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Medical Tourism - Destination - Brazil

General Informations

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Brazil attracts many medical tourists each year, with US citizens accounting for 95% of them, even though the country is relatively unsafe and has a poor public health care system. This could be due to the cost savings of 60% compared to the US. Many medical tourists combine their treatments with a holiday, since Brazil is known as a renowned holiday destination. Moreover, the country’s 20 JCI accredited hospitals are a pulling factor as well as the proximity to the US more over there are no visa requirements. Those who come for medical reasons wish to take advantage of Brazil’s reputation for cosmetic and plastic surgery. With the Ministry of Tourism’s promotion campaigns, the country aims to maintain its position in medical tourism.

Brazil
Localisation South America, bordering Argentina, Uruguay, Paraguay, Peru, Bolivia, Colombia, Venezuela, Suriname, Guyana and French Guiana
Capital Brasilia
Biggest cities (population) São Paulo (10,990,249), Rio de Janeiro (6,161,047), Salvador (2,948,733)
Inhabitants 191,241,714
Politics presidential federal republic
Religion Catholicism (73.9%), Protestantism (15.4%), atheism (7.3%), other (3.4%)
Currency Real (BRL) = € 0.387732
GDP € 609,840 million, 2.58% of the world’s GDP
Official language(s) Portuguese
Climate equatorial, tropical, semiarid, highland tropical, temperate, and subtropical. Average temperatures vary strongly among regions, but are between 10 ºC - 27ºC in winter and between 16º C - 30ºC in summer
Time zone GMT-3 and -4, summertime GMT-2 and -3
Happy Planet Index (HPI) 9

Cultural Aspects

General Culture

Brazilian culture is a blend between Native American, Portuguese and African cultures, influenced to a lesser extent by the settlement of Spaniards, Italians, Germans and Japanese. The Native American influence is particularly strong in the national food and language, while the African influence on a national level is quite subtle and obvious only in a number of regions. The cuisine varies strongly by region, but its main ingredients are corn, rice, beans and chicken. Feijoada, a black meat and bean stew, is the national dish. Brazil is famous for its music and the annual carnival, of which the festive centre is Rio de Janeiro. The national music style samba is popular with all layers of the population and, thus, a way of keeping the country united.

Safety

Brazil ranks 85 on the GPI, being safer compared to other South American countries, however, on a global scale this indicates that it is a relatively unsafe country. Tourists should be aware of the dangers when being in the slums (favelas).

Tourists Attractions and Sights

  • Christ the Redeemer: the famous statue of Christ overlooking the city of Rio de Janeiro from Corcovado Hill
  • The Copacabana: a lively stretch of beach running alongside Rio de Janeiro
  • Salvador da Bahia: one of the oldest settlements in the Western hemisphere, a centre of Brazilian history and culture
  • Amazon Rain Forest: the world’s largest rainforest, home to numerous species of flora and fauna
  • Iguaza Falls: a collection of 275 waterfalls at the border with Argentina and Uruguay, some of which can reach up to 70 meters

Visa Requirements

Most countries do not require a visa for stays up to 90 days. These countries include: Andorra, Argentina, Austria, Bahamas, Barbados, Belgium, Bolivia, Bulgaria, Czech Republic, Chile, Colombia, Costa Rica, Croatia, Denmark, Ecuador, Finland, France, Germany, Greece, Guatemala, Guyana, Honduras, Hungary, Iceland, Ireland, Israel, Italy, Vatican, Liechtenstein, Luxembourg, Malaysia, Monaco, Morocco, Namibia, Netherlands, New Zealand, Norway, Malta, Panama, Paraguay, Peru, Philippines, Poland, Portugal, San Marino, Slovakia, Slovenia, South Africa, South Korea, Spain, Suriname, Sweden, Switzerland, Thailand, Trinidad and Tobago, Tunisia, Turkey, United Kingdom, Uruguay, US, Vatican City, Venezuela.

Infrastructure

Transportation

Only 5.5% of roads in Brazil are paved, therefore, road safety outside the urbanised areas can be unsatisfactory at times. Although car density is relatively low, there can be large traffic jams in São Paulo and Rio de Janeiro. The country’s main international airports are situated in São Paulo and Rio de Janeiro. Domestic flights are expensive but due to the vast size of the country, these can be necessary to travel between destinations. Buses are a popular and reliable means of transportation. Bus rides are cheap and can bring passengers to all corners of the country, including the Amazon rainforest. Taxis are also relatively cheap and reliable and are the best way for tourists to get around in the cities.

