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THE SUPPLY CYCLE
OF HEALTHCARE PRODUCTS
IN BRAZIL
YEARBOOK
4th editionwww.abraidi.com.br
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2 0 2 1
THE SUPPLY CYCLE 
OF HEALTHCARE PRODUCTS
IN BRAZIL
YEARBOOK
ABRAIDI
Associação Brasileira de Importadores
e Distribuidores de Produtos para Saúde
4th edition
2 0 2 1
THE SUPPLY CYCLE 
OF HEALTHCARE PRODUCTS
IN BRAZIL
YEARBOOK
ABRAIDI
Associação Brasileira de Importadores
e Distribuidores de Produtos para Saúde
4th edition
THE SUPPLY CYCLE OF HEALTHCARE PRODUCTS IN BRAZIL004
AUDIT COMMITTEE
Eduardo S. Facci (holder)
ORTHOMAXX HOSPITALAR EIRELI/SP
Fernando Reatto (holder)
CIENLABOR INDÚSTRIA E COMÉRCIO LTDA./
PB
Hugo Feijó F. Freire (holder)
JOTEC DO BRASIL IMP. E COM. 
EQUIPAMENTOS HOSPITALARES/SP
José Luis Pollesi (alternate)
MULTIVISION COMÉRCIO 
DE MATERIAL HOSPITALAR EIRELI/ES
ETHICS AND PROCESSING COMMITTEE
President
Volnei Luiz Ortigara
CANADÁ CENTRAL DE NEGÓCIOS DO BRASIL 
LTDA./RS
Vice-President
Henrique César Martins
HMS IMPORTAÇÃO E COMÉRCIO 
DE PRODUTOS MÉDICOS EIRELI/SP 
Members
José Luis Pollesi (holder
MULTIVISION COMÉRCIO 
DE MATERIAL HOSPITALAR EIRELI/ES
Aline Moura (1st alternate)
ATRIAL SAÚDE/SP
Roberley Carlos Polycarpo (2nd alternate)
UL QUÍMICA E CIENTÍFICA LTDA./ES
BOARD OF DIRECTORS 
President AT. CIRÚRGICOS LTDA./RS
Vice-President 
Ronaldo Sampaio Carneiro
MARIN MEDICAL LTDA./BA
Director
Cândida de Fátima Bollis
SP INTERVENTION LTDA./SP
Counselors
Cassius Maggioni
CORTICAL COMÉRCIO 
DE PRODUTOS CIRÚRGICOS LTDA./SP
Eduardo Ferreira Simões
IMPLAMED IMPLANTES ESP. 
COM. IMPOR. EXP. LTDA./SP
Fábio Zanini
LIVANOVA BRASIL COM. 
E DIST. DE EQUIP. MÉD. HOSP. LTDA./SP
Gláucio Pegurin Libório
ORTHOHEAD INSTRUMENTOS 
E IMPLANTES CIRÚRGICOS LTDA./SP
Henrique César Martins
HMS IMPORTAÇÃO E COMÉRCIO 
DE PRODUTOS MÉDICOS EIRELI/SP
Luzia de Almeida Assis Silva
PORTO SURGICAL COMÉRCIO 
DE MATERIAL HOSPITALAR LTDA./RJ
Marcos Sylvestre
MEDARTIS IMPORTAÇÃO E EXPORTAÇÃO 
LTDA./SP
Maria Cecilia Patrícia Braga Braile Verdi
BRAILE BIOMÉDICA IND. COM. 
E REPRESENTAÇÕES LTDA./SP
Murilo P. Rocha
CICLOMED DO BRASIL LTDA./SP
Roberley Carlos Polycarpo
UL QUÍMICA E CIENTÍFICA LTDA./ES LTDA./SP
GOVERNANCE
MANAGEMENT 2020-2023
THE SUPPLY 
CYCLE OF 
HEALTHCARE 
PRODUCTS
IN BRAZIL
005
EXECUTIVE AND TECHNICAL STAFF
Executive Board
Bruno Boldrin Bezerra 
Technical Board
Sérgio Alcântara Madeira 
Administrative Staff
Daise de Oliveira Domingues
ADMINISTRATIVE/FINANCIAL
Deborah Ramos
SECRETARIAT
Lucas Macedo
GOVERNMENT AND INSTITUTIONAL RELATIONS
Tatiane Munhoz
COMMUNICATION/EVENTS
Tayane Araújo
RELATIONSHIP/SERVICE TO THE MEMBER
ABRAIDI YEARBOOK 
2021
IMPLEMENTATION
Associação Brasileira de Importadores e 
Distribuidores de Produtos para Saúde – 
ABRAIDI
Websetorial Consultoria Econômica
Duplo Z Inteligência de Comunicação
COOPERATION
(In alphabetic order)
Bruno Boldrin Bezerra
ABRAIDI
Fanny Rosa Zygband
DUPLO Z INTELIGÊNCIA DE COMUNICAÇÃO
Lucas Flávio de Macedo
ABRAIDI
Patrícia Véras Marrone
WEBSETORIAL
Sérgio Alcântara Madeira
ABRAIDI
Sérgio Dilamar Bitencourt da Rocha
ABRAIDI
SPECIAL COOPERATION – ARTICLES
Celso Ienaga (Dextron Consulting) – 
Sustainability of the health system
Jefferson Fernandes (Associação Brasileira 
de Telemedicina e Telessaúde) – Digital 
Health: Opportunities at the Front Door
Leonardo Giusti e Sheila Mittelstaedt 
(KPMG) – Changes in health in post-covid-19
Proofreading and translation: Vero Verbo 
Serviços Editoriais 
Graphic design: Laika Design
Print: Centrográfica
Table of Content
LETTER TO 
THE READER
MISSION, 
OVERVIEW 
AND VALUES
INTRODUCTION
10.
12.
14.
16. ABRAIDI’S ACTIONS AND 
NUMBERS
24. THEMES AND ACTIONS 
2020/2021
37. COMPLIANCE
CHAPTER 1
46. INDUSTRY AND INTERNAL 
MARKET NUMBERS
42. HEALTHCARE PRODUCTS 
SECTOR
CHAPTER 2
53. FOREIGN TRADE IN 
HEALTHCARE PRODUCTS
74. CHANGES IN HEALTH 
POST-COVID-19 (KPMG)
62. COVID-19: POST-
-PANDEMIC IMPACTS AND 
CHANGES
CHAPTER 3
92. DIGITAL HEALTH: 
OPPORTUNITIES AT THE 
FRONT DOOR (ABTMS)
98. HEALTH 
DISTORTIONS AND 
THE SUSTAINABILITY 
OF THE SECTOR
101. SUSTAINABILITY OF 
THE HEALTH SYSTEM 
(DEXTRON)
CHAPTER 4
124. CONCLUSION
126. ABRAIDI 
MEMBER 
COMPANIES
108. PAYMENT MODELS 
AND HEALTHCARE 
PRODUCTS 
SUPPLIERS
110. DISTORTIONS IN 
HEALTH
110. REVENUE RETENTION
118. FINANCIAL DISCOUNT
121. PROVISION 
OF ADDED 
SERVICES
122. COST OF 
DISTORTIONS
114. DISALLOWANCES
116. DEFAULT
THE SUPPLY CYCLE OF HEALTHCARE PRODUCTS IN BRAZIL008
LIST OF CHARTS
Chart 1: Segmentation of Abraidi Members by Type of 
Activity. Page 18
Chart 2: Distribution of Abraidi Members by Size (Annual 
Revenue). Page 19
Chart 3: Distribution of Abraidi Members by Region. Page 
20
Chart 4: Distribution of Abraidi Members by Federation 
Unit. Page 21
Chart 5: Segmentation of Abraidi Members by Specialty. 
Page 22
Chart 6: Impacts of the 18% Tax Rate on Medical 
Devices in Abraidi Members in the State of São Paulo. Page 
27
Chart 7: Status of Abraidi Members in Relation to 
Compliance Programs. Page 41
Chart 8: Contractualization of Abraidi Members. Page 46
Chart 9: Participation of Players in Contractualization with 
Abraidi Members. Page 46
Chart 10: Consumption of Healthcare Products by SUS. 
Page 48
Chart 11: Top 10 Main Products – OPSM Consumed by 
SUS. Page 49
Chart 12: Distribution of Abraidi Members’ Revenue by 
Paying Source. Page 51
Chart 13: Income Distribution by Type of Customer. Page 
52
Chart 14: Apparent Consumption of Implantable Medical 
Devices, Materials and Support Equipment and Percentage 
Share of Imports in this Market. Page 54
Chart 15: Brazilian Production of Implantable Medical 
Devices, Materials and Support Equipment. Page 55
Chart 16: Trade Balance of Implantable Medical Devices, 
Materials and Support Equipment. Page 56
Chart 17: Main Countries of Origin of Imports of 
Implantable Medical Devices, Materials and Support 
Equipment. Page 57
Chart 18: Main Destination Countries for Implantable 
Medical Devices, Materials and Support Equipment 
Exports. Page 60
Chart 19: Measures Taken to Reduce Costs During the 
Pandemic Period. Page 67
Chart 20: Increased Revenue Retention, Disallowances 
and/or Defaults During the Pandemic. Page 69
Chart 21: Perspective of Recovery by Abraidi Members. 
Page 70
Chart 22: Permanent Changes that have Been or will Be 
Adopted After the Pandemic. Page 72
Chart 23: Revenue of Abraidi Members Retained by Paying 
Source. Page 110
Chart 24: Average Number of Days Until the Invoice Is 
Issued by Abraidi Members by Paying Source. Page 111
Chart 25: Average Number of Days Between Invoice 
Issuance and Payment – Abraidi Members By Paying 
Source. Page 112
Chart 26: Disallowance Practice by Health Insurance 
Plans. Page 114
Chart 27: Total Volume of Disallowances from Abraidi 
Members. Page 115
Chart 28: Losses with Default by Hospitals, Health 
Insurance Companies and Public Agencies. Page 116.
Chart 29: Default Volume – Resources Receivable for More 
than 180 Days or Lost – Abraidi Members. Page 117
Chart 30: Hospital Discounting Practice/Financial. 
Page 118
Chart 31: Retaliation by Denying the Granting of a 
Hospital Discount. Page 119
Chart 32: Percentage of Suppliers’ Operating Costs 
Arising from Distortions in the Healthcare Products 
Industry. Page 122
THE SUPPLY 
CYCLE OF 
HEALTHCARE 
PRODUCTS
IN BRAZIL
009
LIST OF FIGURES
Figure 1: Open letter to the government of São Paulo, 
published on January 15, 2021. Page 25
Figure 2: Folha de S.Paulo Seminar sponsored by 
Abraidi. Page 26
Figure 3: International Compliance Seminar and 
launch of the 4th edition of the Abraidi Code of Ethics 
and Conduct, with the participation of Nancy Travis, 
vice-president of Compliance of AdvaMed. Page 37
Figure 4: International Compliance Seminar and 
launch of the 4th edition of the Abraidi Code of Ethics 
and Conduct, with theparticipation of representatives 
from Latin America and Europe associations. Page 39
Figure 5: Average percentage drop in revenue and 
surgical volume during the most acute phase of the 
pandemic in 2020 – Abraidi members. Page 66
Figure 6: Average increase in revenue retention, 
disallowances and default – Abraidi members. Page 70
Figure 7: Possible resumption pattern for healthcare 
product suppliers. Page 85
Figure 8: Possible resumption patterns for health and 
life sciences. Pages 86-87
Figure 9: The crisis and the different effects on the 
sectors. Pages 88-89
Figure 10: The organizational impacts of the crisis. 
Page 90
Figure 11: VBHC Implementation Matrix (EIT 
Health). Page 105
Figure 12: Average time between invoice issuance and 
receipt from Abraidi members – 2020. Page 113
Table 1: Main Countries of Origin of Implantable 
Medical Device Imports, by Product – 2020. Page 59
Table 2: Main Destination Countries for Implantable 
Medical Device Exports, by Product – 2020. Page 61
Table 3: Payment Models Used by Hospitals and 
Health Insurance Companies that Are Clients of 
Abraidi Members. Page 109
LIST OF TABLES
THE SUPPLY CYCLE OF HEALTHCARE PRODUCTS IN BRAZIL010
Letter to the Reader
THE SUPPLY 
CYCLE OF 
HEALTHCARE 
PRODUCTS
IN BRAZIL
011
The year 2020 went down history because 
of the covid-19 pandemic, which hit the entire 
planet and challenged the health system around 
the world. For medical device suppliers, it was 
a difficult year of overcoming, resilience and 
caution.
In order to capture the impact of the pandemic 
on manufacturers, importers and distributors of 
healthcare products, Abraidi promoted a change 
in the production schedule of the Yearbook, 
conducting the survey with its members between 
January 18 and February 22, 2021. Thus, the data 
contained in this 4th edition reflects consolidated 
information for the entire year of 2020, unlike the 
methodology used in previous editions, which 
enabled a more accurate analysis of the facts.
During the most acute phase of the first wave 
of the pandemic, between March and May 2020, 
a significant portion of the members practically 
paralyzed their activities, due to the suspension, 
cancellation or postponement of elective 
surgeries. This situation has led many companies 
to review their operations and make changes to 
stay alive.
In order to bring to the authorities the 
challenging scenario and the difficulties faced 
by their members and the supply sector as 
a whole, Abraidi has participated intensely 
and actively in several fronts of sectorial and 
governmental dialogue. Besides the suspension 
of elective surgeries, companies were severely 
affected by the problems of international and 
national transport of products, especially to more 
distant regions, and by the shortage of essential 
products, such as personal protective equipment 
(PPE) and respirators, to mention some. We also 
contributed to the development of health safety 
protocols for supplier’ operations, emphasizing 
the most acute stages of risk, such as presence 
in the hospital environment, and we requested 
the federal government to prioritize industry 
professionals and distribution of healthcare 
products in the vaccination campaign against 
covid-19.
In short, it was a year of great difficulties and 
hard work. Despite a tentative recovery in the 
third and fourth quarters of 2020, we are currently 
living with a new wave of the pandemic, which has 
overcrowded hospitals and threatened the health 
system. We are again facing the closure and 
suspension of several activities and operations, 
which represents another testing period for the 
entire society and also for our industry.
We hope that vaccination can take great 
steps, as this is the only way we will be able 
to take care of patients awaiting treatment and 
those whose health is already aggravated. In this 
way, we will be able to fully resume our activities 
and reassume the economic importance that the 
sector represents, contributing to the country’s 
recovery and to overcome the crisis in which we 
live.
Good reading!
Sérgio Dilamar B. da Rocha
President the Board of Directors
012
MISSION, 
OVERVIEW 
AND VALUES
THE SUPPLY CYCLE OF HEALTHCARE PRODUCTS IN BRAZIL
THE SUPPLY 
CYCLE OF 
HEALTHCARE 
PRODUCTS
IN BRAZIL
013
Ensure that member companies represent the cutting edge in healthcare 
solutions.
Mission
To be an association that represents distributors and importers of 
healthcare products, supported by ethics and transparency, promoting 
actions that make our members references in the health market.
Overview
Good citizenship, which include:
> Ethics
> Social responsibility
> Quality management systems
> Continuous focus on the weakened being, the patient
Values
THE SUPPLY CYCLE OF HEALTHCARE PRODUCTS IN BRAZIL014
Introduction
The data in this 4th edition of the Yearbook refers to the period between 
January and December 2020. From this year on, Abraidi will adopt the 
closed fiscal year as a reference for collecting information. Until last edition, 
the calculation was based on the months of September to August of the 
following year. The association believes that the new criteria will make it 
possible to draw a more accurate radiography of the sector, in addition to 
making the respondents’ work easier.
The paradigm change may help explain any differences in results 
between this edition and the previous one, such as the numbers related to 
sales, even discounting the effects of the pandemic.
Another variable that may have influenced some results was the 
increase in companies associated with Abraidi in the last year: there are 
297 in total, 17 more than in 2019. According to the methodology adopted 
by Websetorial, responsible for the technical preparation of the report, after 
extracting the data from respondents, an extrapolation of the results is 
made for the set of members.
THE 2021 ABRAIDI YEARBOOK – THE SUPPLY CYCLE OF HEALTHCARE 
PRODUCTS IN BRAZIL IS PUBLISHED IN A PARTICULARLY DIFFICULT 
MOMENT NATIONALLY AND GLOBALLY. ITS CONTENT STRONGLY 
REFLECT THE IMPACT THAT THE COVID-19 PANDEMIC HAD ON 
IMPORTERS, DISTRIBUTORS AND MANUFACTURERS OF HEALTHCARE 
PRODUCTS ASSOCIATED WITH THE ENTITY AND WHO PARTICIPATED 
IN THE PREPARATION OF THE DOCUMENT.
