Foreign Direct Investment in Brazilian Hospitals: Mapping Institutional Environment and Scenarios for the Investors

This article maps the probable scenarios for Brazilian hospital market, considering the institutional environment of the country from the law change, which allowed for the first time, from January 2016, foreign direct investment (FDI) in healthcare services. To present the likely scenarios of the next decade, in the opinion of healthcare actors in Brazil, a quantitative–qualitative field study was conducted. The first step was to carry out in-depth interviews with 13 experts from hospital groups, private health insurance companies, government, healthcare workers and foreign investors. Three scenarios for the next 10 years were built with 21 variables derived from the panel. The second step of the research was a survey with 134 healthcare stakeholders who indicated the probability of each variable. The results of the study indicated that the complexity of hospital market will be the biggest challenge for investors in Brazil. There are no signs of barriers that would prevent foreign investment in hospitals. However, there is a concern whether in the future there will be or not regulations, and which agency will be responsible. The likely entry modes for foreign investors will be joint ventures with Brazilian hospital groups and acquisitions of operations in the country.