Accommodation

In both São Paulo and Rio de Janeiro many of the major hotel chains are present, such as Marriott Hotels and Resorts, Starwood Hotels and Resorts Worldwide, Accor Hotels, InterContinental Hotels Group and Golden Tulip Hospitality Group. Accommodation ranges from budget to high end, with even the high-end hotels being affordable to the main-flow tourists as the Real has devaluated in comparison to the USD and the Euro. There are no hospitals that have cooperation with hotels.

Health Care System

WHO ranking 125
Physicians per 10,000 population 12.0 (2000)
Nurses per 10,000 population 38.0 (2000)
GDP spent on health care 8.2% (2008)
Education period of doctors 6 years
Education period of specialists additional 4 to 5 years

Health Care Providers

There is a total of 7,500 hospitals, of which 61% are private and 39% are public. In Brazil, 67% of the country’s total hospital expenditure is allocated to private hospitals and 33% to public hospitals. The Brazilian government is not only financing public facilities, but also contributes to private health care providers.

Insurance

Health insurance in Brazil is provided by a universal and publicly funded Single Health System. Supplementary health care coverage can be purchased by means of private health insurance. These are strictly regulated, with mandatory minimum coverage and price controls. In 2000, 25% of the population was covered by insurance, 75% of those used a private insurance scheme. The public health system in Brazil has a lot of problems, such as crowded facilities, patchy coverage and long waiting times, even in cases of emergency.

Reforms/Policies

Brazil’s health system has undergone many reforms since the 1960’s, all of which have resulted in the current Single Health System. However, in recent years there have not been made any significant changes in this system.

General Medical Tourism Information

Brazil received 5.2 million tourists in general, which resulted in annual revenue of USD 5.78 billion (€ 3.86 billion) in 2008, making it the biggest tourism destination in South America. Brazil is a well-established destination for cosmetic and plastic surgery as it has a worldwide reputation for both elective and reconstructive aesthetic treatment. The number of medical tourists and the specific revenue is not known. This is due to Americans not needing a visa to enter Brazil.

In 2006, Brazil’s Ministry of Tourism announced plans to dramatically increase the investments in tourism promotion over the following years, which also includes the promotion of medical tourism. The investments, which were traditionally between USD 10-15 million (€ 4.46-10 million), would become USD 200 million (€ 133.6 million) in 2009. The promotion specifically targeted towards medical tourism is still mainly in the hands of private companies.

Flows

The main flow of medical tourists coming to Brazil is from the US (95%). The other regions contributing to the inbound medical tourism are Latin America and Canada.

Reasons

  • Cost saving: prices for treatments in Brazil count a cost saving of 60% of the US price and 49% of the UK price.
  • Holiday destination: Brazil is famous for beaches and sightseeing.
  • Proximity: Brazil is situated closer to the US compared to Asian destinations.

Specialisation

Although Brazilian hospitals offer a wide range of treatments, the country’s reputation and promotion regarding medical tourism is mainly focussed on one area of expertise:

  • Cosmetic and plastic surgery (elective and reconstructive)

Top Facilities

The top facilities have been selected using the following criteria’s, listed in order of importance: JCI Accreditation, ISQua accreditation, international orientation. In general national accreditation systems have not been taken into consideration, due to the fact that there are too many and judging them is out of scope of this study. Brazil has 20 JCI accreditations, which have been awarded not only to hospitals and clinics, but also to other types of facilities, such as rescue units. The four hospitals analysed in this report are:

  • Hospital Israelita Albert Einstein, São Paulo
  • Hospital Sirio Libanes, São Paulo
  • Sociedade Hospital Samaritano, Bela Vista
  • Hospital Alemão Oswaldo Cruz, São Paulo

SWOT

Strengths Weaknesses
  • Cost savings: 60% compared to US prices and 49% compared to UK prices
  • Proximity to the US
  • Established holiday destination
  • Established reputation for cosmetic and plastic surgeries
  • 20 JCI accredited hospitals
  • Foreign languages are not well spoken
  • Ranks 85 on GPI, therefore, unsafe
  • Road infrastructure is unsatisfactory
  • Public health system is of poor quality

Conclusion

Regardless of the poor public health care system and being a relatively unsafe country, Brazil attracts many US (95%) medical tourists each year. This could be as the cost savings of 60% compared to the US draws them. This is aided by the country’s 20 JCI accredited hospitals, but, more importantly, by its proximity to the US and no visas being needed to enter. Those who come for medical reasons wish to take advantage of Brazil’s reputation for cosmetic and plastic surgery and with the Ministry of Tourism’s promotion campaigns, the country aims to maintain its position in medical tourism.