THE SUPPLY 
CYCLE OF 
HEALTHCARE 
PRODUCTS
IN BRAZIL
015
The information in the 2021 Yearbook was 
obtained from a 49-question questionnaire, 
available on an online platform. 103 companies 
responded to the survey, although the number 
of participants varied among the questions. In 
compliance with the General Data Protection 
Law (LGPD), both in the questionnaire and in 
the extraction of information, no personal or 
participating company data was identified.
For the yearbooks to provide an increasingly 
reliable portrait of the body of members and the 
industry, with their specificities in terms of size, 
revenue, number of employees and types of 
activity, Abraidi created, in 2019, a control group 
of companies, trying to maintain the existing 
proportionality in the set. The idea is to build, over 
time, a representative and relevant database of 
the sector and a historical series that contribute 
to the entity’s interaction with its stakeholders, 
and the internal public’s interaction (the members 
themselves) with the government.
Abraidi considers it essential to give visibility 
to this sector that supplies hospitals and other 
healthcare service providers with equipment, 
materials and medical devices and whose 
performance is decisive to ensure the quality of 
life in the population, in addition to contributing to 
socioeconomic development of the country.
We are talking about companies that were 
responsible, last year, for more than 15,000 direct 
jobs, which had revenues of around R$ 7.1 billion 
in 2020 and which, although concentrated in 
São Paulo and in the Southeast region, operate 
nationwide, due to a surprising capillaritythat 
reaches all regions and states in the country.
In order to describe faithfully this universe, its 
contributions, difficulties and efforts to overcome 
problems, as in the covid-19 pandemic, is the 
purpose of this Yearbook and the next ones to 
come. We hope that they provide a comprehensive 
view of the sector’s commitment to the Brazilian 
health.
DATA IN THIS YEARBOOK 
– 4TH EDITION – RELATE 
TO THE PERIOD BETWEEN 
JANUARY AND DECEMBER 2020.
1
1
ABRAIDI’S Actions and Numbers
NUMBERS
297
MEMBERS1
MORE THAN 
15 thousand
R$ 7.1 billion3
DIRECT JOBS2
IN REVENUE IN 2020
Source: ABRAIDI.
IMPORTER ONLY 10 - 3.4%
DISTRIBUTOR 
AND 
MANUFACTURER 
3 - 1.0%
IMPORTER AND 
MANUFACTURER 2 - 0.7%
IMPORTER, 
DISTRIBUTOR AND 
MANUFACTURER
12 - 4%
1February 2021
2 Estimate based on a survey with a sample of 100 member companies and extrapolated for the entire group of members.
3Calculation based on a survey with a sample of 77 member companies and extrapolated for the entire group of members.
ABRAIDI’S ACTIONS AND 
NUMBERS
Segmentation of Abraidi Members by Type of Activity
In % and number of members – February 2021
CHART 01
MANUFACTURER 
ONLY 1 - 0.4%
DISTRIBUTOR 
ONLY 137 - 46.1%
DISTRIBUTOR 
AND IMPORTER 132 - 44.4%
THE SUPPLY 
CYCLE OF 
HEALTHCARE 
PRODUCTS
IN BRAZIL
019
MICRO: over R$ 2 million;
LOW: over R$ 2 million;
AVERAGE: over R$ 6 million;
HIGH II: over R$ 20 million;
HIGH I: over R$ 50 million. Source: ABRAIDI
Distribution of Abraidi Members by Size (Annual Revenue)
In % of members – February 2021
CHART 02
41%
AVERAGE
11%
MICRO
20%
LOW
9%
HIGH I
19%
HIGH II
ABRAIDI size rating 
(in annual revenue):
1. ABRAIDI’S ACTIONS AND NUMBERS020
Distribution of Abraidi Members by Region
In % of members – February 2021
CHART 03
Source: ABRAIDI
14%
NORTHEAST
3%
NORTH
63%
SOUTHEAST
7%
MIDWEST
13%
SOUTH
THE SUPPLY 
CYCLE OF 
HEALTHCARE 
PRODUCTS
IN BRAZIL
021
SÃO PAULO 133 - 45%
31 - 10%RIO DE JANEIRO
MINAS GERAIS 14 - 5%
PERNAMBUCO 14 - 5%
DISTRITO 
FEDERAL
ESPÍRITO 
SANTO
11 - 4%
9 - 3%
BAHIA 9 - 3%
PARÁ 6 - 2%
GOIÁS 5 - 2%
PARAÍBA
RIO GRANDE 
DO NORTE
CEARÁ 4 - 1.3%
3 - 1%
3 - 1%
MARANHÃO
MATO GROSSO 
DO SUL
1 - 0.2%
1 - 0.2%
SANTA CATARINA 4 - 1.3%
MATO GROSSO 3 - 1%
3 - 1%
3 - 1%
PIAUÍ
SERGIPE
AMAZONAS 2 - 0.4%
1 - 0.2%
1 - 0.2%
1 - 0.2%
ALAGOAS
AMAPÁ
ACRE
18 - 6%PARANÁ
RIO GRANDE 
DO SUL 17 - 6
%
Distribution of Abraidi Members by Federation Unit
In % and absolute number of members – February 2021
GRÁFICO 04
Source: ABRAIDI
1. ABRAIDI’S ACTIONS AND NUMBERS022
5%
1 It is common for importers and distributors to work in several specializations at the same time.
2 Orthopedics also includes spine.
3 Cardiovascular surgery comprises cardiology, vascular surgery and interventional cardiology.
4 Special materials: any materials or devices for individual use that help in diagnostic or therapeutic procedures and that do not fit 
the specifications of orthotics or prostheses, implantable or not, and may or may not reprocessed, according to rules determined by 
Anvisa.
ORTHOPEDICS2 73%
70%CARDIOVASCULAR SURGERY3
GENERAL SUR-
GERY 21
%
OTHERS 20%
UROLOGY 15%
BUCOMAXILLARY 13%
CONSUMPTION 11%
PLASTIC 
SURGERY 9
%
NEPHROLOGY 6%
RADIOLOGY
ODONTOLOGY 5%
4%OPHTALMOLOGY
53%NEUROSURGERY 
SPECIAL
MATERIALS4 23
%
Segmentation of Abraidi Members by Specialty1
In % of members – February 2021
GRÁFICO 05
Source: ABRAIDI
THE SUPPLY 
CYCLE OF 
HEALTHCARE 
PRODUCTS
IN BRAZIL
023
The covid-19 pandemic, which led public and 
private hospitals to cancel, suspend or postpone 
elective surgeries to meet the growing number of 
patients with the disease, had a significant impact 
on the surgical volume performed by Abraidi 
members in 2020.
Compared to the previous year, there was 
a drop of 8.3% in relation to SUS surgeries 
and 40.4% in procedures performed by 
supplementary health.
Surgical volume
THE DROP IN SURGICAL 
VOLUME REPORTED BY 
MEMBERS IN 2020 WAS 
8.3% IN SUS AND 40.4% 
IN SUPPLEMENTARY 
HEALTH.
TEMAS E AÇÕES 
2020/2021
The decision of the government of the state of 
São Paulo to restrict the application, as of January 
2021, of the ICMS Agreement No. 01/99, which 
exempted 197 products which are important to 
the public and private health systems, led Abraidi 
to adopt a set of initiatives to try to reverse the 
measure and reduce the negative impact it will 
have on companies in the area and, therefore, on 
patients.
The new rule increases from 0% to 18% 
the ICMS rate on the sale of healthcare 
products to clinics, laboratories, hospitals 
and private health insurance plans. Even 
though the tax acts on the private sector, the 
measure will affect the entire health chain, as the 
exemption maintained in sales to public hospitals 
and Santas Casas finds a tax credit problem that 
falls on the distributor, who buys from the industry 
and subsequently sells to SUS.
Besides that, the state will “export” ICMS 
to other states. Because all operations with 
healthcare products that have their origin or 
destination in São Paulo will suffer impacts. It is 
important to remember that the state of São 
Paulo is a national and international hub, where 
most of the imported products that supply Brazil 
pass through, in addition to having the largest 
concentration of manufacturers.
The restriction imposed by São Paulo 
may trigger a fiscal war with other states and 
compromise the renewals of ICMS Agreement 
No. 01/99 nationwide. If this eventually occurs, 
the application of an 18% rate on the 
products can result in an increase in costs 
of R$ 2.54 billion/year for public health and 
R$ 2.73 billion/year for supplementary health, 
according to estimates by Aliança Brasileira da 
Indústria Inovadora em Saúde (ABIIS).
Besides the abrupt increase in the tax, Abraidi 
questions the moment when the decision was 
taken, when companies are financially weakened 
as a result of the drop in economic activity caused 
by covid-19. The health sector was the only one 
to have the full increase in taxation, at a level far 
above the 20% cut in tax benefits announced 
by the government when it presented Bill of Law 
No. 529/2020 in the Legislative Assembly of the 
State of São Paulo (Alesp). Among the initiatives to 
reverse the decision, Abraidi forwarded, together 
with other entities in the health area, several 
proposals to the state government and state 
deputies, including helping to claim the exemption 
for the public sector, which was contemplated in 
the Law No. 17,293/2020.
ABRAIDI PROMOTES SEVERAL INITIATIVES AGAINST THE 18% 
RATE AND PARTICIPATES IN THE UNITED FOR HEALTH MOVE-
MENT #AGORANÃOÉHORASP* *NOWISNOTTHETIMESP.
ICMS Agreement No. 01/99: 
Renewal and Changes in 
São Paulo
THE SUPPLY 
CYCLE OF 
HEALTHCARE 
PRODUCTS
IN BRAZIL
025
See below other actions taken by Abraidi to 
defend the industry and its members and try to 
reverse the decision of the government of São 
Paulo:
Negotiation: a proposal was presented to 
the state government to reduce the 18% rate to 
2%; with the government resistance, the industry 
then presented a proposal to reduce it to 4.14%, 
both without response;
Public letters: three open letters to the 
government of São Paulo were published in the 
Folha de S.Paulo asking for the maintenance 
of the ICMS exemption for healthcare products 
and alerting to the risks to the system and to the 
patients;
In December 2020, the association filed legal 
measures against the decision and, in February 
2021, together with a group of entities in the sector, 
became part of the United for Health Movement, 
with the motto #AgoraNãoÉHoraSP. As part of this 
broad mobilization strategy, in February the entities 
held a motorcade to the Assembly, on the same 
day that Bill of Law No. 82/2021 was presented, 
which aims to revoke article 22 of the law that 
promoted the ICMS increase. The plea has the 
support of a group of more than 30 deputies 
willing to revoke theICMS increase.
Other initiatives
Figure 1. Open letter to the government of São 
Paulo, published on January 15, 2021.
1. ABRAIDI’S ACTIONS AND NUMBERS026
Webinar: in January 2021, ABRAIDI held a 
webinar with more than 220 participants to discuss 
the impacts of the new ICMS-related rules in the 
state of São Paulo. In a survey with 117 responses 
carried out during the event, 65% of entrepreneurs 
stated they will no longer serve the Brazilian Health 
System (SUS) in the state and 72% answered that 
they will lay off employees due to the increase in 
costs that the new taxation will bring.
Seminar “The impact of theICMS increase 
in the health sector”: ABRAIDI was one of the 
sponsors of the event, held by Folha de S.Paulo in 
January 2021, which discussed the serious effects 
of the tax increase;
Recommendations and announcements: 
since the government of São Paulo revoked 
the ICMS exemption, Abraidi has sent several 
announcements and recommendations to its 
members, presenting the new tax scenario in the 
state and other factors that also impact the cost 
of products and suppliers’ operations, such as the 
increase in the exchange rate and freight values, 
among others;
Judicial: ABRAIDI filed two Writs of 
Mandamus with requests for preliminary injunctions 
to guarantee the exemption of the products. 
Both were dismissed, even after appeals by the 
association;
STF: ABRAIDI also pleaded with the 
Federal Supreme Court (STF) to appear as an 
interested party (amicus curiae) in one of the direct 
actions of unconstitutionality that try to invalidate 
the ICMS increase;
Figure 2. Folha de S.Paulo Seminar sponsored 
by ABRAIDI.
65% OF 
ENTREPRENEURS 
STATED THAT THEY 
WILL STOP SERVING 
SUS IN THE STATE, 
AND 72% WILL LAY 
OFF EMPLOYEES.
THE SUPPLY 
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027
Impacts of the 18% Tax Rate on Medical Devices in Abraidi Members in the 
State of São Paulo1
In % – January 2021
GRÁFICO 06
THEY WILL 
STOP SERVING 
SUS
THEY WILL 
LAY OFF 
EMPLOYEES
1 In the survey, there were companies that selected both response options.
Source: Survey conducted by ABRAIDI with 117 member companies, during a webinar in January 2021.
The renewal of the ICMS 
Agreement No. 01/99
Only in 2020, the Agreement had its validity 
extended twice: initially until December 31, 
2020, and then until March 31, 2021. This 
year, the National Council of Finance Policy 
(Confaz) met in March and renewed the 
Agreement until March 31, 2022. Before the 
renewal, Abraidi, together with several health 
entities, participated in meetings at Confaz and 
the Ministry of Economy to defend the renewal, 
emphasizing the serious health situation in the 
country and the negative impact of São Paulo’s 
measure for the whole country.
65%72%
Since the approval of the ICMS Agreement 
No. 01/99 for over 20 years by Confaz, Abraidi 
has been working for its maintenance due 
to the importance that the ICMS exemption 
represents for the health sector and, above all, 
for the patient.
A survey carried out by Abraidi nationwide 
in 2019 identified that 80% of member 
companies sell products exempted from 
ICMS under this Agreement. If it was not 
renewed by Confaz, 43.5% could close their 
doors, 38.7% would no longer serve SUS 
and 47% would lay off employees.
1. ABRAIDI’S ACTIONS AND NUMBERS028
SECTOR DISCUSSED 
WITH THE STF AND 
CNJ THE PROBLEM 
OF “CONFISCATION” 
OF EQUIPMENT 
AND MATERIALS TO 
COMBAT COVID-19.
Abraidi participated in a virtual hearing, in April 
2020, with the then president of the STF, Minister 
José Dias Toffoli, to ask for action regarding the 
“confiscation” of respirators, ventilators, masks, 
gloves and other PPE by the federal government, 
states and municipalities.
The shortage of this equipment and materials, 
essential for the prevention and treatment of 
serious cases of covid-19 and for the protection 
of health professionals, generated a dispute 
among federation entities, which began to 
Hearing with Minister Dias 
Toffoli on the “confiscation” 
of equipment and PPE
“confiscate” them through judicial measures and 
administrative requisitions. The lack of criteria for 
these actions led Abraidi and nine other health 
organizations to appeal to the STF and the 
National Council of Justice (CNJ) in search of a 
nationwide resolution that would guide judges 
across the country and delimit the circumstances 
in which this type of confiscation could occur.
Besides the legal uncertainty for companies, 
the concern is that random confiscations would 
harm the supply chain and, above all, patients.
On May 12, 2020, the CNJ issued a technical 
note addressed to the federal government, 
states, municipalities and the Attorney General’s 
Office, proposing the adoption of management 
measures to minimize the effects of the covid-19 
crisis and prevent judicialization. Among the 
recommendations is the adoption of hospital 
contingency strategies based on service capacity 
levels.
THE SUPPLY 
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029
 Abraidi apresented to the Minister of 
Infrastructure and Anac the logistical 
problems faced by medical device suppliers
Representing the health sector, Abraidi had 
virtual meetings with the Minister of Infrastructure, 
Tarcísio Gomes de Freitas, and the deputy director-
president of the National Civil Aviation Agency 
(Anac), Juliano Noman, to present the difficulties 
with air transportation faced by supply and 
distribution companies of healthcare products, 
which directly impacted the supply of hospitals, 
clinics and laboratories and, consequently, the 
patients.
As a result of the coronavirus pandemic, there 
was a drastic reduction in the frequency of national 
and international flights, as well as last-minute 
cancellations, causing a great impact on product 
delivery and lack of storage space for cargo that 
cannot be shipped. In addition, the reduction in the 
supply of cargo transportation caused the price of 
national and international freight to soar, reaching 
levels considered abusive.
In the meetings, Abraidi explained that, with 
the decrease in air transportation, some locations 
in Brazil now have only one flight a week, delaying 
the shipment and arrival of essential medical and 
hospital products and equipment, including for the 
fight against covid-19, especially in the North and 
Northeast regions.
