ITIC Americas: Access to healthcare in Latin America - Market insights and solutions

Olga Lucia Mendez Tovar, CHSM Director, Fundación Santa Fe de Bogotá (FSFB)

Olga’s presentation focused on the reasons why Colombia is an ideal destination to provide health services to international visitors. Beginning with details about the number of international patients seeking care in the county, Olga showed which were the biggest source markets, and where they are going in Colombia for their care. Cartagena’s position on the coast and its international airport means that good-quality healthcare is simple for visitors to access.

International tourism to Cartagena continues to grow significantly, even during the pandemic, and it is predicted to follow the growth curve going forward. 38 per cent of visitors come from the US. Olga gave details to the audience about the source markets for tourism, and about the number of hotels and beds available.

Moving onto FSFB’s services specifcally, Olga showed the services the hospital offers, including the imaging and nuclear medicine facilities, cancer institute, critical care operating rooms and specialised consultation facilities for outpatients. The hospital’s international office allows the hospital to offer services directly to patients in their own language and develop a commercial agenda that caters specifically to new and potential patients. Services are developed in line with the items that are most important to medical tourists, which include superior clinical outcomes and post-operative support, along with travel assistance services. The most in-demand services for the international patients FSFB treats include cancer treatment, diagnostic imaging, oral health, neurosurgery and cardiovascular surgery.

Sergio Abril, Chief Commercial Officer, Helidosa

Sergio’s presentation focused on the medical transport side of access to healthcare in Latin America, beginning with an introduction to Helidosa. Sergio showed the medical transport resources that are available to patients in the Americas – there are 19 EURAMI-certified operators in the region, four of whom are in Latin America, and many more certified by NAAMTA and CAMTS, demonstrating the level of quality available. There are also an undetermined number of brokers and non-certified operations. “It is vital,” said Sergio, “that payers do their due diligence on their medical transport partners in the region, as quality varies widely.” A key difference between the north and south American air ambulance providers is the medical crew configuration – Latin American crews tend to be more physician-based, while in North America, it tends to be more nurse-led.

The air medical sector is obviously very dependent on the international tourist market – there are no big internal air ambulance markets for Latin American providers, which is very different from North America. Covid has therefore had a huge impact on air medical operations in Latin America.

One of the nuances of operating in Latin America is the bureaucracy that companies have to deal with. There can be a lack of oversight of local operations, which results in an increased level of bureaucracy, which can make the evacuation process slower.

Moving on, Sergio discussed the local commercial structure of the air medical sector, emphasising the impact of the peaks and troughs of the tourist season, the difference in purchasing power and wages of the employees, and the need to maximise income during the ‘high’ tourist season. This can result in patients being funnelled to a certain healthcare provider, who relies on the relationships they have with other people in the chain of companies that deliver care to international patients, from the medevac provider to the ground ambulance operations and taxi services.

The effect of civil unrest and economic sanctions in certain countries in Latin America can complicate the international evacuation and payment processes, which is challenging for payers – there is therefore uncertainty in logistical preparedness and it can take longer to organise medical transport services. Concerns about security in countries like Haiti also have to be a factor in when patients are treated and transported. Helidosa, for instance, won’t fly at night in Haiti.

The impact of the No Surprises Act for air ambulance operations, said Sergio, could be significant. While air ambulance companies used to take the risk of performing a medevac and not taking prepayment, so they’d do the flight and then submit the bill to the insurance company. If the insurer then didn’t want to pay the full amount, the air ambulance company could instead bill the patient. The result of the No Surprises Act is that this approach is no longer legal. The law is currently being put to the test, so the industry must watch and wait while cases are heard and see how the law is being applied.