Opportunities of the healthcare sector in Colombia.

8/13/2019 Opportunities of the healthcare sector in Colombia.

1/51

Opportunities of the healthcare sector

in Colombia.


2/51

About us

Proexport is Colombias entity in charge of thepromotion of International Tourism, Foreign Direct

Investment, and non-traditional exports

EXPORTSINVESTMENTTOURISM


3/51

Proexports network: 28 offices around the worldand 8 offices in Colombia


4/51

COLOMBIAFACTS & FIGURES


5/51

Irene Mia (EIU) May 2013:

Colombia has been highlighted in recent years as a safe countryfor foreign investment with great potential both because of thesize of its population and the amount of resources it has

Regional Director for Latin America & The Caribbean - The Economist Intelligence

Unit (EIU)

Christine Lagarde (IMF) - December 2012:

Colombia currently has a very small deficit and a quite balanceddebt, so the macroeconomic situation is very promising,additionally it is in a situation in which the Fund can offer theirhelp, which could not in the past

Managing Director (MD) of the International Monetary Fund (IMF)

What World Experts Say


6/51

General facts

In terms of population, Colombia is twice as populousas Australia and bigger than all Central America.

In Colombia 55% of the population is less than 30years old. There are seven metropolitan areas with

over one million people.

Colombia is the worlds second most biodiversecountry and is among the 12 megadiverse countries of

the planet.

Colombia is the only country in South America withaccess to both, the Atlantic and the Pacific ocean.

Colombia has preferential access to more than 1.5billion consumers, due to international

trade agreements.


7/51

A competitive location with easy accessto markets around the globe

United States

Mexico

BrazilPeru

Ecuador Over 800 weekly directinternational flights.

More than 4.500 weekly domesticflights.

Less than 6 hours to the maincapital cities in Latin America.

More than 20 different airlinesoperating in Colombia.

New York5H35M

Miami3H00M Caracas

1H20M

Lima3H00M

Sao Paulo5H45M

Mexico City4H45M

Santiago Chile5H00M

Buenos Aires6H15M

Los Angeles8H20M

Toronto6H05M

Quito1H30M

Chile Argentina

Canada

Madrid Paris

Frankfurt

Barcelona


8/51

GDP growth: 4.0%

Higher than

expected averagegrowth rate for Latin America (3.2%)

Unemploymentrate: 10.4%

9,2%

unemployment rateby the end ofDecember 2012

1 million barrelsper day of oilproduction

Fourth largestproducer in LatinAmerica

Direct ForeignInvestment: USD15,612 MM

Record figure in thehistory of Colombia

Exports of goodsand services

USD 60,667 MM

5.7% growth rate

Record figure in thehistory of Colombia

Controlledinflation

2.4%*

*Under inflationtarget

2012: a year of great economic achievements


9/51

Source: DANE. EIU - Economist Intelligence Unit. 2013.* Forecast.

196.5

116.20

81.67 78.0966.46

58.6547.15 46.62

30.38 25.53 22.91 19.04 15.20 10.28 8.86 7.99 7.16 6.60 6.13 4.48 3.96 3.85

Population 2013*Million

The second largest Spanish speaking country in theworld and the 23 rd most populated


10/51

Colombia's population is 47.5 millionThe percentage of population under 30 years of age is 55%

7 metropolitan areas with over 1 million people


11/51

136

232

248

254

320

321324

326

370

402

412

420

434497

498

976

1,562

2,060

2,331

2,3593,318

New Zealand

Denmark

Israel

Singapore

Vietnam

ChileNorway

Peru

Hong Kong

Sweden

Switzerland

Philippines

BelgiumMalaysia

Colombia

Australia

South Korea

Mexico

France

BrazilGermany

PPP - Purchasing Power Parity. e: estimated.Source: EIU - Economist Intelligence Unit. 2012.

Colombia is the 28th largest economy in the world and one of the largest non-OECD economies

GDP at PPP 2012eUS$ Billion


12/51

!"#$%&$

("()*&*

+,"-!,&,

0

2,000

4,000

6,000

8,000

10,000

12,000

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013p

Per capita National Income (PPP).2000 2013 US$

Source: EIU Economist Intelligence Unit GDP Adjusted to purcahsing power parity PPA.