AS A SPOKEPERSON FOR THE SECTOR’S ENTITIES, THE ASSOCIATION REPORTED THE IMPACTS ON 
PATIENTS, SUPPLIERS AND SERVICE PROVIDERS, AMONG THEM DELAYS IN THE DELIVERY OF ESSENTIAL 
MEDICAL-HOSPITAL EQUIPMENT AND PRODUCTS
After the meeting, Anac, which had already 
established an “essential air network” and 
temporarily qualified air taxi companies to transport 
cargo, adopted three other measures:
 Suggestion for companies with essential 
products to also use state government and military 
aircraft as an alternative for transportation.
 Reinforcement of protocols so that 
transportation companies prioritize the transport of 
products and equipment to deal with covid-19.
 Commitment to strengthen the dialogue 
with the Ministry of Health’s crisis group, along with 
health sector entities.
Minister Tarcísio de Freitas said that he acted 
to ensure that the land circulation of vehicles 
with healthcare products was not impeded by 
state or municipal governments and that ports 
remained open and operating with a large 
volume of imported healthcare products. He also 
informed that a Council was created with state 
Transportation secretaries to coordinate actions 
during the pandemic.
1. ABRAIDI’S ACTIONS AND NUMBERS030
Virtual Regional Meetings
Abraidi adopted the online format for its regional 
meetings due to covid-19 and, since May, it has promoted 
11 virtual meetings with representatives of member 
companies from all regions and states of the country.
The objective was to make a deeper survey of the 
impacts caused to members of the pandemic and to better 
understand the peculiaritiesand needs of each state before 
the situation. Although Brazil is a country with continental 
dimensions and different realities, some problems were 
common to all regions. The reduction in elective and 
emergency surgeries, the increase in logistics costs, 
especially freight, payment delays and disallowances were 
recurrent themes in the meetings.
Due to its national character and the presence of 
members in 23 states, Abraidi has held, since 2013, annual 
in-person meetings in all regions of the country to report on 
its actions, collect demands and monitor the situation of 
members– a pioneering work in the medical device industry.
As of 2018, in response to the request of companies 
headquartered outside São Paulo, Abraidi started to hold 
courses, lectures and webinars with online transmission to 
all members in Brazil – another innovative initiative in the 
industry.
With the pandemic, this format has intensified, and the 
contents has also become available on the Abraidi channel 
on YouTube, which has made it possible to further expand 
the access of members to the association’s contents and 
materials.
ABRAIDI INTENSIFIES VIRTUAL REGIONAL MEETINGS AND 
CONSOLIDATES ANOTHER INNOVATION IN RELATIONSHIP 
WITH MEMBERS
ABRAID HAS 
PROMOTED 11 
VIRTUAL MEETINGS 
WITH MEMBERS 
FROM ALL REGIONS 
AND STATES OF THE 
COUNTRY.
THE SUPPLY 
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031
Abraidi and UPS close a 
partnership to offer better 
logistical conditions to 
members
Abraidi signed a collective agreement with 
UPS to help member companies solve one of the 
main problems generated by covid-19 in the in-
dustry: the transportation barriers caused by qua-
rantine around the world, which has caused flight 
cancellations and an increased in the price of air 
cargo transportation.
The partnership provided the members with 
special rates for domestic and international ex-
press shipments of healthcare products, in an ef-
fort by Abraidi to help them balance delivery speed 
and operating costs.
SPECIAL RATES HELP THE INDUSTRY TO FACE 
BARRIERS REGARDING THE SHIPMENT OF 
PRODUCTS IN THE COUNTRY AND ABROAD The agreement was detailed in a webinar at-
tended by Abraidi and UPS directors. They highli-
ghted the need to make changes in operational 
processes and look for new logistical solutions to 
reduce costs and maintain efficiency in situations 
such as customs clearance, storage, distribution, 
tracking and product insurance, among other me-
asures. UPS highlighted that the health sector is 
one of the main pillars of the company’s opera-
tions. For Abraidi, it was an opportunity to contri-
bute with its members, through the agreement, to 
reduce costs and damages in such an essential 
sector as the supply of medical devices to hospi-
tals and other healthcare service providers.
Proposals for updating nomenclatures in 
Appendix I of the ICMS Agreement No. 
01/99
In March 2020, Abraidi sent Confaz a proposal 
for updating the terminology of five medical 
devices, whose outdated definitions generate 
tax litigation for companies, often preventing 
certain products from being covered by the 
tax exemption provided in ICMS Agreement 
No. 01/99.
The list and description of the products 
eligible for the benefit are contained in Appendix 
I of the ICMS Agreement No. 01/99 which, since 
it was created more than two decades ago, has 
undergone few changes and has not kept up 
with the evolution and modernization of a wide 
range of products.
The fact that the nomenclatures are outdated 
often creates problems of interpretation regarding 
the exemption provided by the Agreement, 
according to each tax inspector or state treasury, 
which has led to tax litigation, in addition to 
hindering free competition among companies, 
precisely the problems that Abraidi hopes to help 
solve.
OUTDATED TERMINOLOGY OF THE LEGISLATION GENERATES 
TAX LITIGATION AND DAMAGES TO FREE COMPETITION
TEMAS E AÇÕES 
NO RADAR
Based on the proposal delivered to Confaz, 
the Ministry of Health started a broader review 
of the list, consisting of 197 products, with the 
participation of Anvisa and other entities in the 
medical device sector, who met in January 2021 
to define the suggestions that were sent to the 
Ministry. The matter is expected to be referred by 
the Ministry to Confaz by May 2021.
THE SUPPLY 
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IN BRAZIL
033
Collective lawsuits against 
alteration of NCMs by 
Camex
In order to maintain the ICMS exemption for several medical 
devices, threatened by Resolution No. 52, of June 17, 2020, 
of the Executive Secretariat of the Foreign Trade Chamber 
(Camex), ABRAIDI filed collective lawsuits in 13 states. 
The list and description of the products eligible for the benefit 
are contained in Appendix I of the ICMS Agreement No. 01/99 
which, since it was created more than two decades ago, has 
undergone few changes and has not kept up with the evolution 
and modernization of a wide range of products.
The fact that the nomenclatures are outdated often creates 
problems of interpretation regarding the exemption provided 
by the Agreement, according to each tax inspector or state 
treasury, which has led to tax litigation, in addition to hindering 
free competition among companies, precisely the problems 
that Abraidi hopes to help solve.
Based on the proposal delivered to Confaz, the Ministry of 
Health started a broader review of the list, consisting of 197 
products, with the participation of Anvisa and other entities in 
the medical device sector, who met in January 2021 to define 
the suggestions that were sent to the Ministry. The matter is 
expected to be referred by the Ministry to Confaz by May 2021.
CAMEX’S DECISION AMENDING NCMS PUTAT RISK THE 
ICMS EXEMPTION ON HEALTHCRE PRODUCTS
1. ABRAIDI’S ACTIONS AND NUMBERS034
Economic monitoring 
of medical devices
After participating directly and recommending the 
participation of its members in three Public Consultations 
on economic monitoring of medical devices held by 
Anvisa in August 2020, the agency published in March 
the RDC No. 478/2021, establishing the monitoring, 
in addition to Normative Instructions (INs) No. 
84/2021, with the list of medical devices selected by 
Anvisa for monitoring, and IN No. 85/2021, with the 
technical attributes of the selected devices.
ABRAIDI believes that economic monitoring is an 
important measure, as long as it does not hinder the 
incorporation of new technologies in the country and 
free market competition, and has actively encouraged 
its member companies to respond individually to public 
consultations. Besides, it prepared a contribution on behalf 
of its members, with the participation of the Regulatory 
Affairs Working Group (RAQA). Public Consultations No. 
876, 877 and 878, all from 2020, referred, respectively, 
to the economic monitoring of medical devices, the list of 
products that will be the object of the measure and their 
technical attributes.
Since 2018, Anvisa has been evaluating the Economic 
Monitoring of Health Products in Brazil as an alternative to 
price controls. In 2019, the agency released the Preliminary 
Regulatory Impact Analysis Report and a monitoring panel 
with the results of a pilot project that used stents as a 
model.
ABRAIDI AND MEMBERS PARTICIPATED IN PUBLIC 
CONSULTATION AND SENT CONTRIBUTIONS TO ANVISA
ANVISA PUBLISHED 
IN MARCH RDC 
NO. 478/2021, 
ESTABLISHING 
ECONOMIC 
MONITORING.
THE SUPPLY 
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IN BRAZIL
035
Public Consultations No. 584, 585 
and 586 are on Anvisa’s agenda, 
but remain without deliberation
In 2020, the discussion on the use and reuse of healthcare products was on 
the agenda of Anvisa’s Collegiate Board meeting, but there was no decision, as 
the CEO of the Agency, Antônio Barra Torres, asked for more time to study the 
process.
Abraidi is not in favor of reuse for patient safety reasons. The association 
understands that it will hinder product traceability and recallin case of problems 
in any batch. Abraidi has been following the topic, which is relevant to the sector, 
since discussions began in 2018.
Decision on alteration 
in RDC No.185/2001 
reaches GGTPS
ABRAIDI is following the developments of Public Consultation No. 730/2019, 
promoted by Anvisa to improve RDC No. 185/2001, which regulates the risk 
classification of medical devices, the registration system and the requirements for 
labeling and instructions for use. The deadline for submitting suggestions ended 
on January 29, 2020.
Besides encouraging its members to participate in the consultation, Abraidi 
sent its own contribution with recommendations on the standardization 
of definitions and nomenclatures, using Anvisa’s materials.
In 2021, Anvisa’s General Management of Healthcare Products Technology 
must analyze the proposed changes and send the consolidated document to 
the rapporteur of the process, the director-president Antônio Barra Torres. The 
agency must also hold a public meeting before the conclusion of the process and 
publication of the new text.
1. ABRAIDI’S ACTIONS AND NUMBERS036
Abraidi supports members in the 
implementation of the General Data 
Protection Law (LGPD)
In order to help its members adapt to the requirements of the LGPD, which 
provides for the processing of personal data and the right to privacy, Abraidi 
adopted a set of initiatives based on a consultation with Anvisa in early 2020. The 
main point in the dialogue with the agency was to obtain some information on how 
suppliers should behave, considering the new law, in relation to the requirements 
of traceability of healthcare products.
Thereafter, the association issued a series of recommendations to companies 
about refraining, for example, from receiving information about surgeries, patient 
data and any documents related to medical procedures that are personal and 
sensitive data, especially for revenue and internal control purposes. Abraidi 
complemented it with a series of webinars and lectures on the subject.
In addition, it presented to Instituto Coalizão Saúde (ICOS) the proposal for the 
creation of an industry working group aimed at mitigating problems and facilitating 
dialogue among players in the health sector in the compliance with the LGPD.
THE SUPPLY 
CYCLE OF 
HEALTHCARE 
PRODUCTS
IN BRAZIL
037
Figure 3. International 
Compliance Seminar and 
launch of the 4th edition of 
the Abraidi Code of Ethics 
and Conduct, with the 
participation of Nancy Travis, 
vice-president of Compliance 
of AdvaMed.
COMPLIANCE
Abraidi promotes an international event on 
compliance and launches the 4th edition of 
the Code of Ethics and Conduct
In December 2020, Abraidi held an 
international seminar on ethics and compliance in 
the health area, broadcast live by YouTube for the 
entire world. During the event, the entity launched 
the 4th edition of its Code of Ethics and Conduct, 
which includes several advances, including the 
inclusion of the “Bogotá Principles”, which guide 
the Inter-American Coalition of Ethics in the 
Medical Devices Sector and orient the adoption of 
ethical practices in the sector.
The Code also provides updates on general 
compliance standards, addresses the LGPD, 
which entered into force in 2020, and creates 
the Reporting Channel on the Abraidi website, so 
that any violations of the Code can be reported. 
INTERNATIONAL SEMINAR IN PARTNERSHIP WITH ADVAMED HAD THE PARTICIPATION OF MEDICAL 
DEVICE ASSOCIATIONS FROM LATIN AMERICA AND EUROPE, IN ADDITION TO A WORKSHOP WITH 
PRACTICAL CASES
In addition, it includes as an appendix the Internal 
Rules of the Ethics and Processing Committee of 
Abraidi.
The vice-president of Compliance of AdvaMed 
(Advanced Medical Technology Association) in the 
United States, Nancy Travis, participated in the 
opening of the event and mentioned the update 
of the American association’s Code of Ethics in 
2020, and detailed the cooperation agreements 
that AdvaMed is signing. The vice-president of 
Government Relations of AdvaMed, Steven Bipes, 
closed the event together with the Executive 
Director of Abraidi, Bruno Boldrin Bezerra.
038
THE 4TH EDITION OF THE 
ABRAIDI CODE OF ETHICS AND 
CONDUCT BRINGS UPDATES 
ON GENERAL COMPLIANCE 
STANDARDS AND INCLUDES 
PROVISIONS ON THE LGPD AND 
THE BOGOTÁ PRINCIPLES.
THE SUPPLY 
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IN BRAZIL
039
Inter-American Coalition on 
Ethics in the Medical Device 
Sector
The association also announced some 
actions that the Coalition must prioritize between 
2020 and 2023, such as the group’s integration 
with other players in the health sector and the 
launch, by AdvaMed, of a kit of integrity and 
compliance materials for distributors, which can 
be used by any company in the world.
A MEMBER OF THE EXECUTIVE COMMITTEE OF THE INTER-AMERICAN COALITION OF ETHICS IN THE 
MEDICAL DEVICES SECTOR, ABRAIDI PRESENTED THE RESULTS OF THE LAST TRIENNIUM AND PLANNED 
ACTIONS UNTIL 2023.
Among the various panels and roundtables 
discussions at the international seminar, one of 
them discussed the actions of the Brazilian health 
sector in the field of ethics and integrity, with the 
participation of the president of Abraidi, Sérgio 
Rocha, and the president of Instituto Ética Saúde, 
Eduardo Winston.
The event also included a panel on international 
compliance efforts and experiences in the medical 
devices industry, which was attended by Andrew 
Blasi, technical secretary of the Inter-American 
Figure 4. International Compliance 
Seminar and launch of the 4th 
edition of the Abraidi Code of 
Ethics and Conduct, with the 
participation of representatives 
from Latin America and Europe 
associations.
Coalition of Ethics in the Medical Devices Sector, 
as well as representatives of medical devices 
associations from Argentina, Chile, Mexico, 
Colombia and Portugal, who discussed and 
presented international compliance efforts and 
experiences in their respective countries.
In the second part of the seminar, members 
had an exclusive workshop with discussions and 
practical cases on compliance and the LGPD.
The global vice-president of Governance 
and Compliance of AdvaMed in the United 
States, Nancy Travis, explained details of the 
entity’s Code of Ethics, which came into effect in 
2020, and presented general data from a survey 
conducted by the Coalition on adherence to the 
“Bogotá Principles”, which guides the adoption 
of ethical practices in the medical devices sector.
1. ABRAIDI’S ACTIONS AND NUMBERS040
Compliance in Action Program
Through the Compliance in Action Program, 
developed and launched by Abraidi in 2018, the 
association has promoted a series of actions 
for its members aimed at training and qualifying 
companies in matters of integrity, ethics, 
compliance and the LGPD. There are lectures, 
webinars, workshops, courses and several 
materials available annually that aim to help 
members develop and improve their integrity and 
compliance programs.
With this qualified support work and thanks 
to the effort, dedication and commitment 
on the part of Abraidi members, we have 
achieved increasingly positive results in terms 
of the adoption of integrity and compliance 
ABRAIDI MEMBERS 
HAVE THE INTEGRITY 
PROGRAM FULLY 
IMPLEMENTED OR 
IN AN ADVANCED 
DEVELOPMENT 
STAGE.
Abraidi also participated in the second virtual 
meeting of the Coalition held in December last 
year, in which the group’s objectives for 2021, 
the impact of covid-19 and the priorities of the 
action plan that will be taken to the next Coalition 
meeting were discussed.
THE SUPPLY 
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HEALTHCARE 
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IN BRAZIL
041
Status of Abraidi Members in Relation to Compliance Programs
In % of members – 2017-2020
CHART 07
14
9.3
15.1
49.2
25.9
14
33.3
28.3
51.8
46
26
13
3.8
17.5
52.8
IT DOES 
NOT HAVE A 
COMPLIANCE 
PROGRAM
IT HAS ONLY 
CODE OF ETHICS 
AND CONDUCT
IT HAS CODE OF 
CONDUCT AND 
IS DEVELOPING 
A COMPLIANCE 
PROGRAM
IT HAS A 
COMPLIANCEPROGRAM FULLY 
IMPLEMENTED
2017 20192018 2020
Source: ABRAIDI based on a sample survey with member companies.
programs by the healthcare product supplier companies 
associated with Abraidi. In 2020, we reached 82.5% 
of survey participants with their integrity program fully 
implemented or in an advanced development stage. This 
demonstrates the pioneering spirit and responsibility that 
these companies have with society in general, with their 
employees and, above all, patients.
