
public and private purchasers of health services and among institutional providers
of healthcare. Health authority should have a strong regulatory role to guarantee a
seamless access of individuals to the insurance company and the health care unit
of their choice. Quality supervision and information gathering and warehousing

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could be the responsibility of a new independent agency.14 This agency should
give priority to the integration of a patients’ information system, based on the
interconnection of Electronic Health Records (EHRs) that every health unit should
have. This kind of information would allow a better planning and monitoring of
health services.
“…change means empowering citizens so they can choose their general
practitioners (and keep them, despite shifting labor conditions), from a range
of public and private providers, and let this decision signal how institutions
are to be allotted funds…”
Miguel Angel González Block, Founding member of the Pwc Mexico Thought
Leadership Council15
For that to happen, regulation should be updated. The Mexican health authority,
for example, has sent to the Senate an initiative to reform the Constitution in order
to strengthen the federal government’s regulatory capabilities throughout the
national health system, including all public and private participants.
Health systems in the four member countries of Pacific Alliance have basic
characteristics in common, but also important differences. Chile’s health system
seems the more advanced, since it has already merged the two public segments of
contributory social insurance and subsidized social insurance, and since it has an
older, more consolidated, private health insurance sector. Along with the
unification of public sector funds in one institution, Chile is also promoting payers’
freedom of choice, so demand from individuals can generate competence among
health institutions and incentives to enhance services. And a third element in
Chile’s health design, is that it is making explicit the entitlement of population to
specific essential services, including coverage of severe illnesses. There is a lot of
room for experience and best practices exchange among the countries within the
Pacific Alliance framework.
“The Pacific Alliance countries can be benefited by a comparison
between their healthcare models, which are really different and have
different regulations, to identify their advantages and disadvantages, so
that they can learn from each other and share their experience. Maybe
we would be able to synthetize a single one”
14
As proposed by the Mexican health authorities and suggested by the OECD.
15
Prologue to the publication Megashifts, a driver to the healthcare sector: doing business in Mexico; PwC
Mexico, 2013.

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Ignacio Aramburu, Executive Vice President of finance and risk
control, RIMAC Seguros
New operational and business models should be piloted and improved. If they turn
out to be successful, then they should be disseminated throughout the region.
Technology will be a clear driver in this regard, looking to increase service quality
and reduce costs.
Financial strengthening of national health systems is an imperative. Every country
that has reached and maintained universal health coverage has resorted to some
type of general taxes. This is a clear area for experience and knowledge exchange
among the Pacific Alliance countries and other exemplary nations.
Regarding PPPs, it is necessary to disseminate experience and knowledge
obtained in projects implemented over the past few years, so as to converge in
similar practices, contracts and criteria that can facilitate the participation of
regional and global players, stimulate competition and achieve better projects in
the future from the service and financial points of view.
A recent PwC review of healthcare public-private partnerships in Latin America
concluded in some useful lessons learned:
SOURCE: Lessons from Latin America: The early landscape of healthcare public-private
partnerships. Healthcare public-private partnership series, No. 2; Llumpo, A., Downs, S., Montagu,
D., Foong, S., Brashers, E., Feachem, R.; San Francisco: The Global Health Group, Global Health
Sciences, University of California, San Francisco and PwC.-United States. First edition, November
2015.
Doctors and specialists across the Latin American region have a long history of
professional exchange, information and research sharing, through entities like the

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Panamerican Health Organization (PAHO). Health authorities also cooperate in
regional campaigns and, special groups like the working group created by the
health ministers of the Pacific Alliance region to address an agenda of common
issues of interest.
“The [health] ministers in the AP region had a first meeting to select the subjects to
discuss. Two important issues were identified:
• Medicaments regulations, including sanitarian registries, prices,
bioequivalence and bioavailability.
• Quality in service, including harmonization of medical specialities and
certification within the four countries.
It’s important to also analyse comparatively our attention models, not only from
the service perspective but as risk management models too.
The implementation of the EHRs could be boosted through the Pacific Alliance
by the exchange and discussion of standards, rankings, definition of minimum
group of variables and systems interoperability.
Medical tourism could be promoted in the context of development of healthcare
clusters. As an example, in Colombia, there are at least four cities with the
necessary conditions to achieve this: Bogota, Cali, Barranquilla and
Bucaramanga.
Given the configuration of the healthcare system of Colombia, applying a full
PPP scheme (including medical services) is really difficult, but in could be
relevant to renew or expand infrastructures. High complexity public hospitals
would be natural candidates for this.
We must differentiate the Pacific Alliance exchange process from others we
already have, for example, through the Pan American Health Organization
(PAHO), the Mesoamerican Project (formerly known as Puebla-Panama Plan),
and the agreements within the Andean area, to complement them, not to
compete with them. One possibility would be to emphasize research and
development.
Dr. Fernando Ruiz, Health Vice Minister, Colombian Government16
And cooperation should explore new possibilities. High quality human resources
are scarce. The region can promote their best use strengthening research
networks and specializing certain places in certain disciplines, in order to
concentrate and make regional investment more productive. The idea of health
clusters should be explored, looking into each country’s comparative advantages.
16
Interview held on December 23, 2015.