Colombia's per capita Income has grown almost twicesince 2000, maintaining a Middle High Income

Middle HighIncome

Middle LowIncome

Low Income


13/51

GDP Growth, Inflation and unemployment Rate. 2002 2016p%

p: Projected. e: EstimatedSource: DANE- Colombia Central Bank - EIU: Economist Intelligence Unit. 2013.

Inflation

Unemployment

Macroeconomic stability and strong economicperformance in the long run

GDP

15,6 14.1 13.7

11.8 12.0 11.2 11.3 12.0 11.8

10.8 10.4

7.0 6.5 5.5 4.9

4.5

5.7

7.7

2.0 3.7

2.4

10.1 9.9 9.7 9.3

3.1 3.1 2.9 2.9

2.5 3.9

5.3 4.7 6.7 6.9

3.5

1.7

4.0

6.6

4.0 4.7 4.9 4.9 4.7

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013p 2014p 2015p 2016p


14/51

A high growth of middle class in Colombia isexpected

Middle class: Monthly household income between US$ 1,054 and US$ 4,329. Source: Fedesarrollo

Evolution of middle class in Colombia % of total population

16.2%

25.3%

43.8%

59.9%

16.2%

25.3%

37.3%

46.3%

2002

2012

2020

2025

Low scenario High scenario

6.7

6.7

22.3

19.0

32.1

24.7

Millioninhabitants

11.6

11.6


15/51

The top three risk-rating agencies awarded the investmentgrade to Colombia

Rating DateRating

Agency

Long Term ForeignCurrency

Short Term ForeignCurrency

Long Term LocalCurrency

Short Term LocalCurrency

Outlook

StableBBB

A 2

BBB +

A - 2

24 Apr - 2013

24 Apr - 2013

5 Mar - 2007

5 Mar - 2007

Long Term ForeignCurrency

Short Term ForeignCurrency

Long Term LocalCurrency

Positive BBB

F 3

BBB

22 Jun - 2011

22 Jun - 2011

22 Jun - 2011

Long Term ForeignCurrency PositiveBaa3 7 Feb- 2012

S&P (April 2013) andFitch (march 2013)

upgraded Colombias sovereign debt

outlook to positive

Effectiveimplementation of

recent fiscal reformscould improve its debtand interest burdens

S&P

Term

On July 2013 , the outlook on Colombia's government bond rating was revised upward to positive fromStable by Moodys , based on expectations that Colombia will continue its fiscal consolidation, on thecountry's reduced fiscal deficits and a consistent macroeconomic policy environment. Colombia's bondrating was affirmed at Baa3.

Since 2011 Colombias sovereign debt has been positively rated by the three top risk-rating agencies,coinciding with a reduction in its vulnerability to external shocks, i ts historic fulfillment of obligations,confidence in the governments macroeconomic policy and its improvement in security policies.

Source: S&P Ratings; Dinero Magazine.


16/51

Source: Doing Business 2013 World Bank Report*Positive numbers indicate improvements in business environment

Colombia is the third country with the most businessfriendly environment in the region

Doing Business Ranking*2008-2013Change in the number of positions

CountryWorld

Ranking2013

Chile 37Peru 43Colombia 45Mexico 48Panama 61Costa Rica 110

Argentina 124Brazil 130Ecuador 139Venezuela 180

30

16

8

7

3

0

-2-8

-13

-21

Colombia

Panama

Costa Rica

Mexico

Peru

Venezuela

EcuadorBrazil

Chile

Argentina


17/51

Source: Doing Business Report World Bank. 2013.

6 Colombia13 Peru

32 Chile

49 Mxico

82 Brazil

82 Panama

117 Argentina

181 Venezuela

Colombia is the leader in terms of Investor Protection inthe region

8.37.7

6.36.0 5.3 5.3

4.7

2.3

C o

l o m

b i a

P e r u

C h i l e

M e x

i c o

B r a z i

l

P a n a m a

A r g e n

t i n a

V e n e z u e

l a

Investor Protection IndexDoing Business - 2013

WorldRanking Country


18/51

Colombia shows a remarkable growth on itsexports

Variation 2010 - 2012: 52%Variation 2011 - 2012: 5.7% Source: DANE.