0
2
2
Healthcare Products Sector
HEALTHCARE PRODUCTS 
SECTOR
The fact that was crucial to the retreat of 
the national healthcare products sector was 
mainly the cancellation of surgeries and elective 
procedures by health insurance companies and 
some state governments and, by extension, 
the drop in demand for equipment, implants, 
materials and supplies for medical and hospital 
use.
In order to get an idea of the extent of this 
fact, hospitalizations for surgery in SUS 
had a reduction of 25.5% last year. To make 
beds available for covid-19 patients, the public 
system stopped performing 1.3 million 
elective surgeries in 2020 according to 
Datasus.
ANS has not made available the data 
regarding the suspension of non-urgent surgeries 
in the private health system. However, it is to be 
assumed that there has also been a significant 
drop in this sphere, considering that health 
insurance companies serve approximately 
a quarter of the population and that ANS 
recommended the cancellation of surgeries, 
procedures and elective exams as soon as the 
pandemic began to spread across the country.
The drop in demand for healthcare products 
also affected the national production of medical 
devices, which fell 22.2% from January to 
December 2020. The retraction in the sector 
was about five times greater than in the Brazilian 
manufacturing industry, which shrank 4.6% last 
year.
From the standpoint of international trade, 
the disorganization of global markets caused 
by covid-19, mainly due to blockages and 
impediments to the movement of people and 
goods imposed by governments around the 
world, affected the import of medical devices in 
Brazil.
TALKING ABOUT THE PERFORMANCE OF THE HEAL-
THCARE PRODUCTS SECTOR IN 2020 WITHOUT MEN-
TIONING THE COVID-19 PANDEMIC AND THE ENTIRE 
ARSENAL OF TRANSFORMATIONS AND IMPACTS THAT 
IT PRODUCED WOULD BE, AT LEAST, UNREALISTIC. LAST 
YEAR, THIS MARKET INVOICED US$ 11.1 BILLION IN BRA-
ZIL AND SUFFERED A 1.5% DOWNSIDE COMPARED TO 
2019, AFTER THREE CONSECUTIVE YEARS OF GROWTH. 
EVEN SO, THE DROP WAS LESS THAN THAT OBSERVED 
IN THE GLOBAL MEDICAL DEVICES MARKET, WHICH 
SHRANK 3.2%, ACCORDING TO THE ECONOMIC BULLE-
TIN OF ABIIS.
THE SUPPLY 
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IN BRAZIL
045
Despite the barriers, in the medical devices 
sector, there was a 12.9% increase in the 
volume of foreign purchases, which totaled 
US$ 6.2 billion. This was mainly due to the 
import of products to fight against covid-19, 
such as reagents and analyzers used in 
tests and kits for tracking the spread of 
coronavirus.
However, if we analyze separately 
the three segments that make up the 
healthcare products market, we will see 
that the pandemic penalized each of them in 
different ways. The in vitro diagnostics segment, 
mentioned above, registered a 20.5% growth 
in imports. On the other hand, the segment of 
import and supply companies of health products, 
especially equipment, raw materials, orthotics, 
prostheses and other devices – represented 
by Abraidi – experienced a 29.5% drop in the 
indicator. The area of manufacturing medical 
and hospital materials and equipment, in turn, 
shrank 12.4%.
Besides the cancellation of elective surgeries 
in the country and the international barriers, 
import and distribution companies suffered from 
the exchange rate variation, which increased 
the price of raw materials, inputs and imported 
products. The internal restrictions on air and road 
SUS STOPPED 
PERFORMING 1.3 
MILLION ELECTIVE 
SURGERIES IN 2020.
transportation, which affected the availability 
of some products, delivery time and prices 
impacted by the increase in freight costs, also 
was crucial to the drop in performance.
At Anvisa, besides the covid-19 pandemic, 
the changes in the board of directors that took 
place throughout 2020 ended up affecting the 
progress of the discussion of some relevant topics 
for the sector. Among them are the monitoring 
of healthcare products, measures to improve 
risk classification, registration and labeling of 
products, and definitions of reuse.
Throughout this publication, we will look in 
more detail at other indicators and factors that 
influenced the performance of the import and 
distribution of healthcare product in 2020.
NÚMEROS DO SETOR 
E MERCADO INTERNO
Source: ABRAIDI – Websetorial Survey.
NOYES
Source: ABRAIDI- Websetorial Survey
Contractualization of ABRAIDI Members
In % – 2020
CHART 08
Participation of Players in Contractualization with ABRAIDI Members
In % – 2020
GRÁFICO 09
Contracts 
8%92%
98%
51% 49%
WITH 
SUPPLIERS 
WITH 
HOSPITALS 
HEALTH 
INSURANCE
COMPANIERS
THE SUPPLY 
CYCLE OF 
HEALTHCARE 
PRODUCTS
IN BRAZIL
047
The survey of the theme of contractualization4 
in the import and supply of healthcare products 
sector has been systematically addressed in 
Abraidi’s publications since the 2nd edition of 
“The supply cycle of healthcare products in 
Brazil”, in 2019, base year 2018. The need to 
better understand the business relationships 
of members arose from the perception of the 
existence of informal practices in the sector, as 
traditionally occurs in the Brazilian health system.
An analysis of the historical series of Abraidi’s 
publications shows that the percentage of 
companies working under contracts has 
remained practically stable in recent years, with 
some improvement in 2020, which recorded 92% 
of positive responses. In 2019, the practice was 
adopted by 88% of companies and 90% in 2018. 
The greatest advance in the formalization of 
business ties took place between importers 
and distributors with health insurance 
companies: in this field, there was a 12% growth 
between 2018 and 2020 from 37% to 49%.
The positive result stems from the actions 
developed by Abraidi with its members 
companies to encourage the formalization of 
legal instruments that provide greater security 
and possibility of judicial questioning in case of 
abusive practices. In addition, this procedure 
is in line with the best integrity and compliance 
practices recommended by Abraidi in its Code of 
Ethics and Conduct.
Despite advances, there is still a long way 
to be covered. Looking at the issue from the 
opposite side, the survey reveals that almost 
50% of members maintain informal ties with 
customers, which in practice puts them in a 
situation of vulnerability and subject to possible 
abusive or unethical business practices.
To reduce this risk, Abraidi has worked on the 
development of guidelines with recommendations 
and has promoted webinars, workshops and 
lectures to make members aware of the need 
to formalize supply contracts, providing more 
transparency to the conditions negotiated by 
mutual agreement and respecting the law and 
codes of conduct of the sectors involved.
FORMALIZATION OF BUSINESS 
RELATIONSHIPS BETWEEN 
IMPORTERS AND DISTRIBUTORS 
WITH HEALTH INSURANCE 
COMPANIESADVANCED 12% FROM 
2018 TO 2020.
4 Contractualization – the act or effect of inserting into a contract, formally and legally establishing what was verbally agreed upon.
2. HEALTHCARE PRODUCTS SECTOR048
Consumption of Healthcare Products by SUS5
In R$ million6
CHART 10
5 ERRATA: This chart in previous editions mentioned the data as “Volume of material sales from ABRAIDI members to SUS”, and 
the correct one is the total volume of healthcare products consumed by SUS, and not only by ABRAIDI members.
6 Annual data at the time of extraction may vary due to the delay in some statesand municipalities in passing on the information 
to the Ministry of Health.
2015 2017 20192016 2018 2020
1.522
1.3331.316
1.353
1.409
1.313
Source: Datasus/Info ABRAIDI.
After a gradual and consistent growth that started climbing with a 0.3% 
increase between 2015 and 2016 and reached 8% in 2019, the consumption 
of healthcare products by the public system suffered a 12.4% drop in 
2020 compared to the previous year.
The retraction of the indicator is probably related to the cancellation of 
elective surgeries to make way for the care of patients with covid-19, one of the 
consequences of the atypical year that the pandemic produced in all markets, 
especially in health sector.
Sales and Invoicing 
THE SUPPLY 
CYCLE OF 
HEALTHCARE 
PRODUCTS
IN BRAZIL
049
CORONARY ARTERY 
STENT
MULTI-PROGRAMMABLE 
CARDIAC PACEMAKER
EXTRACORPOREAL 
CIRCULATION SET
ANGIOPLASTY BALLOON 
CATHETER
IMPLANTABLE 
CARDIOVERTER 
DEFIBRILLATOR
LINEAR CUTTING 
STAPLER
CARDIOVERTER 
DEFIBRILLATOR WITH 
MULTISITE PACEMAKER
PEDICULAR DEVICE FOR 
SCREW FIXATION
DEFINITIVE 
ENDOCARDIAL 
ELECTRODE
CORONARY ARTERY 
DRUG-ELUTING STENT
TOTAL R$ 1,333 MILLION
Top 10 Main Products – OPSM Consumed by o SUS
In % of total value1 sold - 2020 
CHART 11
The portfolio of products purchased by the SUS is quite varied, but among 
the most representative items in terms of values are surgical devices and 
materials for the field of cardiology. For the third consecutive year, the most 
purchased product by the public sector was the coronary artery stent, which 
represented 9.3% of sales, equivalent to R$ 123,9 million
1 The total amount encompasses all materials in addition to the Top 10.
Source: Datasus/InfoABRAIDI.
9.3%
9.2%
6.5%
3.7%
3.5%
3.4%
2.9%
2.7%
2.3%
2.2%
THE SUS REFERENCE 
TABLE OF VALUES 
HAS REMAINED 
PRACTICALLY 
UNADJUSTED FOR 
MORE THAN 20 
YEARS.
2. HEALTHCARE PRODUCTS SECTOR050
THE SUPPLY 
CYCLE OF 
HEALTHCARE 
PRODUCTS
IN BRAZIL
051
Distribution of Abraidi Members’ Revenue by Paying Source
In % of revenue – 2019-2020
CHART 12
Private health is historically responsible for 
the main portion of Abraidi member’s revenue, 
representing more than 80% of revenue in 
2020. Moreover, its share has been increasing 
in recent years, going from 73% in 2018 to 78% 
in the following year and growing by another 3% 
in 2020.
The growth of the private client was probably 
an alternative found by the sector to overcome 
recurrent problems in the business relationship 
with SUS. One of the main problems is the lag in 
the table of amounts paid, which has remained 
practically unadjusted for more than 20 years, 
compromising the economic and financial 
capacity of suppliers to serve the public sector.
Although SUS is a market with the 
capacity to move large volumes of resources 
and materials as it serves about 170 million 
Brazilians, supplementary health – which has 47 
million users – offers better prices, even though 
it moves a smaller volume.
PRIVATE PAYING 
SOURCES IN 
REVENUE (%)
PUBLIC PAYING 
SOURCES IN 
REVENUE (%)
2019 20192020 2020
19%
81%
22%
78%
Source: ABRAIDI – Websetorial Survey.
2. HEALTHCARE PRODUCTS SECTOR052
Income Distribution by Type of Customer
In % of income – 2020
CHART 13
A more detailed analysis of the customers of Abraidi members reveals that health 
insurance companies – with hospitals or not – are the largest customers of 63% of 
responding companies. For 21%, public hospitals are the largest customers, while private 
hospitals are the main source of income for 16%.
When asked about the representativeness of the largest customer in the company’s 
revenue, the participants answered as follows:
 For 56% of companies, the largest customer represents up to 20% of revenue.
 For 27%, the largest customer represents between 21% and 40% of revenue.
 For 13%, the largest customer represents between 41% and 60% of revenue.
 For 4%, the largest customer represents between 61% and 80% of revenue.
 For 0%, the largest customer represents more than 81% of revenue.
In addition, 66% stated that their largest customer is a market leader in their region of 
operation. In 2019, the indicator was 62.9% and totaled 76.1% in 2018. This reduction may 
signal a diversification of customers by suppliers, in order to reduce risks and, eventually, 
negotiate better business conditions.
Source: ABRAIDI – Websetorial Survey.
21%
PUBLIC 
HOSPITAL
26%
HEALTH INSURANCE 
COMPANY NOT 
INTEGRATED TO 
HOSPITALS
(NON-VERTICALIZED)
37%
HEALTH INSURANCE 
COMPANY INTEGRATED 
TO HOSPITALS 
(VERTICALIZED) 
16%
PRIVATE 
HOSPITAL 
THE SUPPLY 
CYCLE OF 
HEALTHCARE 
PRODUCTS
IN BRAZIL
053
7 Até o momento não há estimativas para 2020. Imarc Group. Available at: https://www.imarcgroup.com/implantable-medical-
devices -market#:~:text=The%20global%20implantable%20medical%2n0devices%20market%20was,US%24%20103.3%20
Billion%20in%202019. Access on: March 20, 2021.
Foreign trade in 
healthcare products
The global implantable medical devices 
(IMD) market turned over US$ 103.3 billion7 
in 2019, according to the American research 
company IMARC. Brazil had a 2.7% share of 
the total that year.
In 2020, the spread of covid-19 to all 
continents and lockdowns imposed by several 
countries disrupted the operations of many 
companies and affected the supply chain 
around the world. As a result of the impact of 
this situation, IMARC predicts a slow industry 
recovery and moderate growth over the next 
five years.
However, the consultancy believes that an 
aging population and increasing prevalence of 
chronic diseases should drive some expansion, 
causing the global implantable medical 
devices market to reach an estimated value 
of US$ 160 billion by 2026.
The Brazilian IMD market was also greatly 
affected by the pandemic in 2020, mainly due to 
the cancellation, suspension or postponement 
THE SPREAD OF 
COVID-19 AND 
LOCKDOWNS 
IMPOSED BY SEVERAL 
COUNTRIES HAVE 
AFFECTED THE SUPPLY 
CHAIN AROUND THE 
WORLD.
of elective surgeries by SUS and ANS, and by 
interruptions and problems in the global supply 
chain such as flight restrictions, border closures, 
product confiscations, production stoppage 
of raw materials and final products, exports 
restrictions and bans etc.
2. HEALTHCARE PRODUCTS SECTOR054
Apparent Consumption1 of Implantable Medical Devices, Materials and 
Support Equipment and Percentage Share of Imports in this Market
Import share in %: apparent consumption in US$ million
CHART 14
¹Apparent consumption: sum of national production and imports, minus exports.
(P): Projected – IBGE updates of the value of national production occur every two years.
Source: Comex Stat; IBGE/PIA Produto 2018. Published in 2020.
2012 20162014 20182013 20172015 2019 (P) 2020 (P)
47%
2,338
2,631
2,872
2,418 2,603
2,813 2,882
2,118
2,554
47%
36% 36% 36%
35%
39% 37%
46%
Import share in apparent consumption – % Apparent consumption in US$ million
The cancellation, suspension or postponement of elective surgeries in 2020 for fear of covid-19 
contamination caused a “shrinkage” of the market for implantable medical devices, materials and support 
equipment in Brazil, which went from US$ 2.8 billion in 2019 to US$ 2.1 billion in 2020. The result 
represented a 26% contraction in the sector, resulting from a 22.2% drop in national production 
and a 29.5% drop in imports
In recent years, there has been a decline in the import share in the apparent consumption of the 
sector’s products. From 47% in 2012, imports now represent 35% in 2020, indicating an increase in the 
participation of national production in the period
THE SUPPLY 
CYCLE OF 
HEALTHCARE 
PRODUCTS
IN BRAZIL
055
Brazilian Production of Implantable Medical Devices,
Materials and Support Equipment
In R$ million and in US$ million
CHART 15
8 R$/US$ = 2,33 on December 2020.
Source: IBGE/PIA Produto 2018. Published in 2020.
(P): Projected – IBGE updates occur every two years.
2012 20162014 20182013 201720151,515
2,596
1,702
3,057
2,117
4,334
1,695
3,747
1,925
4,275
2,023
4,531
2,089
4,762
1,588
3,705
1,639
3,072
In R$ million In US$ million of PPP
The national production of medical devices, materials and support 
equipment in Brazil showed a 22.2% decline in 2020 compared to 
2019, reaching the value of R$ 3.7 billion or US$ 1.6 billion at the 
exchange rate of Purchasing Power Parity (PPP).8
 It is important to note that, for the conversion of health sector 
data, it is agreed to use the PPP exchange rate. Using this conversion 
rate facilitates international comparisons by minimizing distortions caused 
by different exchange rates, living costs and incomes of a country’s 
population.
