1) Even socialist regimes like Chile want to include private healthcare providers in public provision. Reasonably enough, as in Europe, they are seeking to exert more control over what they charge. Generally, governments want to work with private players. Colombia has set up free trade zones to attract players and build medical tourism. In Peru private players are seen as integral to delivery.

2) The recession should help. Brazil opened up its private hospital sector to external investors partly because of the recession. The crisis in Colombia’s statutory insurers may force privatisation.

3) Consolidation is happening fast. Some countries, such as Chile, are already consolidated. Most others are not. Integrated payor providers are powerful in Chile, Argentina and Brazil. But ceilings are being applied to how many hospital beds they can own.

4) There is plenty of innovation. That is particularly true in Mexico where entrepreneurs have been forced to focus on the mass market as rich Mexicans who get sick just go north. Budget hospitals like Swiss Hospital in Monterrey run by Aries Capital, dialysis operators like Médica Santa Carmen, and opthalmology chains like salaUNO backed by private equity are growing fast.

The odd man out remains Argentina (well, OK, there is always Venezula, but we decided to not go there). The paradox is that it boasts integrated payor/providers with sales of over $1bn, yet lack of information and huge political uncertainty is deterring all but the very brave.

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