Exports. 2000 2012FOB ValuesUSD Million

13,158

21,190

37,626

32,852

39,820

57,420

60,667

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Top export destinations2012

United States US$ 21,980 million 36.2% share

Spain US$ 2,940 million

4.8% share

China US$ 3,343 million 5.5% share

Venezuela US$ 2,691 million 4.4% share


19/51

Imports also have increased rapidly

Variation 2011 2012: 7.2% Source: DANE

11,757

21,204

39,669

32,830

54,675

58,632

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Top imports by origin 2012 Imports, 2000 2012 USD Million

United States US $14,062 million 24% share

Mexico US$ 6,362 million 11% share

China US$ 9,565 million 16% share

Brazil US$ 2,796 million 4.8% share


20/51


21/51

IN FORCE SIGNED IN NEGOTIATION

Canad

United States

Mexico

Guatemala

HondurasEl Salvador

EcuadorBrazil

Peru

Argentina

Paraguay

Uruguay

Liechtenstein

Switzerland

IcelandNorway

EuropeanUnion

TurkeyIsrael

Japan

Fuente: Colombian Ministry of Commerce, Industry and Tourism. 2013.

Free Trade Agreements

Panama

Chile

Bolivia

Costa Rica

Venezuela*

Pacific Alliance

SouthKorea

Nicaragua*

Cuba*

* These are Partial Scope Agreements (PSA)


22/51


Note: The International investment agreements (IIA) include Agreement Investment Treaties BIT (agreement) and Free Trade Agreements FTA- with investment section (chapter).

International Investment Agreements - IIA

Canada

Peru

Mexico

Spain

Switzerland

Liechtenstein

Chile

India

NorthTriangle

United States

SouthKorea

Japan

Iceland

Norway

United Kindom EuropeanUnion

Turkey

Panama

Kuwait

Israel

Uruguay

Russia

Azerbaijan

Canada

Peru

Mexico

Spain

Switzerland

Liechtenstein

Chile

China

India

NorthTriangle

SouthKorea

JapanUnited States

Iceland

Norway

United Kindom EuropeanUnion

Turkey

Panama

Kuwait

Russia

Israel

Singapore

Uruguay

Azerbaijan

Qatar


23/51


Ecuador

Peru

Bolivia

Spain

Chile

SwitzerlandCanada

Mexico

SouthKorea

India

Japan

Germany

CzechRepublic

Holanda

Belgium

Portugal France

UnitedStates

Double Taxation Agreements - DTA

FUTURE

Qatar

ItalyChina

Brasil

Singapure


24/51

Variation 20112012: +16.3% Share of all countries with positive cumulative investment, without reinvested prots or investments in the oil sector Note: the list of the top countries investing in Colombia does not include Panama.Source: Balance of Payments - Banco de La Republica.

Top Investing Countries inColombia 1994 2013 (1Trim)

In 2012 Colombia reached a new record in FDI:Nearly 6 times of what it received 10 years ago

United States USD 11,767 million 19.5% share

Chile USD 4,462 million 7.4% share

Great Britain USD 6,236 million 10.4% share

Spain USD 6,025 million 10% share

FDI Inflows. 1994 2013USD Million

2,504

6,897

13,404

15,612

3,617 3,706

Prom.1994 - 2002

Prom.2003 - 2010

2011 2012 2012 (1Trim) 2013 (1Trim)


25/51

1 , 0

5 3

1 , 1

9 5

1 , 2

2 3

1 , 3

5 4

1 , 4

7 5

1 , 5

8 2

1 , 6

9 2

51127 228

285296

313 254

2006 2007 2008 2009 2010 2011 2012

Arrivals (Migracin Colombia) Visitors in Cruises

Colombia is increasingly attractive to visitors

Sources: Colombia Migration, MCIT, Bank of the Republic. Proexport Calculations.