2019 (P) 2020 (P)
2. HEALTHCARE PRODUCTS SECTOR056
Trade Balance of Implantable Medical Devices, Materials and Support 
Equipment
In US$ million
CHART 16
Source: Comex Stat.
 The import value of medical devices, materials and support equi-
pment in Brazil has been much higher than exports since the beginning of 
the series in 2012. In 2020, imports (US$ 738 million) were equivalent to 
3.5 times exports (US$ 208 million).
Import in US$ (–29%) Export in US$ (–17%)
2012
1,107
284 272 267 258 251
284
223 237
208
2016
945
2014
1,199
2018
1,027
2013
1,202
2017
936
2015
1,021
2019
1,047
2020
738
THE SUPPLY 
CYCLE OF 
HEALTHCARE 
PRODUCTS
IN BRAZIL
057
Main Countries of Origin of Imports of Implantable Medical Devices, 
Materials and Support Equipment
In US$ million – 2019-2020
CHART 17
 In 2020, US$ 738 million in implantable medical devices, materials and support 
equipment were imported, equivalent to 15,609,979 tons.
 The United States remained as the main country of origin of imports, 
representing 29% of total in 2020. Together with Germany and China, these countries 
were responsible for 51% of Brazilian imports in the sector.
 The top ten countries of origin of Brazilian imports of implantable medical 
devices accounted 81% of purchases made abroad.
Fonte: Comex Stat.
UNITED STATES
347
214
OTHER 
COUNTRIES
182
141
GERMANY 86
106
CHINA 73
76
MEXICO
 
51
58
SWITZERLAND
31
62 
PUERTO RICO
29
35 
INDIA 29
30 
FRANCE 27
45
JAPAN 23
34 
IRELAND 33
72
2019 2020
THE UNITED STATES, GERMANY 
AND CHINA WERE THE THREE 
MAIN COUNTRIES OF ORIGIN 
OF IMPORTS OF IMPLANTABLE 
MEDICAL DEVICES IN BRAZIL.
2. HEALTHCARE PRODUCTS SECTOR058 2. O SETOR DE PRODUTOS PARA SAÚDE
THE SUPPLY 
CYCLE OF 
HEALTHCARE 
PRODUCTS
IN BRAZIL
059
90211010 48Orthopedic devices Mexico 22 46% 
90211020 45Fracture apparatus United States 18 40% 
2490183219 Other tubular metal needles China 10 42% 
90213190 23Other joint prosthesis United States 11 50% 
90219081 31Expandable implants (stents) Ireland 11 35% 
Main Countries of Origin of Implantable 
Medical Device Imports9
by Product – 2020
TABLE 01
Source: Comex Stat.
90183929 211Other probes, catheters and cannulas
United States 74 35% 
2490213930 Coated vascular prosthesis Germany 3 15% 
90189095 46
Clamps and clips, their 
applicators and extractors Puerto Rico 17 38% 
90183119 36Other syringes, whether or not with a needle, of plastics Portugal 13 37% 
90213980 25Other prosthetic devices
Netherlands 
(Holland) 6 26% 
9 It does not include materials and support equipment.
NCM
CODE
TOTAL 
IMPORTED
(IN US$ 
MILLION)
NCM
DESCRIPTION
MAIN COUNTRY 
OF ORIGIN
COUNTRY 
IMPORTS 
(IN US$ 
MILLION)
COUNTRY 
SHARE 
OF TOTAL 
ITEM (%)
2. HEALTHCARE PRODUCTS SECTOR060
Main Destination Countries for Implantable Medical Devices, Materials and 
Support Equipment Exports
In US$ million – 2019-2020
CHART 18
 In 2020, US$ 208 million in implantable medical devices, 
materials and support equipment were exported, equivalent to 
1,601,599 tons.
The United States was the main destination country for 
exports, representing 28% of total in 2019. Together with Belgium 
and Switzerland, they represented 56% of exports.
 The top ten export destinations together accounted for 
84% of Brazilian exports.
Source: Comex Stat.
UNITES STATES
79.2
57.7
ECUADOR 3.1
2.4
CHILE
8.7
8.2
ARGENTINA 8.1
10.9
SPAIN
 
8.5
7.4
MEXICO
14.7
12.7 
BELGIUM
25.9
39.5
SWITZERLAND
33.9
29.5 
OTHER 
COUNTRIES 34.1
42 .7
COLOMBIA 14.3
13.5
2019 2020
THE SUPPLY 
CYCLE OF 
HEALTHCARE 
PRODUCTS
IN BRAZIL
061
30061090 46Other sterilized catguts etc. for surgical sutures Bélgica 13
29% 
90183220 19Needles for sutures United States 17 91% 
690183929 Other probes, catheters and cannulas Argentina 1 24% 
90183119 4Other syringes, whether or not with a needle, of plastics Chile 2 51% 
90183924 8
Peripheral intravenous 
catheters, polyurethane or 
ethylenetetrafluoroethylene 
copolymer (ETFE)
Mexico 1 18% 
Main Destination Countries for Implantable Medical Device Exports10
by Product – 2020
TABLE 02
Source: Comex Stat.
90213919 49Other cardiac valves Switzerland 20 40% 
530061010 Materials for surgical sutures (Polydioxanone) Luxembourg 1 26% 
90211010 32Orthopedic devices Switzerland 13 42% 
90183219 14Other tubular metal needles Spain 8 55% 
90213980 12Other prosthetic devices Colombia 7 59% 
NCM
CODE
TOTAL 
EXPORTED 
(IN US$ 
MILLION)
NCM
DESCRIPTION
MAIN 
DESTINATION 
COUNTRY 
COUNTRY 
EXPORTS 
(IN US$ 
MILLION) 
COUNTRY 
SHARE
OF TOTAL 
(%)
10 It does not include materials and support equipment.
3
3
Covid-19: Post-pandemic impacts 
and changes
In order to have a more precise dimension 
of the effects that the pandemic produced in 
2020, nine specific quantitative questions on 
the subject were included in the survey for this 
Yearbook. Besides, to the participants were 
given a space for the inclusion of qualitative 
responses, which enabled them to obtain a more 
comprehensive diagnosis of how this unique 
event was experienced in the companies and 
the entrepreneurs’ vision of the future for when 
the pandemic ends or recedes. The survey was 
answered by 61 companies, varying by the 
question.
The radiograph that emerges from the results 
points to a market whose general conditions 
have worsened for members. In addition to the 
drop in revenues and sales – resulting from the 
postponement of elective surgeries – and the 
increase in air and sea freight rates, historical 
COVID-19: POST-PANDEMIC 
IMPACTS AND CHANGES
THE OBJECTIVE OF THIS CHAPTER IS TO TAKE 
A DEEPER AND MORE CAREFUL LOOK AT THE 
IMPACT THAT THE COVID-19 PANDEMIC HAS 
HAD ON THE IMPORTATION, DISTRIBUTION 
AND MANUFACTURING COMPANIES 
ASSOCIATED WITH ABRAIDI. IN ADDITION 
TO MEASURING AND ANALYZING THESE 
REPERCUSSIONS, WE ALSO LOOK TO THE 
FUTURE. THUS, TWO ARTICLES ARE PRESENTED 
THAT DETAIL THE PRESENT SITUATION AND 
PROVIDE RECOMMENDATIONS, POINTS OF 
ATTENTION AND TRENDS OF CHANGE FOR 
SUPPLIERS AND HEALTH IN GENERAL.
distortions in the sector were accentuated due 
to the pandemic, such as revenue retention, 
disallowances and defaults, which will be 
discussed in detail in chapter 4.
All these factors coexisted – and were 
amplified – due to structural issues, such as the 
rise in the exchange rate and the increase in 
the ICMS rate in the state of São Paulo, where 
most companies are headquartered and where 
most products pass through. All this inevitably 
imposes higher costs on the sector, as well as 
the need to review operations and contracts.
To survive this intricate equation, companies 
have made different types of negotiations, 
diversified their product basket – including items 
to combat covid-19 –, downsized their physical 
structure and reduced working hours and the 
number of employees.
Regarding the future, the survey participants 
believe that specific issues directly related to 
covid-19, such as the cancellation of elective 
surgeries, will be resumed when most of the 
population is vaccinated. They understand that 
some changes are positive and should remain 
after the pandemic, such as the adoption 
of more innovative management and new 
business models that contribute to the growthof companies.
THE SUPPLY 
CYCLE OF 
HEALTHCARE 
PRODUCTS
IN BRAZIL
065
But they also envision a slow recovery, 
which could be aggravated by the explosion of 
cases and deaths recorded in March this year 
and by the consequent restrictions imposed by 
governments to contain the worst moment of 
the pandemic so far, whose term is uncertain. 
In addition, they see some gray clouds on the 
horizon, formed mainly by the high tax burden, 
exchange problems, difficulties in negotiating 
with the public and private health systems and 
the instability of the country’s political, social and 
economic scenario.
THE RADIOGRAPHY 
THAT EMERGES 
FROM THE RESULTS 
POINTS TO A MARKET 
WHOSE GENERAL 
CONDITIONS HAVE 
WORSENED FOR 
MEMBERS.
3. COVID-19: POST-PANDEMIC IMPACTS AND CHANGES066
Average percentage drop in revenue and surgical volume during the most acute 
phase of the pandemic in 2020 – ABRAIDI members
FIGURE 05
The healthcare products supply market was strongly impacted by 
the covid-19 pandemic and by the obstacles it generated, producing an 
average drop of around 50% in the member companies’ revenues.
In some regions of the country and in certain specialties served, 
the drop in both revenue and surgical volume reached 90%.
Factors such as the reduction in elective surgeries and the 
consumption of medical and hospital materials, in addition to national and 
international logistical problems, contributed to this result. Restrictions 
on the circulation of products imposed by some countries and the high 
prices of air and sea freight also influenced on the sector’s performance.
More than 1 million surgeries were suspended in the public 
health system alone, according to the ABIIS bulletin. Supplementary 
health data was not available, but it is important to remember that sales 
to health insurance companies represent about 80% of Abraidi members’ 
revenues.
REVENUE
50.8%
SURGICAL 
VOLUME
59.8%
THE SUPPLY 
CYCLE OF 
HEALTHCARE 
PRODUCTS
IN BRAZIL
067
Measures Taken to Reduce Costs During the Pandemic Period 
In % – 2020
CHART 19
To reduce costs and try to cushion the drop in activity and 
revenue, the companies in the sector adopted a set of measures that 
mainly involved the business relationship with customers and suppliers 
and the staff. Debt renegotiation and reduction of working hours 
and salaries were the strategies indicated by 59% of survey 
participants.
8%
26%
48%
8%
31%
54%
59%
59%REDUCTION OF EMPLOYEES’ WORKING HOURS 
AND SALARIES
DEBT 
RENEGOTIATION 
COLLECTION/
REVENUEOF 
RECEIVABLES
RENEGOTIATION/
CANCELLATION OF 
CONTRACTS WITH 
SUPPLIERS
SUSPENSION 
OF EMPLOYEES’ 
CONTRACTS
DISMISSALS
REDUCTION 
IN PHYSICAL 
STRUCTURE
NONE OF THE 
PREVIOUS
3. COVID-19: POST-PANDEMIC IMPACTS AND CHANGES068
Fifty-four percent of the companies chose to collect receivables 
from customers, that is, revenue that were retained by health insurance 
companies or hospitals. This occurred because of the need to maintain 
the companies’ cash flow, impacted by the sharp drop in revenues 
and operations and by the increase in the minimum operating costs to 
maintain the companies.
This decision may also have been driven by the 18% 
increase in the ICMS rate on healthcare products under ICMS 
Agreement No. 01/99. The tax, which is levied on sales operations 
to hospitals, private clinics and laboratories and health insurance 
companies, would take effect as of January 2021 in the state of São 
Paulo. Thus, surgeries performed with ICMS-exempt products would 
have the additional cost of taxation if billed after the beginning of 2021.
Another resource used by 48% of participants was the 
renegotiation or cancellation of contracts with suppliers.
The pandemic also caused the suspension of employee 
contracts in 31% of companies participating in the survey 
and layoffs in 26%. In other words, a quarter of the members laid 
off, the highest rate among the segments that make up the medical 
device sector (considering the areas of OPSM, equipment and in vitro 
diagnostics).
THE SUPPLY 
CYCLE OF 
HEALTHCARE 
PRODUCTS
IN BRAZIL
069
Eight percent of the participants reported a reduction 
in physical structure and another 8%, the adoption of other 
initiatives such as the following:
Product diversification.
Reduction of purchases/stock.
Financial loans.
Inclusion of products for covid-19 in the portfolio.
Home office work.
Compensatory time off/time bank.
More than half of the companies (56%) pointed to the growth 
during the pandemic of practices considered “market distortions” by the 
sector and that negatively affect economic performance.
Revenue retention occurs when health insurance companies 
and hospitals prevent, under penalty of retaliation, the invoice of pro-
ducts used in previously authorized surgeries.
Disallowance is the refusal of health insurance companies to pay 
for surgical materials or equipment used and, in some cases, previously 
authorized.
Default occurs when payment to the supplier is not made 180 
days after billing.
Increased Revenue Retention, Disallowances and/or Defaults During the Pandemic
In % – ABRAIDI members
CHART 20
NO
44%
YES
56%
3. COVID-19: POST-PANDEMIC IMPACTS AND CHANGES070
DEFAULT
42.7%
DISALLOWANCE
24.7%
REVENUE 
RETENTION 
39.9%
Average increase in revenue retention, disallowances and default - ABRAIDI members
In % – 2020
FIGURE 06
Perspective of Recovery by ABRAIDI Members11
In % – 2020
CHART 21
11 Perspective as of January 2021.
10%
1ST SEMESTER 
2021 
44%
2ND SEMESTER 
2021 
42%
2022
2%
2023 2%
THE MARKET WILL 
CHANGE AND WILL 
NOT BE AS IT WAS 
BEFORE
THE SUPPLY 
CYCLE OF 
HEALTHCARE 
PRODUCTS
IN BRAZIL
071
Despite the variety and intensity of challenges faced 
during the pandemic, the companies are optimistic about the 
timeline for economic recovery to pre-pandemic levels.
Fifty-four percent believe that recovery will occur as early 
as 2021.
About half of respondents (42%) predict improvement by 
2022.
A small portion (2%) indicates recovery in two years and 
2% believe that the market will not return to its previous level.
072
Permanent Changes that have Been or will Be Adopted
After the Pandemic
In % – 2020
CHART 22
14%
23%
21%
33%
49%
49%OPENING NEW CUSTOMERS IN THE PRIVATE SECTOR 
ACTIVITY AND/
OR PORTFOLIO 
EXTENSION
PHYSICAL AND 
PERSONNEL 
STRUCTURES
REDUCTION 
OPENING NEW 
CUSTOMERS IN THE 
PUBLIC SECTOR
PERMANENT HOME 
OFFICE FOR SOME 
AREAS OF THE 
COMPANY
PRODUCT 
PORTFOLIO 
REDUCTION
3. COVID-19: POST-PANDEMIC IMPACTS AND CHANGES
THE SUPPLY 
CYCLE OF 
HEALTHCARE 
PRODUCTS
IN BRAZIL
073
49% OF 
MEMBERSLOOKED 
FOROPENING NEW 
CLIENTS IN THE 
PRIVATE SECTOR OR 
EXPANDING THEIR 
PORTFOLIO.
To cope with the challenges brought by covid-19, 
the companies adopted practices that will become 
perennial after the pandemic, including the diversification 
of customers and challenges.
Some points highlighted by survey participants:
“The biggest problem for the implantable device 
sector was not the pandemic, but the fiscal adjustment 
package adopted in São Paulo, which affects the entire 
country.”
“The market is moving towards a greater 
concentration between hospitals and health insurance 
companies, which may change the form of negotiations 
between suppliers and these customers.”
“The industry is being directed to new business 
models, not only due to the pandemic, but also due to 
the political, social and economic scenario in Brazil and 
the world.”
“Problems such as tax increase and the difficulty of 
negotiating with the government will persist.”
“The reduction in surgical procedures has greatly 
affected the sector, but the survival of some companies 
is threatened by the increase in the ICMS rate on the sale 
of healthcare products in São Paulo.”
“One of the post-pandemic impacts will be the 
reduction in surgical volume compared to the previous 
period, as many people were laid off and lost their right 
to health insurance plan and, consequently,to use the 
private sector.”