Top Facility Chart

Brazil Hospital Israelita Albert Einstein Hospital Sirio Libanes Sociedade Beneficente De Senhoras Sociedade Hospital Samaritano Hospital Alemão Oswaldo Cruz
Location and website São Paulo www.einstein.br São Vista www.hospitalsiriolibanes. org.br São Paulo www.samaritano. org.br São Paulo www.hospitalalemao. org.br
Accreditations or certifications JCI, ISO 9001:2000, ISO 9001, ISO 14001, Planetree JCI JCI, American Hospital Association JCI, Temos
Capacity of hospital beds 489 beds 300 beds 200 beds 239 beds
Possible for accompanying person to stay in room Yes, in the private rooms No, but assistance with accommodation Yes, in private rooms No, but assistance with accommodation
Medical tourists Information N/A US, Latin America and Europe >3,500 annually from US, Latin America, Africa and EU Information N/A
Number of medical staff doctors/nurses > 6,000 physicians 4,500 physicians, nurses and administration 1,100 physicians 2,467 physicians
Type of rooms available (prices) Private single rooms Private single rooms Private single rooms Private single rooms
International patient department Yes, and a hospitality service centre Yes, they organise all the arrangements Yes, they organise all the arrangements Yes, they organise all the arrangements
Adaptations to cultures and nations Yes, in food and religious habits Yes, in food and religious habits Yes, in food and religious habits Yes, in food
Languages spoken by staff Portuguese, English and Spanish Portuguese, English and Spanish Portuguese, English and Spanish Portuguese, English, German and Spanish
Marketing of the facility/USP Collaboration with medical institutions in the US, EU, Israel and Brazil; community programs, sponsoring initiatives, e.g. Family Health Program, Public Cord Blood Bank Partnerships with international facilities such as American Airlines, BUPA; member of Brazilian Health care Products and Services, a consortium that was set up to promote the export of hospital services Advertising in major local and Jewish newspapers, host of the 2nd International Symposium of Nursing, collaboration with municipal and state organisations on social responsibility Promotion of several events open for the community, such as lectures and exhibitions; hosts exhibitions and concerts; host of the International Symposium of Transplantation
Specialisations Cardiology, neurology, oncology, orthopaedics, ophthalmology, plastic and cosmetic surgery Oncology, cardiology, rehabilitation, urology, gynaecology, orthopaedics and gastroenterology Orthopaedics, neonatology, paediatrics, cardiology, oncology, neurology, bariatric surgery, epileptic surgery, cosmetic and plastic surgery Cardiology, endoscopy, bariatric surgery, nephrology, oncology, orthopaedics, diabetes treatment, rehabilitation, haematology, chemotherapy, iodine therapy

Price Chart (in €uro)

Treatment Average Price Hospital Israelita Albert Einstein
Cardiac bypass N/A 24,050
Gastric bypass 8,263 13,183
Knee replacement N/A 21,325
Hip replacement N/A 24,039
Hip resurfacing N/A N/A
Botox treatment 200 487
Breast augmentation 3,207 1,667
Facelift 2,766 1,706
Liposuction 434 N/A
Dental implants 307 N/A
Rhinoplasty 1,243 1,357
Lasik eye surgery 269 N/A

Note: All prices are estimates, and may vary widely from source to source depending on services included in the estimate (i.e. doctor’s fees, hospitalisation, administration costs or the patient’s age and medical history). Due to non-disclosure strategies of the various locations, it was not possible to make a clear separation between those factors. All prices given for the specific facilities have been provided by the hospitals/clinics themselves via email or telephone contact. The prices are given in Euros (€).

N/A means either that treatment are not available in the specific hospital, that a price estimation cannot be found or that the medical facility did not disclose the information. For the average prices, printed literature has been used before researching sources on the internet.