Foreign visitors in Colombia2006 2012Thousands

Main nationalities of foreignvisitors in Colombia, 2012

United States 319,202 visitors

18.9% share

Venezuela 250,404 visitors 14.8% share

Argentina 111,555 visitors 6.6% share

Ecuador

114,564 visitors 6.8% share


26/51

Haga clic para modificar el estilo de ttulo del patrn

. "#$#% $&'()&* #+ ,-./- /#$-+-* &01/&

2%3#$)&+'#.4# $1&./- .#$#%)4& 5&$#* 6.,&%)% #. &+7- - $&'()&*/# 4#'&

Stucture of ColombiasHealthcare sector


27/51

Structure of the Healthcare System inColombia

Contributory SystemContributions by workers

and employers

Subsidized SystemFor those who are unable

to pay

Law 100 of 1993

EPSHealth Management

Companies

SISBENIdentification and

Classification System forPotential Beneficiaries of

Social Programs

IPSHealthcare Providers

Level I, II and III Hospitals, Clinics and Laboratories

POSObligatoryHealth Plan


28/51

Fuente: Secretaria Distrital de Salud de Bogot D.C.

Healthcare providers (IPS)by Level of Care

FIRST LEVEL OF

CAREPromotion and preventionactivities, basic care planactivities, general medicalexams, clinical laboratory,radiology, hospitalization,emergency care and laborand deliveries with a Low

Level of Complexity .

SECOND LEVEL OFCARE

Medical exams,hospitalization, basic

emergency carespecialties (surgery,

pediatrics) and certainsub-specialties such as

laboratory work, dentistryand psychology with a

Medium Level of

Complexity.

THIRD LEVEL OFCARE

This level is associated withall health plan services

involving specialties(cardiology, plastic surgery)and sub-specialties with a

High Level of Complexity aswell as critical care for

adults, children andnewborns.


29/51

The Ministry is responsible for coordinating,executing and overseeing public

governmental policies related to health.

The Superintendence is responsible formonitoring, controlling and overseeing all

actions and activities of the General HealthSocial Security System.

Sector Associations

Health Regulatory Entities


30/51

Healthcare system World HealthOrganization.

0,573

0,722

0,755

0,807

0,834

0,838

0,849

0,870

0,881

0,902

0,908

0,910

0,915

0,991

0,994

0,000 0,200 0,400 0,600 0,800 1,000

125 -Brazil

75 - Argentina

61 - Mexico

47 - Thailand

39 - Cuba

37 - United States

36 - Costa Rica

33 - Chile

30 - Canada

25 - Germany

23 - Sweden

22 - Colombia

21 - Belgium

2- Italy

1 -France Colombia ranks 22nd in theworld, being the besthealthcare system in Latin America.

World Health Organizationranks Colombian healthcaresystem as one of the bestamong developing countries.

Colombia allocates 7.5% of itsGDP, and 13.9 % of its publicexpenditure in healthcare


31/51


. "#$#% $&'()&* #+ ,-./- /#$-+-* &01/&

2%3#$)&+'#.4# $1&./- .#$#%)4& 5&$#* 6.,&%)% #. &+7- - $&'()&*

/# 4#'&

Medical tourismaround the world and in Colombia


32/51

Medical tourism in response to !

Canada Long wait times

Caribbean Technology availabi lity Low capacity

Europe Aging population Income decrease

Japan Aging population Hospitalization times

Africa Low capacity Quality problems

United States High costs Uninsured population

Fuente: ANDIElaboracin: Proexport

81&+)40

9$$#%)()+)40

:#$5.-+-70

;&)4


33/51

Top 20 destinations for medical tourism

Estimated market value ofUS$15 billion

Approx. 5 million patientsworldwide

Average spending per

surgery is US$3,000

Fuente: Patients without borders (Medical Tourism Facts). ANDIElaboracin: Proexport

Top 20 destinationsby number of patients


34/51

Global market (2008 2014)

PROYECTIONS 2014 Curative medicine

- 300,000 travelers

- US$4,000 millionPreventive and estheticmedicine

- 1,200,000 travelers- US$2,600 million

Wellness- 58,000,000 travelers- US$48,000 million

Fuente: ANDI

Market value (2008 - 2014)

Income in US$ billion

Wellness

Esthetic medicine

Preventive medicine

Preventive medicine


35/51

Outbound patient flow for medical tourism isestimated have a growth rate over 10 times

U.S. Outbound Patient FlowProjection (Million)

(2007 2017)

=>?> @#/)$&+ :*&"#+ 4*#./ %5-A% 45# 4*#'#./-1% 3-4#.


