Telemedicine is Transforming Hospitals in Latin America

Q: GHI’s “Lessons from the Pandemic” series identifies areas to improve in Latin America after the COVID-19 crisis. What were the main findings of the study?

A: One of the main findings was that hospitals accelerated the adoption of telemedicine. We also observed a difference in the telemedicine solutions developed nationally and those developed in other countries. The latter can be applied across more specialties than others. For example, Latin American countries can access telemedicine services from providers in other countries as the region shares the same language and similar health profiles. Nevertheless, there will be specialties that require in-person consultations and a national telemedicine follow-up.

Q: From your work mapping hospitals in the country, how much are the domestic private and public sectors investing in telemedicine?

A: We have found that the hospitals that were more willing to invest in telemedicine were those that had already begun the transformation. Epidemiological trends are moving toward geriatrics, obesity treatments and mental health, which are expected to impose a burden on investment. Despite this, many providers still have linear investment plans, lagging behind the existing healthcare trends. This shows that health investment is unlikely to follow these trends without scalability, which can be made possible through the use of technological tools that allow remote monitoring, telemedicine and electronic clinical records, among other solutions that will improve provider efficiency without large changes in physical infrastructure.

Nevertheless, the pandemic accelerated the will to invest in these technologies and some actors experienced the benefits right away. For example, during the pandemic, the Hospital Italiano in Argentina went from seeing around 4,000 patients per year to seeing 4,000 patients per day through telemedicine. As it was already transitioning to digital practices, it only had to invest in bandwidth to expand its services. With the pandemic under control, the trend has now reversed and 80 percent of the hospital’s consultations are back to being in-person. Yet the fact remains that the Hospital Italiano has a major infrastructure advantage in being able to pivot back to online consultations via telehealth at a moment’s notice.

Q: How will telemedicine be included in GHI’s indicators when ranking hospitals?

A: At a regional level, telemedicine is present in about 12-14 percent of hospitals, with those in Puerto Rico being outstanding due to their alignment with US insurance services and the overall US health system. We also found that there are two types of telemedicine adopters in this regard: hub hospitals, where specialists are centered; and spokes, from which patients connect with the hub hospital. With this model, primary care facilities can connect to general hospitals and even specialized hospitals for a collaborative approach. This model can be fluid, so some centers can be spokes and hubs simultaneously.

In Mexico, private hospitals are significantly smaller than their public counterparts; private hospitals have about 16 beds per institution versus 95 in the public sector. This represents a large disparity compared to other countries in the region, where private hospitals will have 40 beds and public hospitals 50 beds. This gap becomes significant when we look at their investment capacity: public hospitals are far more capable of investing due to their size.

Private hospitals are also divided into large centers, such as Médica Sur, Centro Médico ABC and Hospital Español, and small institutions, the latter of which take up the largest percentage in the overall census. While large hospitals invest in modernizing their infrastructure to have a digital hospital, this is much more complicated from a financial standpoint for smaller facilities. Nevertheless, some private hospitals will practice telemedicine using free access sources like social media, which is not necessarily the best way to do so as they lack the electronic clinical record and other valuable health data that professional telemedicine services offer. Free access sources also limit telemedicine because they are not connected to PACS or RIS systems, so while they can be useful for certain specialties within telehealth, they are not applicable to all specialties.

Q: What are Mexico’s latest trends in the medical devices industry?

A: Of the 17 markets monitored in Latin America, Mexico ranks fifth in terms of medical equipment. The country stands out for its high-tech equipment in the areas related to birth (radiant heat cribs, incubators and newborn cribs), basic surgery (anesthesia machines, high-temperature sterilization machines, surgical generators and surgery tables), patient care (patient monitoring systems and ventilators) and basic imaging diagnostics (X-ray and, ultrasound machines and mammography systems). However, Mexico uses low-tech equipment in the areas of advanced surgery (catheterization laboratories, endoscopy towers and laparoscopic surgery equipment), diagnostics (echocardiogram machines) and advanced imaging diagnostics (stereotactic mammography systems).

In recent years, Mexico has adopted some high-tech equipment in the areas of basic surgery (high and low temperature sterilization machines, surgery tables), advanced surgery (catheterization laboratories, endoscopy towers, laparoscopic surgery equipment), patient care (patient monitoring systems) and diagnostics (echocardiogram machines).

Q: What are Mexico’s largest areas of opportunity in the field of medical devices?

A: This is an area with many opportunities. The country could strengthen its supply chain as the US is largely dependent on manufacturing in Asia. Mexico and other Latin American countries could take advantage of local manufacturing to gain greater proximity with the US supply chain. In the same way that Mexico has gained a unique competitive foothold with vertical integration in the automotive industry, one could envision a similar path for the medical sector. The country could begin manufacturing devices to supply both local and foreign demand. There are many possibilities related to nearshoring in this regard.

Q: Hospitals in Mexico expected to overcome the procedures backlog by 1Q22. To what degree was this goal achieved and what are your expectations for 2022?

A: About 15-20 percent of the surgeries that should have taken place during the pandemic will no longer happen after patients had second thoughts regarding non-priority surgeries. From October 2021 to March 2022, hospitals were getting back on track regarding their waiting lists and are now working on schedule.

While patients are essential for hospitals, these facilities are aware that there needs to be a balance between in-person visits and telemedicine consultations. So, hospitals need to balance these capacities to have flexible responses to the patient’s needs. We need to change the mindset of tech being a cost to tech being an investment in health systems, one that enables greater capacity and flexibility moving forward.

Global Health Intelligence (GHI) conducts market research to provide strategic data on health infrastructure in emerging Latin American and Asian markets. The company offers four main services: HospiScope, ShareScope, SurgiScope and In-Scope.