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c) Strategic bets
Develop instruments to strengthen prevention and primary care as the center of
national health systems.- Health IT or eHealth should pave the road for the new
health paradigm based on prevention and primary care. Also, qualified human
resources are needed for family medicine, not as an initial stage in the physician’s
career, but as a real life-long specialization.
MANAGEMENT SYSTEM FOR PRIMARY CARE UNITS
CASALUD is an innovative model that the Carlos Slim Institute for Health
(ICSS)17 designed and developed in order to re-engineer primary care for
chronic diseases through a preventative focus that promotes continuous care
of the patient from the moment they show signs of being at risk. It includes a
comprehensive management system for primary medical units that included
the electronic health register for patients and a set of apps for illnesses’
prevention and treatment, such as Diabe-diario, for the patient empowered
treatment of diabetes (the burden of disease in the case of diabetes mellitus
II has been estimated in 2.25% of Mexico’s GDP in 2013). It has a
technological platform that ensures precise measurements and follows up
with the patient.18.
SPECIALIZED HUMAN RESOURCES FOR FAMILY MEDICINE
The shift to prevention and primary care has to be accompanied by the
correlative development of qualified human resources. The Ministry of
Health in Colombia has set the target to prepare five thousand specialists in
family medicine to attend the increasing demand of high quality primary care.
In its last review of the Mexican health system (January 2016), the OECD
has recommended the design of a university specialty career to form the
physicians that are will be increasingly needed to attend primary care units.
Develop an independent agency with the responsibility of quality supervision of
health services and information gathering, warehousing and public accesability.-
Health coverage has to do with quality services. If an individual is insured but the
services he receives are not satisfactory, then he will look for other options. If the
institutional framework allows him to choose another health provider, he will look
for one with a good track record. If a health unit is failing in what it should deliver,
the authority should be able to take pertinent steps to correct it. All of this needs
17
Instituto Carlos Slim para la Salud.
18
Converging health and business – PwC Mexico

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information, and the best source of information is the patient himself. So there
needs to be a third-party independent entity, with no compromises with public or
private health units, responsible for quality supervision and enforcement. And to
comply with this task, it has to gather information from operational units and
patients themselves.
SOCIAL PROTECTION COMPREHENSIVE INFORMATION SYSTEM
Colombia is developing a data warehouse that is intended to bring together
several databases that cover financing and health accounts, individuals’
health care needs, risk factors and service utilization, distribution and
characteristics of insurers; and distribution and characteristics of providers,
including indicators of quality and outcomes. Once fully operational,
SISPRO19 will support health system monitoring and planning, as well as
providing public access to key health system statistics and reports.
ITALIAN AGENCY AS A REFERENCE
OECD recommended to take the case of the National Agency for Regional
Healthcare (AGENAS) in Italy as a good example of what a quality review
independent agency should be.20
Develop and interconnect Electronic Health Records (EHRs).- Advances in this
regard are different in the four countries. Chile has managed to integrate a
national information system, that even allows patients to interact (to make
appointments, for example) and consult their own data. Mexico’s EHRs have
evolved on an institutional basis issuing a norm to regulate the EHR, but extending
usage and interoperability are still big pendings to act upon. Exchange of
experiences is necessary to enhance national efforts and define clear roadmaps.
EHRs are a key piece in the development of a health national information system.
Promote healthcare service integrators development and better conditions for
PPPs.- The region has had experience with PPP health projects regarding the
construction, equipment and general services of complete new hospitals. And
more projects are in the pipeline, that can learn from this past experience, and
improve facilities, financial conditions and risks, and overall costs. Exchange
among the four countries can help to define similar contracts and tenders, to
facilitate the participation –and increase competition- between global and regional
players. Also, health institutions have been contracting, as outsourcing or
insourcing, certain services based on expensive and sophisticated equipment (like
19
Sistema Integral de Información de la Protección Social.
20
Mexico Health System Review 2016, OECD.