36/51

Colombian Medical Tourism Exports

Colombian medical tourism exports(2007 - June 2013)

U S $ m

i l l i o n

0,0

20,0

40,0

60,0

80,0

100,0

120,0

140,0

2007 2008 2009 2010 2011 2012 Ene - Jun 2012 Ene - Jun 2013

42,8

68,5

41,5

53,0

77,0

134,0

46,0

115,6

!"#$%

&'#"%

"!%

&(#$%

)*(#+%

,&,#!%

?-1*$#D Productive Transformation Program (PTP)


37/51

Non-resident patients

Non-resident patients*(2011 - Junio 2013)

U S $ m

i l l i o n

*Information of total non-resident travelers from Migracin Colombia

?-1*$#D E9F2> Monthly hospitality survey- Non-resident guests that declared health purposes.

-

5.000

10.000

15.000

20.000

25.000

30.000

2011 2012 Ene-Jun 2012 Ene-Junio 2013

17.805

29.170

9.987

24.477

!"#$!%

&'$(%


38/51


39/51

Country of Origin of international patients

Source: Migracin Colombia, MinCIT

-

100

200

300

400

500

600

700

Ene - Jun 11 Jul - D ic 11 Ene - Jun 12 Jul - D ic 12 Ene - Jun 13

Curazao

Aruba

Holanda

Venezuela

Estados Unidos

Ecuador

!"#$%

&'#(%

&'#(%"#(%

)#!%

$#*%

!$#+%

,-./0/1

2.-3/

415/67/

89690-95/

:;6?71;

:@-/71.

A


40/51


. "#$#% $&'()&* #+ ,-./- /#$-+-* &01/&

2%3#$)&+'#.4# $1&./- .#$#%)4& 5&$#* 6.,&%)% #. &+7- - $&'()&*

/# 4#'&

Added value of theColombian offer


41/51

Experience

G#*


42/51


43/51


44/51

Procedure Colombia USA India Mexico Thailand CostaRica

KidneyTransplant

$25,000 $120,000 - $45,000 - -

BreastEnlargement

$2,600 $8,600 $2,600 $5,000 $5,700 $2,700

Rhinoplasty $1,900 $6,500 $2,100 $2,800 $2,000 $2,500

Abdominoplasty $3,000 $8,500 $3,400 $4,500 $4,000 $4,000

Eyelid Surgery $1,700 $7,500 $1,850 $4,000 $1,400 $2,500

Colombia offers some of themost competitive costs in Latin America forsurgeries, medical treatments and medications. Colombia offers complete

treatments at just10% of the cost in the United States

Examples of Medical Procedure Costs

Costs may vary depending on the quality and infrastructure of the medical center. Average costs from tourismoperators. Includes surgery and post-operative treatment. Proexport estimates.

Medical procedures in Colombia are low incost and high in quality

Costs


45/51

19 Colombian hospitals inthe ranking of the top 45

hospitals in LatAm (3more than in 2012)