O CICLO DE 
FORNECIMENTO 
DE PRODUTOS 
PARA SAÚDE 
NO BRASIL
THE SUPPLY CYCLE OF HEALTHCARE PRODUCTS IN BRAZIL074
Strong pressure on the supply chain – 
logistical restrictions and relevant exchange rate 
increase.
Decrease in demand – reduction in 
the sale of medicines and devices (implantable 
and materials), focusing “only” on combating 
covid-19, and postponement of elective 
treatments.
Operational-financial sustainability – 
primarily of national capital and smaller suppliers.
Greater protagonism in the client-patient 
relationship, which now has even greater power 
of decision/choice over what will be used in its 
procedures, debating and actively looking for 
this knowledge now that health is increasingly on 
the agenda.
Regulatory challenges – here the 
dysfunctionality related to prices and product 
similarities and the challenges related to the 
economic monitoring of these healthcare 
products stand out. This leads to increased 
health expenditures, hinders access and 
reduces the quality of healthcare provided in the 
country.
CHANGES IN HEALTH 
POST-COVID-19
The global economy is expected to grow 
5.5% in 2021 and 4.2% in 2022. Effective mul-
tilateral cooperation is needed to control the 
pandemic everywhere. These efforts include in-
creased funding for Covax12 deployment to ac-
celerate access to vaccines across all countries, 
ensuring universal distribution of vaccines and 
facilitating access to affordable therapy for all.
While recent vaccine approvals have raised 
hopes of a turnaround in the pandemic, new wa-
ves and new variants of the virus pose concerns 
about the global resumption outlook. Even so, it 
is expected to give rise to increased momentum 
in the second quarter as vaccines and therapies 
become more readily available, allowing for the 
strengthening of direct-to-public contact activity.
In this context, the main challenges and 
trends for suppliers in the healthcare chain are:
Leonardo Giusti (KPMG)
Sheila Mittelstaedt (KPMG)
THE GLOBAL GROWTH CONTRACTION FOR 2020 HAS BEEN ESTIMATED AT -3.5% 
(0.9% HIGHER THAN PROJECTED IN THE PREVIOUS FORECAST), REFLECTING A 
STRONGER-THAN-EXPECTED BOOST IN THE SECOND HALF OF 2020.
¹² Covax is part of the Access to COVID-19 Tools (ACT) Accelerator, a mechanism that WHO created in response to the 
pandemic, a coalition of 165 countries to guarantee a vaccine against the coronavirus for the poorest nations.
THE SUPPLY 
CYCLE OF 
HEALTHCARE 
PRODUCTS
IN BRAZIL
075
Use of technologies and artificial 
intelligenceto identify significant health 
outbreaks, as well as to accelerate the 
development of medical devices and 
medicaments.
Potential reduction in private 
participants of the value chain due to financial 
consequences resulting from the pandemic, 
the isolation situation, the sudden drop in 
revenue and the difficulties of recovery.
Here are some of the important issues to be addressed in this article in different ways:
THE GLOBAL ECONOMY 
IS EXPECTED TO GROW 
5.5% IN 2021 AND 4.2% IN 
2022.
Acceleration of digital transformation 
in the value – multiple channels for contact 
with the medical class and in the client-patient 
relationship.
New business models, industry with 
greater customer-patient proximity.
How will the new 
restrictions needed to 
contain transmission affect 
activity in the short term 
before vaccines begin to 
provide effective protection 
for the entire society?
A
How will vaccine 
expectations and public 
policy support affect the 
economic activity of the 
healthcare industry?
B
How will financial conditions 
and commodity prices 
evolve?
C
3. COVID-19: POST-PANDEMIC IMPACTS AND CHANGES076
Restriction of suppliers’ productive 
capacity, causing supply disruption.
Map and understand the production 
capacity of the main suppliers and 
assess stock availability for short term.
Lack of supply chain visibility, making 
traceability and physically location of 
materials difficult.
Evaluate inventory levels of raw 
material, in-process and finished product, 
prioritizing customers and placed orders
Logistics operators/third parties being 
impacted by operational constraints 
related to customer service capacity.
Establish a short-term plan with current 
logistics operators/third parties, evaluating 
operational constraints and possible 
impacts on the business.
Lack of visibility in the purchasing area 
regarding the criticality of some 
materials.
Establish partnerships to operationalize 
sales through digital platforms, expand 
sales channels and enable last mile 
delivery.
Logistic routes facing operational 
difficulties to ensure the physical flow of 
goods.
Map the entire logistics network and 
establish new routes and alternative 
modes of transportation.
Drop in sales volume due to the lack 
of online sales channels; logistical 
operation difficulties to operate the last 
mile efficiently.
Establish a logistical committee and 
map the physical location of materials in 
transit to report status to the customer
Legal disputes and contractual 
fines caused by non-compliance with 
contractual requirements with suppliers.
Map existing contracts, assess 
responsibilities and financial risks. Bring the 
legal area closer to the parties in order to 
minimize legal disputes.
Evidence of Brazil’s dependence on other 
countries and the lack of integration in 
global health value chains.
Structure the Strategic Purchasing 
Matrix and define a supply chain risk 
mitigation plan.
Stock-out of inputs and finished products, 
directly impacting customer service.
Supply Chain & Operations (Healthcare 
Providers) – Impacts and 
Crisis Response
The crisis impacts...
Responses to the crisis...
1.
1.
6.
5.
3.
3.
8.
7.
2.
2.
7.
6.
4.
4.
9.
8.
5.
077
Review the business strategy 
considering alternative suppliers in order to 
ensure the continuity of the operation.
Review raw material and finished 
product safety stock policies in order to 
mitigate supply risks.
Establish a contingency plan with 
new operators/third parties in order to 
meet the demand in case of unscheduled 
downtime.
Develop Omni Channel platform for 
online service, establish contracts and 
define service levels with logistics partners 
to operate last mile.
Structure logistical network scenarios 
and contingency plan, evaluating new 
transportation routes/modalities, mitigating 
risks in the process of moving materials 
and products.
Implement raw material and finished 
product tracking solutions in order to 
promote supply chain visibility
Structure a contract review plan 
evaluating contract clauses and coverage 
related to force majeure events.
Define specific strategies for critical and 
strategic materials groups, develop new 
suppliers and perform Make or Buy 
analysis to verticalize operations.
Coming out of the crisis...
1. 5.
3. 7.
2. 6.
4. 8.
O CICLO DE 
FORNECIMENTO 
DE PRODUTOS 
PARA SAÚDE 
NO BRASIL
078
Finance and Liquidity
The crisis impacts...
Increased in accounts 
receivable defaults.
Retraction of the banks regarding the 
availability of credit lines.1. 3.
Reduction in demand for
products and services.
Impact on liquidity 
and accelerated cash burn.2. 4.
3. COVID-19: IMPACTOS E MUDANÇAS NO PÓS-PANDEMIA
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Review the projected cash flow, 
pay attention to accounts receivable 
performance, review non-essential 
expenses.
Identify with banks and credit funds the 
availability of new lines of credit.
Define the degree of intensity and urgency 
of stabilization actions.
Assess government measures that make 
tax payments more flexible and reduce 
personnel expenses.
Continuously perform cash stress tests. Look for flexibility regarding short-term 
maturities.
Optimize working capital through:
actions with customers to secure 
receivables and measure changes in 
future demand;
reassessing credit policies regarding 
limits and payment terms;
monitoringthe supply chain, identifying 
flexibility in terms and conditions of 
payment and capacity for continuity 
of supply.
Identify and implement operational and 
non-operational cost reduction.
Organize a narrative consistent with the 
company’s strategic vision, the actions 
being taken to minimize the crisis impacts 
and a medium- and long-term vision.
Responses to the crisis...
1. 5.
3. 7.
2. 6.
4. 8.
9.
Reassess financial planning and cash 
flow.
Strive to lengthen the average terms of 
existing indebtedness.
Plan the resumption of activities in 
sync with the supply chain, involving the 
supply chain, and pay attention to any 
vulnerabilities of suppliers/partners that 
need support.
Sell non-strategic assets.
Strengthen the company’s liquidity 
position by negotiating new lines with the 
banks.
Diversify funding sources, including 
access to capital markets.
Reassess the required capital structure.
Adjust operational and financial 
strategy and develop a robust narrative 
regarding its strategy and vision for 
the future, to interact with its various 
stakeholders.
Assess the company’s need for 
capitalization.
Coming out of the crisis...
1. 6.
3. 8.
2. 7.
4. 9.
5.
Fraud and non-compliance
Effects of covid-19 on suppliers’ financial 
statements and disclosure
EMERGING RISKS BRAZIL 2021 – 
NEW POINTS OF ATTENTION
On March 20, 2020, due to the pandemic, the federal 
government decreed a state of public calamity in the 
country. Among other measures, this decree exempts 
the government from adhering to the precepts of the 
Bidding Law (Law No. 8,666/93), which establishes 
the principles that govern bids and other administrative 
contracts for the entire federal, state and municipality 
government. The flexibilization of this law makes room 
for countless types of fraud arising from government 
procurement processes, including embezzlement of 
funds and assets.
The “Covid-19: Compliance Survey”, carried out by 
KPMG in Brazil, identified the adaptation to emerging 
risks as one of the main impacts reported by the Chief 
Compliance Officers (CCOs), with respect to the role 
of compliance in companies. Among these emerging 
risks, the most concerning are those related to fraud, 
corruption and misconduct, motivated by factors such 
as donations, the need to hire new third parties and new 
regulations and procedures.
A careful assessment must be made of the 
necessary and useful information to users of the financial 
statements (investors, partners, directors and other 
managers) about the effects of covid-19, which will be 
disclosed in the notes. Check on the next page a list of 
some items that should be considered in the context of 
the covid-19 pandemic:
THE BEST TOOL THAT THE COMPANIES 
CAN HAVE TO PROTECT THEMSELVES 
FROM THIS TYPE OF SITUATION ARE 
ACTIVE AND EFFECTIVE INTERNAL 
CONTROLS, WHICH PROVIDE 
TRANSPARENCY TO THE PROCESSES AND 
ENSURE THAT NEW INTERACTIONS ARE 
NOT MISINTERPRETED, WHICH CAN 
GENERATE ACTS OF CORRUPTION AND 
CAUSE IRREVERSIBLE DAMAGE TO THE 
COMPANY’S REPUTATION.
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FOCUS ON 
CONTINGENCIES, 
ESPECIALLY ON 
LEGAL AND LABOR 
ASPECTS.
Focus on contingencies, especially in legal and labor 
aspects, which may generate lawsuits due to the several situations 
triggered by the pandemic, and possible disputes with suppliers, 
lessors, customers and financial institutions.
Analyze the possible circumstances that may cause the 
need for reduction to the recoverable value of assets. Also focus on 
disclosures that must fully comply with the rules, so that they are 
clear and objective.
Covenants: in general, companies have focused their 
attention on complying with restrictive clauses (covenants) in 
loan and financing agreements at the balance sheet date. This is 
because, in case of non-compliance with these clauses, there may 
be some significant consequences for the equity position of the 
companies
Operational continuity: making projections in the current 
scenario can be a complex and challenging exercise. The point 
of attention is that previously considered items may no longer be 
reasonable in a stressful situation. The ability to renew credit lines or 
access the capital market may have undergone a significant change as 
a result of the current scenario imposed by the pandemic.
After the LGPD officially went into effect, companies are moving 
to an increasingly data-driven business model. Personal information 
accumulates value, which can be translated into strategic assets for 
the economy. Companies need to be able to customize their products/
services and anticipate their consumers’ expectations and needs. In 
Brazil, this regulation is very new, but it is essential to understand that 
this adaptation is not a requirement of the regulator itself, but a matter 
of competitiveness. Therefore, the company must be able to efficiently 
choose investments to establish a coherent cybersecurity strategy.
Data-driven Market
3. COVID-19: POST-PANDEMIC IMPACTS AND CHANGES082
Covid-19 has disrupted 
business as we know 
it and started digital 
transformation 
strategies.
Extending financial losses, reducing 
workforce, supply chain delays, increasing 
security risks, adapting quickly to a new way of 
doing business, discovering new secure ways to 
serve customers and rebalancing priorities while 
moving to a very remote workforce. Sixty-three 
percent of organizations have increased Digital 
Transformation (DT) budgets.
Companies are 
transitioning their 
processes to a digital 
future of work.
The main digital priorities include adding new 
digital capabilities and creating new digital pro-
ducts and services, building digital platforms, 
creating digital business models, and automa-
ting business processes. Eight out of ten orga-
nizations are using collaboration and cloud com-
puting tools to enable their digital transformation 
strategy; about six in ten are adopting systems 
integration technologies: IoT13 and ITSM14.
Some key 
points that will 
address changes 
throughout the 
current pandemic 
scenario and should 
be part of the 
priority strategies 
to be developed by 
Abraidi members:
13 IoT – Internet of Things. The Internet of Things (IoT) describes the network of physical objects – “things” – that are embedded 
with sensors, software and other technologies in order to connect and exchange data with other devices and systems over the 
internet. These devices range from common household objects to sophisticated industrial tools. With more than 7 billion IoT 
devices connected today, experts expect this number to rise to 10 billion by 2020 and 22 billion by 2025
14 ITSM – Information Technology Service Management, which stands for IT service management. We are talking about a set of 
strategies, tools and software that track and manage the entire lifecycle of IT services.
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The pandemic is 
driving customer 
centricity even higher 
on the priority list.
Improving the customer experience (82%) 
and creating a customer-centric digital business 
system (70%) are the main drivers of DT leaders’ 
digital transformation strategy. In addition, more 
than half say that they are accelerating initiatives 
on connecting the front, middle and back offi-
ce, creating an employee experience to deliver 
better value and aligning with partners to meet 
commitments together.
The “critical” business 
processes on site span 
front, middle and back 
office
Front office: 61% are automating or will au-
tomate claims, followed by customer service 
(52%). While 38% plan to automate any front 
office business process and 35% will focus on 
product design and program development/deli-
very, sales (30%) and clinical (30%).
Middle office: automation is a slightly more 
common practice among middle office proces-
ses: 72% are automating or will automate inven-
tory management and distribution, while 65% 
are automating/willautomate operations or su-
pply chain (60%).
Back office: automation is also being levera-
ged for back office processes: 72% are automa-
ting or will automate procurement, while about 
six in ten are automating IT processes (65%), 
transparency and traceability (63%), human re-
sources (60%), finance (59%) or security (59%). 
Between 20% and 42% are exploring automa-
tion of back office processes; most notably, bu-
siness partner/reseller/distributor support (42%), 
risk and compliance (35%), and security (32%).
3. COVID-19: POST-PANDEMIC IMPACTS AND CHANGES084
In this immense turbulence derived from 
covid-19, a crisis is spreading among individuals, 
companies and countries globally. A crisis with 
repercussions not only in health, but also in 
economic, social, financial, structural, political 
and security aspects.
In a survey we recently launched in Brazil, 75%
of respondents reported that their company had 
gone through at least one crisis in recent 
Implement/update the Crisis Management 
and Business Continuity plan.
Develop/update the Risk Management 
plan.
Perform continuous monitoring of third- 
-party risks and readjustment of the contracting 
process and contract management, including 
contractual reviews (suppliers, partners and 
customers).
Monitor business practices adopted with 
third parties and analyze the correct approval 
chain for discounts, bonuses or agreed terms.
Crisis management 
– impacts and recommendations
The crisis impacts...
Coming out of the crisis...
FINALLY, SOME GENERAL RECOMMENDATIONS WILL SERVE 
FOR MOST COMPANIES OTHER HEALTHCARE:
Structure LGPD Analytics.
Perform investigative monitoring on critical 
and/or emergency transactions.
Customer retention: mapping customer 
profiles and contracts, understanding 
contractual clauses (for example: health fine) 
and defining and implementing the retention 
plan.
Monitor post-crisis financial risks.
Activate the whistleblower channel to 
capture new potential incidents of deviations 
and/or crises.
years, but only 45% had a corporate crisis 
management policy. At this moment when 
instability is real and growing, it is of utmost 
importance to manage it. When everything 
returns to normal, it should be considered 
whether the lessons learned at this moment 
should not be incorporated or adapted to the 
company’s routine.
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Establish and activate the crisis management and response plan.
Manage the impacts of risks in the different areas of the company and its ecosystem..
Establish a central risk response team.
Establish a continuous emergency support structure (PMO).
Develop an internal and external communication plan.
Develop a rapid deployment plan for business continuity.
Structure Compliance Analytics.
Review contracts and disputes.
Responses to the crisis...