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hemodialysis), in order to modernize their own equipment and make a better use of
it (since the new facility would provide services to several health units). These
contractors are known as healthcare service integrators and have been operating
in a very flexible way. They can set up a new surgery room and provide general
services and consumables, or they can also provide the physicians, nurses, etc.
Conceptually, this kind of arrangement is also a PPP, although its focus is more
specific and the investment involved is usually smaller. It generates savings for the
contracting entity and, within an accountability framework, also quality service
improvement.
Promote regional specialization through bioclusters development.- Pacific Alliance
member countries can increase their research resources and patent generation
capabilities through an agreed concentration of certain health specialties in certain
areas, according to each countries strengths, in order to take advantage of scarce
very qualified human resources and make a more efficient use of scarce financial
resources. This concentration would benefit from a cluster-type organization, that
can attract other important players to build a strong innovation ecosystem with a
regional perspective. It might makes sense, for example to intensify diabetes and
heart research in Mexico; while Chile develops capabilities for cancer research;
Colombia develops research in ophthalmology and plastic and reconstructive
surgery; and Peru emphasizes respiratory diseases. Telemedicine would be a
useful instrument in this context, to disseminate region-wide the knowledge
developed in these places.
Facilitate establishment of hospital regional chains and medical tourism.- Within a
health cluster it is only natural to establish healthcare units and some of these units
could very well be designed to promote medical tourism. Although establishment
of regional hospital chains in not a priority for many national organizations, which
prefer to attend their known local market, some others are clearly oriented towards
patients from abroad. Mexico and Colombia have location advantages with
respect to the United States market, and their cost comparison is overwhelming.
Mexico has 107 hospitals certified by the local authority and 10 certified by the
Joint Commission International. It is the second destiny worldwide with 1.1 million
foreign patients in 2012 that generated 3.6 billion dollars income.21
REGIONAL HOSPITAL CHAIN
Sanitas International has a network of hospitals and assistance. Starting with
sites in Colombia, Venezuela, Peru, Brazil and Mexico, they recently also
moved to the United States with immigrant populations as their target group.
21
Turismo de Salud; Health Ministry and ProMéxico, 2014.

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Their model is that of complete care, including insurance, hospitals,
specialized doctors, and cutting-edge applied technology.
MEDICAL TOURISM AND HOSPITAL ANGELES
Hospital Angeles (AHI) is the largest private provider of health care services
in México. It has 28 hospitals, with 15 thousand specialists, 2,554 rooms and
234 operating rooms. Mexico’s unique location makes most major cities
easily reachable by air travel where a medical shuttle awaits to take patients
to the Angeles complex. AHI offer patients English-fluent concierge services
handling through their connections with US Hospital Angeles services,
offering everything from medical consults, appointments and records transfer,
as well as travel arrangements for patients and their families in
comprehensive and affordable medical travel packages.
Develop technology applications to enhance health services.- With prevention and
adequate treatment of chronic non-communicable diseases in mind, a myriad of
innovative entrepreneurs is developing all sorts of technological platforms to
stimulate adoption of healthy lifestyles and to facilitate monitoring and real time
responses when needed. Many of these new apps are available through smart
phones, and can offer very sophisticated services that link with internet of things in
wearables like watches, clothes, shoes, etc.
“SOHIN is a Pioneer in Latin America, in addressing comprehensively
chronic – degenerative diseases, through their CONCIERGE specialized
service, which supported by its top technology, accompany the patient