Bogot has 8 of thesehospitals, Medellin has 7,Cali and Bucaramanga

have 2 each

Recognition of Colombian hospitals inLatin America

45 Top hospitals in Latin America (Colombia) 2013

2013Rank

2012Rank Hospital City

Total No.Doctors* 2013

No. of beds2013

4 7 Fundacin Valle del Lili Cali 309 473

6 8 Fundacin Cardio infantil Bogot 233 325

8 9Fundacin Cardiovascular deColombia Bucaramanga 116 207

10 18 Hospital Pablo Tobn Uribe Medelln 248 371

14 20 Centro Mdico Imbanaco Cali 334 121

19 26 Clnica las Amricas Medelln 69 322

20 19 Hospital San Ignacio de Bogot Bogot 245 314

23 24 San Vicente de Paul Medelln Medelln 279 656

25 - Clnica Shaio Bogot 181 274

26 30 Foscal Bucaramanga 304 294

27 29 Inst de Ortopedia Infantil Roosevelt Bogot 23 118

29 44 Mederi Bogot 494 782

30 31 Hospital General de Medelln Medelln 72 418

32 34 Clnica Len XIII Medelln 275 641

34 35 Clnica del Occidente Bogot 176 181

35 38 Clnica Medelln Medelln 33 187

38 - Clnica Reina Sofa Colsnitas Bogot 96 133

40 36 Clnica Marly Bogot 74 108

Source: Amrica Economa Intelligence.* Full-time doctors** La Fundacin Santa Fe de Bogot decidi noparticipar en el ranking 2013.*** La Clnica Universitaria Bolivariana de(Medelln) entr en el puesto 42 al ranking 2013.


46/51

Organization that certifies ahealthy environment for theirpatients, visitors and staff.

Moreover, it has to assure thecontinuous improvement of

customer service processes.

Voluntary process of internal and externalinspection, that allows continuous delivery of

safe healthcare services with high quality.

Quality

Accreditations


47/51

Hospitals

Infrastructure

Bogot6 accredited providers8 hosp in the ranking

Antioquia10 accredited providers

6 hosp in the ranking

Vale del Cauca9 accredited providers2 hosp in the ranking

Santander2 accredited providers2 hosp in the ranking

Tringulo del caf14 accredited providers

Atlntico7 accredited providers

TOTAL+25accredited providers 16 hospin theranking

Magdalena

Bolvar

Nario

* IPS is equivalent to healthcare providersIPS accredited by the Miistry of Health and ICONTEChttp://www.acreditacionensalud.org.co/novedades.php?IdSub=108&IdCat=25&titulo=IPS%20ACREDITADAS 45 Top hospitals in Latin America - Amrica Economa Intelligence


48/51

Free Trade Zones

COMPANY / HOSPITAL EMPLOYMENT LOCATION

Clnica Portoazul S.A. 150 Puerto Colombia - Atlntico

Clnica Hispanoamerica S.A.S. 159 San Juan de Pasto Nario

Clnica los Nogales S.A.S. 191 Bogot CundinamarcaHospital San Vicente de Paul 304 Rionegro Antioquia

Sociedad Clnica Cardiovascular CoraznJoven S.A. 175 Neiva Huila

Fundacin FOSUNAB 198 Floridablanca Santander

Fundacin Cardiovascular de Colombia S.A.S 167 Pedecuesta Santander

Medical Duarte ZF S.A.S. 86 Ccuta - Norte de Santarder

Fresenius Medical Care Servicio Renal S.A.S. 50 Ccuta - Norte de Santarder

Clnica Megacentro Pinares 202 Pereira RisaraldaCentro Hospitalario Serena del Mar S.A. 75 Cartagena Bolvar

TOTAL 1.757

There are 11 Free Trade Zones for the healthcare sector in Colombia.

Infrastructure


49/51

Free Trade Zones General information

Free Trade Zones approved after December 31 st, 2012

15% income tax + 9% CREE tax.

No customs taxes are incurred or paid

(VAT, DUTIES).

Benefits from international trade

agreements.

Participation on local market.

Infraestructura


50/51

Hospital Beds24.800

Out-Patient Offices8.976

Operating Rooms585

Dental Units3,777

34,6 % 40,4 % 25,0 %

Level I Level II Level III

71,4 % 20,0 % 8,6 %

20,5 % 50,8 % 28,7 %

87,6 % 11,3 % 1,1 %

Fuente: Asociacin de Hospitales y Clnicas de Colombia

Installed National Capacity

Infrastructure


51/51

Opportunities of the healthcare sector in Colombia.

Documents

Transcript of Opportunities of the healthcare sector in Colombia.