Nature Consideration
Medical devices Drop in sales and pressure on the supply chain – imports
Suppliers Drop in demand and logistical 
difficulties
Health Products Suppliers
POSSIBLE RESUMPTION PATTERN
FIGURE 7
3. COVID-19: POST-PANDEMIC IMPACTS AND CHANGES086
Health
NATURE
Providers
Drop in demand – focus 
“only” on covid-19
Increase in 
loss ratio
High financial and 
operational/assistance 
pressure
Insurance companies
SUS
RESUMPTION 
PATTERN
Back to 
Normal
See graphic below.
CONSIDERATION
Impacts
Challenges
Tendencies
Predominance of physical 
access throughout the value chain; 
“digital health” strongly resisted by 
trade entities, industry professionals 
and regulatory bodies.
Public-private relationship in 
the fight against covid-19.
Operational-financial 
sustainability in check both in public 
and in private sector.
Scarcity of various types of 
resources to fight the pandemic.
Withholding and 
postponement of treatment and 
elective surgeries – potential for 
post-covid-19 bottlenecks.
Acceleration of digital 
transformation in the value chain 
– technologies that allow the entry 
of digital channels (telemedicine/
teleconsultation/electronic 
prescription) and medium/long- 
-term strategy based on multiple 
channels.
Potential reduction in 
supplementary health beneficiaries 
as a result of the worsening 
economic crisis, with the 
consequent migration of users to 
the public sector.
Potential reduction in private 
value chain participants due to 
financial consequences resulting 
from the situation of isolation and 
sudden drop in revenue.
Acceleration of new 
business models.
Need for optimization of 
the installed health facilities, as well 
as search for greater operational- 
-financial efficiency.
Possible resumption patterns for health and life sciences
FIGURE 08
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NATURE
Medicaments Drop in sales and pressure on the supply chain – imports
Drop in sales and pressure on 
the supply chain – imports
Drop in demand and logistical 
difficulties
Devices
Distribution
Back to 
normal
RESUMPTION 
PATTERN CONSIDERATION
Life Sciences
Strong pressure on the supply 
chain – logistical restrictions and relevant 
exchange rate increase.
Drop in demand – reduction 
in the sale of medicines and devices 
(implantable and materials) given “only” 
the focus on combating covid-19 and 
postponement of elective treatments 
(with a strong retraction in the dispensing 
of hospital and pharmaceutical retail 
drugs).
Operational-financial sustainability 
mainly of national capital and smaller 
participants.
Greater prominence in the 
client-patient relationship– regulatory 
challenges.
Acceleration of the digital 
transformation in the value chain – 
multiple channels for contact with the 
medical class and in the client-patient 
relationship.
Use of technologies and artificial 
intelligence to identify significant health 
outbreaks, as well as to accelerate medi-
cament development.
New business models, industry 
with greater customer-patient proximity.
Potential reduction in private 
participants in value chain due to financial 
consequences resulting from the isolation 
situation and sudden drop in revenue.
3. COVID-19: POST-PANDEMIC IMPACTS AND CHANGES088
The crisis and the different effects on the sectors
FIGURE 09
1. Growth
Industry/companies that scale post-covid with consumer behavior favorably changed during 
the crisis. Investors realize their potential to lead and provide capital to scale aggressively 
during the recovery.
2. Back to normal
Industries/companies seen as essential will suffer from the recession’s effect of social distancing 
but will recover more quickly as consumer demand picks up at similar volumes.
Resumption Pattern
TURNING POINT 
(SPEED)
BEGINNING OF 
CRISIS
END OF 
CRISIS
Online 
retail and 
pharmacy 
Food 
delivery
Chemicals and 
petrochemicals 
Media 
streaming
Telemedicine 
and preventive 
medicine
Digital 
education 
Food and 
beverages 
Financial services Consumer goods (cyclic)
Private equity 
e and asset 
management
Road and urban 
transportation
Telemedicine and 
telecommunications Public utilities 
Agriculture
Health and life 
sciences 
TURNING POINT 
(SPEED)
BEGINNING OF 
CRISIS
END OF 
CRISIS
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3. Transform to Re-Emerge
Industries/companies that will recover, but along an extended path, requiring capital reserves 
to resist and transform operating and business models to emerge stronger and more aligned 
with changing consumer priorities and behavioral patterns.
4. Restart
Industries/companies struggling to recover from covid-19 due to “permanently” reduced de-
mand for offerings, insufficient capital to avoid prolonged recession and/or poor execution of 
digital transformation.
TURNING POINT 
(SPEED
BEGINNING OF 
CRISIS
END OF 
CRISIS
Tourism Miningand Metals 
Oil, gas 
and 
ethanol 
Real state/E&C real 
estate and construction 
companies
AutomotiveConsumer goods (non-cyclical)
Hotels Sports and 
media 
Government Industrial marketsAirportsRetail(other segments)
TURNING POINT 
(SPEED)?
BEGINNING 
OF CRISIS 
END OF 
CRISIS
3. COVID-19: POST-PANDEMIC IMPACTS AND CHANGES090
The organizational impacts of the crisis
FIGURE 10
PERSONS
SUPPLY CHAIN & 
OPERATIONS
FINANCE 
AND 
LIQUIDITY
OPERATION 
SUPPORT 
TECHNOLOGY
TAX AND LABOR 
ASPECTS
Source: KPMG
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Some KPMG publications that 
complement this article and that may be of 
interest to the reader.
Scan the QR Code to access 
KPMG’s covid-19 content.
THE SUPPLY CYCLE OF HEALTHCARE PRODUCTS IN BRAZIL092
DIGITAL HEALTH: OPPORTUNITIES 
AT THE FRONT DOOR
Dr. Jefferson Fernandes
(Associação Brasileira de Telemedicina e Telessaúde)
Digital health (DS) can be defined as 
connected, continuous healthcare using 
digital and communication technologies. SD 
is a broad term in which telemedicine and 
telehealth are also included.
Telemedicine is the practice of 
medicine in different locations through 
the responsible use of information and 
communication technologies. Although the 
terms “telemedicine” and “telehealth” are 
often used interchangeably, it is appropriate 
to understand telehealth as the provision 
of health services in different locations 
by all health professionals, mediated by 
information and communication technologies, 
for healthcare, education, research and 
management purposes. Telehealth is also a 
generic term and the practice of healthcare 
in various professions, such as tele-nursing, 
tele-physiotherapy and occupational 
therapy, telenutrition, telepsychology, 
telephonoaudiology, among others.
DIGITAL HEALTH IS GROWING EXPONENTIALLY ANDENCOMPASSING THE ENTIRE SPECTRUM OF 
HEALTHCARE. THE DIGITAL SOLUTIONS OFFERINGS INCLUDE THE QUALITY OF LIFE AND HEALTH 
PROMOTION, PREVENTION, DIAGNOSIS, TREATMENT, INCLUDING REHABILITATION, AND HOME 
CARE. THIS ACCELERATED EXPANSION, WHICH HAS BEEN OCCURRING IN SEVERAL COUNTRIES, WAS 
DETERMINED BY THE COVID-19 PANDEMIC AND IS EXPECTED TO CONTINUE GROWING EVEN AFTER 
THE PANDEMIC ENDS.
The evolution and expansion of the 
various modalities, applications and use of 
digital health in the real world have generated 
several other names that, little by little, in 
several countries, are replacing the terms 
“telemedicine” and “telehealth”. Among them 
are virtual care, connected care and 
connected health.
The modalities of performance in telemedicine 
can be classified as follows:
Telemetry/orientation: evaluation of 
symptoms, at a distance, to define and refer the 
patient to the appropriate type of care he need.
Teleconsultation: direct doctor-patient 
consultation (for diagnosis and treatment).
Teleinterconsultation/Teleconsultation: 
interaction among physicians to clarify aspects 
of diagnosis, treatment and other issues related 
to patient care. Two types: synchronous and 
asynchronous.
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Telediagnosis: support for reports of 
various types of complementary exams (usually 
asynchronous), such as: teleradiology, tele- 
-electrocardiogram, tele-electroencephalogram, 
telepathology.
Telemonitoring: remote monitoring, 
through electronic systems, of body parameters 
(includes transmission, recording, processing 
and clinical management).
Telemonitoring includes the use of wireless 
devices, wearable and implantable sensors. It 
enables continuous support and management 
of chronic diseases and can be synchronous 
(real time) or asynchronous (storage and 
forwarding), depending on the patient’s need. 
The application of artificial intelligence (AI) and 
machine learning can enable better disease 
surveillance and early detection, improved 
diagnostics, clinical decision support, and 
support for personalized medicine.
THE FUNDAMENTAL ASPECT WAS 
THE PERMISSION FOR THE USE OF 
TELECONSULTATION, WHICH WAS 
THE GREAT OBSTACLE TO THE 
DEVELOPMENT OF TELEMEDICINE IN 
THE COUNTRY.
In Brazil, the advance of telemedicine, after 
decades of restrictions, was initially determined 
by the publication by the Ministry of Health 
of Decree No. 467, of March 20, 2020, which 
authorized the use of telemedicine in all its 
modalities during the covid-19 pandemic. This 
decree was followed by the publication of Law 
No. 13,989, on April 15, 2020, originating from 
a bill prepared and approved by the National 
Congress and sanctioned by the Presidency of 
the Republic. The fundamental aspect of the 
decree and the law was the permission for the 
use of teleconsultation, which was the major 
obstacle to the development of telemedicine in 
the country. The Federal Council of Medicine 
(CFM) resolution on telemedicine still in force is 
Law No. 1,643, of August 2002, which excluded 
teleconsultation.
Physicians who have started using 
teleconsultation are satisfied with the benefits 
and results of this modality of patient care. Of 
course, we should not expect all physicians to be 
3. COVID-19: POST-PANDEMIC IMPACTS AND CHANGES094
interested in its use, either in primary care or in medical 
specialties. This method of care should be used by those 
who want it, both physicians and patients. However, the 
benefits of telemedicine are already clear. We can safely 
say that telemedicine in its various modalities is here to 
stay. Everyone involved needs to know its benefits as 
well as its limitations.
There are several scientific and real-world evidence 
that demonstrate the benefits of responsible use of 
telemedicine and telehealth. Among them are:
A survey carried out by Press Ganey with 1.3 
million patients in the United States in 2020 noted that 
patients appreciate the convenience and, surprisingly, 
the intimacy of virtual visits. However, this survey also 
showed that there is an enormous room for improvement 
in telemedicine/telehealth and teleconsultation 
processes. But how to improve the use of telemedicine 
and its processes?
An efficient way is through the training of physicians 
and health professionals to practice responsible 
connected health, that is, safety, ethics and quality. 
The communication and operational processes of the 
virtual consultation are also important for delivering a 
consistently satisfactory patient experience.
Expanding access to health services. Continuous and articulated follow-up in the different levels of care.1. 4.
Strengthening care coordination. Cost reduction in healthcare.3. 6.
Increasing resolutivity and effectiveness of 
healthcare.
Contribution to the organization of health 
systems, bringing greater effectiveness and 
efficiency.
2. 5.
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THERE IS AN 
ENORMOUS ROOM 
FOR IMPROVEMENT 
IN TELEMEDICINE/
TELEHEALTH AND 
TELECONSULTATION 
PROCESSES.
096 3. COVID-19: POST-PANDEMIC IMPACTS AND CHANGES
Based on the experience we are having 
during this pandemic period, we will be able to 
accelerate the strategic use, operational efficiency 
and quality of connected care to benefit patients, 
physicians and healthcare services and systems. 
It is important to emphasize that telemedicine and 
telehealth are patient care methods, not tools. 
These are the technologies used for its execution 
(hardware, software, internet etc.).
Participants in the health ecosystem are 
increasing their focus on digital health. This 
includes regulators reducing the burden to 
encourage digital innovation and ease time-to- 
-market for needed diagnostic, therapeutic and 
monitoring solutions; paying sources showing a 
greater appetite to expand coverage; healthcare 
providers increasing their use of connected care; 
patients adopting the use of more sophisticated 
digital healthcare technologies; and product 
developers investing in the development of new 
digital technologies.
In Germany, for example, the new Digital 
Health Law made it possible for some health 
apps to be prescribed by physicians with the costs 
covered by health insurance companies, which 
was considered a world innovation. However, 
companiesor startups must demonstrate within 
a year that the digital solution is accurate, when it 
THE DIGITAL HEALTH 
MARKET WAS 
ESTIMATED AT OVER 
US$ 106 BILLION IN 
2019.
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comes to diagnosis, or effective, when it comes 
to directing to therapeutic alternatives that are 
necessary for approval and continuity. Under this 
law, Germany wants more teleconsultations for 
patients, including electronic prescriptions and 
improvements in IT systems for physicians and 
dentists.
In Brazil, the Ministry of Health, through 
Datasus, recently published the so-called “Digital 
Health Strategy 2020-28”. It emphasizes the 
importance of working in harmony among the 
various organizations and institutions from all 
sectors of health, as “the public sector cannot, 
alone, respond to all the needs for scientific 
discovery, industrial production, innovation and 
human resources training for health and even less 
for digital health”. One of the axes of this strategy 
“aims to implement a conceptual, normative, 
educational and technological environment that 
favors effective collaboration”.
The size of the digital health market has 
been estimated at more than US$106 billion in 
2019, and the industry will have a compound 
annual growth rate (CAGR) of 28.5% by 2026, 
that is, to around US$ 640 billion. The increasing 
number of covid-19 cases around the world 
has increased the adoption of digital health 
technologies and will drive the growth of the 
digital health industry. It is estimated that the 
health apps segment will have a CAGR of 38.9% 
in this period and 26.2% for the telemedicine/
telehealth segment.
The increasing number of smartphone users 
around the world and the entry of 5G will drive a 
market growth. The rapidly progressing health IT 
infrastructure in both developed and developing 
countries will also contribute to this market 
growth.
In Brazil, the demographic transition, 
which has shown a significant growth in the 
elderly population, is accompanied by an 
epidemiological transition, that is, a significant 
increase in chronic diseases. These transitions 
will lead to the adoption of new solutions to 
manage people’s health, stimulating demand for 
digital solutions, for example, remote monitoring, 
increasing the market size and driving the 
expansion of the regional industry.
From telemedicine to remote patient 
monitoring and management, new services 
will be adopted quickly, generating countless 
opportunities. Investors will see it.
O CICLO DE 
FORNECIMENTO 
DE PRODUTOS 
PARA SAÚDE 
NO BRASIL
4
4
Health distortions and the 
sustainability of the sector
IN RECENT YEARS, ABRAIDI HAS BEEN CONTRIBUTING TO THE 
DEBATE ABOUT THE SUSTAINABILITY OF BRAZILIAN HEALTH, A 
TOPIC THAT HAS BECOME CENTRAL TO PUBLIC AND PRIVATE 
MANAGERS AND OTHER REPRESENTATIVES OF THE SECTOR 
NOT ONLY IN THE COUNTRY BUT ALSO AROUND THE WORLD 
DUE TO SEVERAL FACTORS SUCH AS PEOPLE LONGEVITY, 
NEW MEDICAL DISCOVERIES, THE DEVELOPMENT OF NEW 
TECHNOLOGIES, INCREASED HEALTH COSTS, AMONG OTHERS.
In this chapter, we present two different approaches that 
add value to this discussion: an article that deepens the debate 
around health sustainability based on the concept of Value-Based 
HealthCare (VBHC), which implies a paradigm shift from disease- 
-oriented care to health-driven care, with a central focus on the 
patient; and the results of the Abraidi members survey on how 
the historical distortions of the business relationship between 
suppliers and customers behaved in 2020 and how much this 
increases costs, burdens the health system as a whole and does 
not represent any benefit to the patient.
HEALTH DISTORTIONS AND THE 
SUSTAINABILITY OF THE SECTOR
THE SUPPLY 
CYCLE OF 
HEALTHCARE 
PRODUCTS
IN BRAZIL
101
SUSTAINABILITY OF THE HEALTH 
SYSTEM
 I believe we can say that the world will no 
longer be the same after the announcement 
of the pandemic created by the coronavirus. 
Regardless of the possibility of returning to the 
pre-pandemic condition, our view of the world 
and, particularly, the value of healthcare have 
been indelibly impacted.
In recent years, the need to shift the focus 
from the cost of illness to the value of health had 
become evident. After all, the so-called health 
system, as we know it today and depend on 
it, is a disease system, in which the generation 
and capture of value begins and ends with 
treating “someone sick”. However, covid-19 has 
certainly accelerated the transformation from a 
disease system to a health system in months, 
which would possibly take years and eventually 
another decade.
In order to clearly understand the depth and 
magnitude of such a change, it is important to 
go back in time to the first practical evidence 
associated with curing diseases and extending 
life as applied by Eastern medicine – Indian, 
Chinese and Tibetan – more than 5,000 years 
ago.