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and its family and guarantees a deeply personalized attention that
includes patient’s genetic information. This technology, includes three
dimensions: genetic diagnosis, the clinic information, CRM and its
transactional features and the mobile tools for the patient and the
corresponding medic.
We are concerned by the global increase in chronic-degenerative
diseases related deaths, which represents a huge challenge to the
healthcare systems and risks country’s productivity. Our value
proposition seeks to transform this patients’ service models so they can
improve their quality of life and optimize the resources for their care, to
therefore increase population’s access to healthcare
SOHIN is a Mexican company, that also started operating in Colombia
this year, and we plan to continue our international expansion to Chile
and the US.
Even though there are breakthroughs in the region to facilitate doing
business, there is still much to do to boost the development of
businesses and job creation among entrepreneurs. Traditionally, big
benefits, as tax incentives, are destined to big corporations and that
widens the gap and unevens the game rules for minor businesses.
Specifically in the health sector, the equalisation in regulatory norms,
could revolutionize and maximize the market, they would benefit the
population with better prices and homologated quality conditions.”
Juana Ramírez, C.E.O. of SOHIN22
Facilitate regional research for patent and generic drugs to speed up their approval
and marketing process.- Universities and health authorities in the four countries
can help the pharmaceutical industry to comply with the required regional research
to demonstrate the usefulness and harmlessness of their products within their
defined sample populations. Countries have much to win in this, since a shorter
period would mean less cost and, hence, a reduced price to user patients.
Harmonize technical rules and standards of medical devices within the region, to
facilitate trade and generate scale economies for industrial producers.- Industry
chambers from the four countries have been discussing for several years now, in
the framework of Pacific Alliance, how to harmonize rules and standards of a wide
variety of products, with the goal of integrating a complementary protocol that could
be part of the Additional Protocol already agreed by the member countries.
Discussions have been intense but very productive, since the industry
22
Interview celebrated on March 16, 2016.

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representatives have visualized many win-win situations that will reflect in cost
reduction, bigger market, and improved customer experience.
Certify pharmacies that offer medical services next door.- In Mexico, pharmacies
with medical offices established as a separate entity but just next door, have
demonstrated their ability to provide convenient access and service, lessening the
stress on traditional health care facilities. Trust and adequate quality supervision
from the sanitary authority of the clinicians at the pharmacies next door is critical
for larger adoption. Self-regulation and adequate internal controls of medical
offices, with adequate Electrionic Health Record (EHR) support would also help
win the trust of the potential patients, resulting in the clinicians gaining good level
of acceptance. If this model achieves linking itself to a network of hospitals and
insurance companies, there would be a winning formula difficult to stop with health
benefits that the population is eager to receive. This model is extending to the
other three Pacific Alliance countries, in part through the purchase of pharmacy
chains that Mexican groups are doing.
More than 13 thousand such pharmacies operate nowadays in Mexico. And they
attend daily almost as much patients as the major health institution (455 thousand
vs 500 thousand), the IMSS.23
CERTIFICATION OF DOCTORS AT FARMACIAS BENAVIDES
Farmacias Benavides in Mexico is following this path of self-regulation and
third-party certification, to demonstrate their will to enhance their medical
services. One of the key challenges for these establishments is to adequately
regulate their activities and their professional and demand implementation of
quality medical care that Farmacias Benavides has looked to address
through self-regulatory mechanism. This form of pharmacies typically serve
between 15-80 patients in a single day, depending on the pharmacy capacity,
location and population density in the area. As these pharmacies gain
recognition and credibility, it would lead to larger number of patient walk-in.
Take advantage of shared logistics and management to reduce costs in the supply
chain.- Finding a quality distributor in Latin American countries is one of the
biggest challenges in the selling of products. The medical device distribution
industry is highly fragmented with hundreds of small distribution companies.
International device companies often rely on distributors to play a more strategic
role with provision of commercial infrastructure. However, trusting external
23
“Consultorios de farmacias acechan servicios del IMSS”; in El Financiero, July 27, 2014.

21
distributor to price, position, and market your device is critical for success in Latin
America.
Pharmacies and Medical Device players in the Pacific Alliance have typically relied
on specialized distributors for transportation of pharmaceuticals and devices which
has been more expensive mode of distribution; thus adding to the cost pressure of
the companies. Aggregation of transportation requirement across pharma, medical
samples and devices would provide scale benefits to aggregators while ensuring
high customer service level and better visibility of the supply chain.
Specialised logistics companies have gradually entered the healthcare industry as
they have witnessed potential market for its development. The challenge in the
logistics and supply chain remains around visibility and responsiveness to change
their models in line with market needs.
FEMSA is a diversified industrial and commercial group in Mexico. It has a
large fleet of trucks that deliver bottled beverages to a very large network of
small stores and its own chain of convenience stores. The group has
recently acquired several medium size pharmacies chains and is starting to
use its trucks to distribute medicines to both networks.

Pacific Alliance: Healthcare sector

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Pacific Alliance: Healthcare sector