There are relatively few Pan-Latam operators of any scale. The big exception is the integrated healthcare management organisations being built by UnitedHealth which is now the largest hospital operator in Brazil and Chile with positions in another half dozen countries. We think that is about to change.

Increasingly, investors are talking about Pan-Latam operations.  Patria for instance wants to take ophthalmology player Opty which it has built to sales $100m this year in Brazil into Mexico and other big markets. And Patria has the money for big health care service deals. Its latest fund, we hear, should hit $2.5bn, of which maybe a third could go on healthcare.

We also notice other PEs marketing their health care businesses as potential Pan-Latam platforms.

But Latam is not Europe. Many Latin Americans look to the USA first and have little sense of shared identity with other nationalities in the continent. And distances are much greater

National markets remain regional. Even the big Brazilian diagnostic groups are conquering city-by-city in Brazil. None have yet gone beyond its borders. Acquirers have to live with far poorer governance in these countries, often strong union influences and, in any case, not many private equity operators, even in Brazil, have the management skills to conduct the slick operation which has built Opty over two years.

But we think things are changing. We see this even in elderly care where several operators are now building in several countries. And European lab groups such as Synlab are also consolidating the market.