Amy Shaw, the incoming CEO of UnitedHealthcare Global (UHCG), the world's largest owner of for-profit hospitals in emerging markets, faces tough choices. UHCG, the international arm of US insurer UnitedHealth, has a colossal headache in Brazil, by far its largest market. For instance, reports suggest UHCG may have to pay R$1bn to shift its personal policy portfolio in a deal which has already been sweetened by the addition of several hospitals. There is speculation that, like Cigna in the 1990s, which wrote off some US$500m on medical plan Golden Cross, that UnitedHealth may decide to exit Brazil completely. A full pull-out looks unlikely, but the full year 2020 results to be announced on Wednesday, January 20 may well see big write-offs.