The concern with the treatment of disease 
probably appears in medieval medicine, but it is 
still associated with divine causes. The history of 
modern medicine begins in the Renaissance, a 
little more than 500 years ago, with the efforts 
to separate divine causes from scientific and 
rational aspects.
IN BRAZIL, THE 
AVERAGE LIFE 
EXPECTANCYWENT 
FROM 53 YEARS IN 1950 
TO 76 YEARS IN 2018.
Celso Ienaga
Managing Partner at Dextron Consulting
102 4. HEALTH DISTORTIONS AND THE SUSTAINABILITY OF THE SECTOR
However, in the last 100 years, advances 
in medicine, which added to the population’s 
increasing access to education, basic sanitation, 
housing and food, have provided a considerable 
increase in the world population’s longevity. In 
the United States, the average life expectancy 
in 1915 was 54 years; today it is possible 
to see a considerable part of the American 
population over 100 years old.15 In Brazil, in the 
last 70 years, the average life expectancy of the 
population, which was 53 years old in 1950, 
jumped to over 76 years old in 2018, an increase 
of approximately 50% in life expectancy.16
The direct consequence of this change in the 
population profile is the need to rethink the focus 
of the current disease-based system to a health- 
-oriented system. It is a transformation that we 
could say that it is almost a general reset and 
reboot of the health operating system.
However, what is the main reason for such a 
change? The sustainability of the health system. 
Rising medical costs (above inflation) and 
constant investments in technological upgrading 
for the treatment of different diseases (new and 
old) added to the need to serve an increasingly 
larger population, more demanding of care and 
more longevous, show the inability to maintain 
and finance the current health model.
It is in this context of strong pressure for a 
change that the Value-Based HealthCare (VBHC) 
emerges, which proposes that the care and 
treatments offered by the health system, public 
or private, should be value-based and patient- 
-centered.
Introduced in 2006 by Michael Porter 
and Elizabeth Olmsted Teisberg, professors 
at Harvard Business School, in the book 
Redefining Healthcare,17 the model aims to 
present a response to the rising costs associated 
with healthcare, the structural inefficiency of 
healthcare and the low generation of patient 
benefits. In short, the concept of VBHC is based 
on a simple account: the value of health to 
the patient is related to the results (outcomes) 
achieved in his treatment and/or consultation 
(functional recovery and quality of care), divided 
by the total cost of the care cycle to generate 
these results.18
Despite the simple definition, the 
implementation of VBHC is highly complex, 
starting with the choice of the metric/indicator 
to be used to measure the outcomes (benefits), 
that is, the quality of the result of care, not 
the quantity of medical services provided. 
This choice is a key success factor, since the 
assessment of the value in health can generatelarge variations depending on the patient or 
health insurance company or hospital’s point of 
view, for example.19
15 SCHNEIDER, Tobias van. All of this happened in less than 100 years. Jan. 10, 2016. Available at: https://vanschneider.
medium.com/100-years-ago-12ca8935f25f#.eq9on7c1q. Access on: Mar. 21, 2021.
16 O MATERIAL jornalístico produzido pelo Estadão é protegido por lei. O Estado de S. Paulo, São Paulo, Dec.11, 2020. 
Available at: https://economia.estadao.com.br/noticias/geral,aumento-da-expectativa-de-vida-demanda-planejamentofinancei
ro,70003547391. Access on: Mar. 21, 2021.
17 PORTER, Michael; TEISBERG, Elisabeth O. Redefining health care: creating value-based competition on results. Boston: Harvard 
BusinessReview Press, 2006.
18 COVID-19 é catalisadora para expandir o Value-Based Healthcare (VBHC)? In Club, Oct. 14, 2020. Available at: http://www.inclublicita.com.br/
covid-19-e-catalisadora-para-expandir-o-value-based-healthcare-vbhc/. Access on: Mar. 21, 2021
19 SAÚDE baseada em valor foi tema de discussão entre especialistas, em congresso realizado em SP, pelo IBRAV’S. Capital Econômico, 
Jul. 1, 2020. Available at: https://revistacapitaleconomico.com.br/saude-baseada-em-valor-foi-tema-de-discussao-entre-especialistas-
emcongresso-realizado-em-sp-pelo-ibravs/. Access on: Mar. 21, 2021.
THE SUPPLY 
CYCLE OF 
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103
The change of the current fee-for-service 
model – in which payment is made according to 
the number of procedures performed, regardless 
of the quality of results and/or costs associated 
with these treatments – becomes even more 
necessary in the Brazilian context21, since:
healthcare inflation is persistently much 
higher than general price indexes. According to 
the Institutode Estudo de Saúde Suplementar, 
on average, the variation in medical and hospital 
costs is 3.4 times greater than the average of the 
Extended National Consumer Price Index (IPCA);
the cost of supplementary health care 
doubles in the 54 to 58 age group, that is, the 
older the population, the greater the expenses in 
the health sector;
Another major challenge for implementing 
VBHC is the remuneration model. Unlike 
other initiatives to modify the system, such 
as evidence-based medicine, new medical 
procedures and protocols, quality health 
programs, co-participation and co-management 
models etc., the VBHC proposes to implement a 
new remuneration system, in which the priority is 
the constant search for improving the quality of 
patient care, simultaneously with an optimization 
of the costs for providing this service20. In other 
words, the adoption of a remuneration model 
based on the value of health.
the waste of the current remuneration 
model, quantified through unnecessary exams 
and hospitalizations, use of extra material, 
adoption of more costly treatments, which could 
be avoided, is estimated at around R$ 32 billion.
According to Instituto Coalizão Saúde, there 
are five value-based payment models: Fee-for-
Service (FFS), Fee-for-Service with performance 
bonus (FFS+P4P), Bundle, Capitation and Global 
Budget. Although the Fee-for-Service model is 
the most adopted by most hospitals and health 
insurance companies in the country, it is already 
possible to observe an accelerated growth of the 
Bundle and Global Budget models, as Abraidi 
showed in the 3rd edition of the Yearbook22.
In terms of results, experiences in the United 
States and Europe, in adopting remuneration 
models based on the VBHC, have managed 
to save amounts exceeding billions of dollars 
or euros. Obviously, the challenge lies in 
implementing this new remuneration model. 
When analyzing best practices, it is possible to 
observe that some practices and priorities are 
key factors for success, such as transparency 
of information, prioritization of primary care, 
management of treatments risks and costs, 
integration with information systems, review of 
processes and the organizational model and 
especially the definition of metrics for outcome 
assessment.
20 MAKDISSE, Marcia. A transformação do cuidado baseada em valor. Medicina S/A, São Paulo, Marc. 3, 2020. Available at: https://medicinasa.
com.br/marciamakdisse-valor/. Access on: Mar. 21, 2021.
21 LINS, Julia. Mudança nos modelos de remuneração médica: qual o impacto? DOC, Oct. 27, 2020. Available at: https://www.universodoc.
com.br/2020/10/27/mudancas-nos-modelos-de-remuneracao-medica-qual-o-impacto/. Access on: Mar. 21, 2021.
22 ABRAIDI. O ciclo de fornecimento de produtos para saúde no Brasil. 3. ed. São Paulo, 2019. Available at: https://www.abraidi.com.br/files/pub/
Anuario_ABRAIDI_2020_PT.pdf. Access on: Mar. 21, 2021.
104 4. HEALTH DISTORTIONS AND THE SUSTAINABILITY OF THE SECTOR
In the specific case of metrics for evaluating 
outcomes, in 2017 the Organization for Economic 
Cooperation and Development (OECD) launched 
at the request of the ministries of health member 
countries a benchmarking study of the outcomes 
that matter most to patients in the different health 
systems in force in their countries. The result of 
the study “Implementing value-based health care 
in Europe – Handbook for pioneers”, conducted 
by the European Institute of Innovation and 
Technology (EIT) Health, was published at the end 
of 2020. Obviously, given the diversity of health 
reality associated with the cultural and social 
aspects of the various countries participating in 
the study, it was not possible to identify a “one- 
-size-fits-all solution” to measure the outcomes.
On the other hand, the study showed that 
health service providers, when implementing the 
VBHC, by taking similar steps and facing similar 
challenges, converge on similar solutions. These 
standardized steps in the VBHC implementation 
resulted in a matrix composed of five critical 
dimensions (Figure 11), a saber:
REGISTRATION: measuring processes 
and outcomes through a scorecard and data 
platform.
COMPARISON: comparison of internal 
and external reports from benchmarking teams.
REMUNERATION: investment and 
creation of incentives based on outcomes.
IMPROVEMENT: organization of 
improvements in the care cycle through 
collective learning.
PARTNERSHIP: aligning internal efforts 
and establishing collaboration with external 
partners.
THE CHALLENGE 
LIES IN THE 
IMPLEMENTATION 
OF THESE NEW 
REMUNERATION 
MODELS.
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105
The final summary of the study, especially taking as reference the 
different real and practical cases mapped out, was that the Patient-Reported 
Outcome Measures (PROMs), that is, the patient-reported outcomes, are 
clearly the basis of the migration, the transformation to the VBHC, as they 
align teams of professionals with what patients consider to be important and 
mobilize internal forces to implement the necessary changes.
According to the study, patient-reported outcomes have the potential to 
introduce a universal language in which stakeholders, interested parties, can 
share and evaluate success in healthcare. PROMs are powerful because 
they use risk-adjusted instruments and turn qualitative symptoms (e.g., 
“how I feel”) into a numerical score (e.g., “how much you feel”), thus allowing 
health-oriented initiatives to be evaluated and improved.
VBHC Implementation Matrix (EIT Health)23
FIGURE 11
23 EIT HEALTH launches guidance on Value-Based Health Care. May 26, 2020. Available at: https://eithealth.eu/news-article/eit-
healthlaunches-guidance-on-value-based-health-care/. Access on: Mar. 21, 2020.
Identifies a patient group
CONDITION1.
Enables data capture, 
interface interactions, 
data analytics and 
access to data
DATA PLATAFORM4.
Defines processes, 
costs and outcome 
indicators while applying 
case-mix adjustment
SCORECARD3.
Consists of mobilizing 
a core team, involving 
patients and making 
board support visible
INTERNAL FORCES2.
Refers to partnering 
with insurers and 
heath authorities
EXTERNAL 
COLLABORATIONS9.
Relies on improvementcycles, training programmes 
and research projects
LEARNING
COMMUNUITY8.
Create outcome-based 
payments and behavioural
encouragements
INCENTIVES7.
Involve human and financial 
resources mobilized for 
implementation
INVESTMENTS6.
Provide transparent 
outcome comparisons 
across providers
BENCHMARKS5.
106 4. HEALTH DISTORTIONS AND THE SUSTAINABILITY OF THE SECTOR
On the other hand, it is interesting to note 
throughout the study that the VBHC is not per se 
the solution to all health-related problems of the 
population, nor the guarantee of greater longevity, 
improvement in quality of life and maintenance of 
individual’s ability to contribute economically to 
the sustainability of the health system. For this, it 
is essential that, in the medium and long term, the 
main players and agents of the health ecosystem 
can realign their interests, roles and positionings 
of the different stakeholders, interested parties 
(that is, government, private initiative, regulatory 
agents, entities of class, academia etc.).
Analyzing the main lessons learned and the 
best practices when adopting the VBHC model, 
either in the context of a hospital or a national 
health system (as in the case of the Netherlands, 
in Europe), it is possible to observe that VBHC- 
-oriented transformation becomes a reality and 
a part of the medical routine, especially when 
four basic principles are adopted by everyone 
involved in the implementation process, 
namely: Equity, Transparency, Accountability 
and Social Responsibility. Interestingly, these 
basic principles are the same four Principles of 
Corporate Governance24, adopted by several 
public and private organizations and entities as 
they look for sustainability and longevity of their 
organizations.
Obviously, the search for sustainability of 
the health system is a great challenge, given 
24 h'ttps://www.ibgc.org.br/blog/principios-de-governanca-corporativa.
25 https://www.anahp.com.br/noticias/noticias-anahp/grupos-de-trabalho-da-anahp-convidam-advisory-board-para-discutir-os-caminhosda-
saude-baseada-em-valor/
the number and diversity of agents and players 
involved, as well as the high complexity of the 
relationships among the parties. However, the 
adoption of the basic governance principles and 
the best practices proposed by the VBHC by 
each of the main health stakeholders, interested 
parties, can be the first step towards solving 
structural problems such as dysfunctional 
incentives25 (such as: bonuses based on a 
greater consumption of unnecessary tests etc.), 
which limit and make access to quality healthcare 
for the population more and more expensive.
THE SUPPLY 
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107
THE SEARCH FOR SUSTAINABILITY 
OF THE HEALTH SYSTEM IS A GREAT 
CHALLENGE, GIVEN THE NUMBER AND 
DIVERSITY OF AGENTS AND PLAYERS 
INVOLVED, AS WELL AS THE HIGH 
COMPLEXITY OF THE RELATIONS AMONG 
THE PARTIES.
O CICLO DE 
FORNECIMENTO 
DE PRODUTOS 
PARA SAÚDE 
NO BRASIL
108 4. HEALTH DISTORTIONS AND THE SUSTAINABILITY OF THE SECTOR
In this edition, with data from 2020, the “open 
account”, which is based on the remuneration of the 
paying agent on the product provided or on the service 
rendered, that is, fee-for-service model is used by 
67% of members’ customer who responded the 
survey. In this format, payment privileges the number of 
procedures performed and products used, regardless of 
the quality of the results for the patient.
The “surgery-restricted package”, also known as 
a bundle – which adopts the expected cost per episode 
as the payment basis –, or the package that includes 
products and services related only to surgery is used 
by 44.9% of members’ customers, which maintains 
the market concentration trend in these two models.26
Payment Models and 
Healthcare Product 
Suppliers
A SURVEY CONDUCTED AMONG THE HEALTH 
PRODUCT SUPPLY COMPANIES ASSOCIATED WITH 
ABRAIDIREVEALS THAT TRADITIONAL PAYMENT 
MODELS STILL PREDOMINATE IN THE MEDICAL 
DEVICES SECTOR. IN THE 3RD EDITION OF THE 
YEARBOOK, LAUNCHED IN 2020 WITH DATA FROM 
2019, THE RESPONSES POINTED OUT THAT 51.4% 
OF MEMBERS’ CUSTOMERS USED FEE-FOR-SERVICE 
MODEL, WHILE 44.1% WORKED WITH BUNDLE OR 
CLOSED PACKAGE MODEL.
26 The sum of the amounts exceeds 100% because a hospital or a health insurance company can work with more than one payment model.
67% OF MEMBERS 
HOSPITALS AND 
HEALTH INSURANCE 
COMPANIES 
CUSTOMERS USE FEE- 
-FOR-SERVICE MODEL.
THE SUPPLY 
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Payment Models Used by Hospitals and Health Insurance Companies that Are 
Clients of ABRAIDI Members1
In % – 2020
TABELA 03
Source: ABRAIDI Survey.
8.3Open account with performance bonus
39.1Treatment package (Surgery + Post)
Open account 67
44.9Surgery-restricted package
32.6Other forms of remuneration
%MODEL
1 For this question, a sample of 41 members was used.
110 4. HEALTH DISTORTIONS AND THE SUSTAINABILITY OF THE SECTOR
The practice known as “revenue retention” 
by health insurance companies, health plans 
and hospitals occur when, after performing a 
previously authorized surgical procedure and 
the use of products and materials necessary 
for the procedure, both the health insurance 
company and the hospital do not authorize 
the revenue, under penalty of retaliation, 
postponing payment of materials.
Revenue Retention
Revenue of Abraidi Members Retained by Paying Source1
In R$ million – 2017-2020
CHART 23
HEALTH PLANS 
AND INSURANCE 
COMPANIES
PUBLIC HOSPITALS
(SUS)
PRIVATE HOSPITALS
331
94.8 113.8
177 162.6 148.9
204
42.4
237.7
392
111
290.4
2017 20192018 2020
Source: ABRAIDI Members Survey.
1 Estimated calculation based on the ABRAIDI Members Survey sample.
TOTAL (2020): R$ 793,4 MILLION
The covid-19 pandemic had major and 
profound repercussions on the operation and 
revenues of medical devices suppliers. In 
addition to the logistical, foreign exchange and 
tax problems already addressed throughout 
this Yearbook, which raised costs and left little 
margin for transfers, the industry’s historical 
Distortions in Health
distortions have accentuated the business 
relationship with the main customers, the health 
insurance companies and public and private 
hospitals. Revenue retention by payers exploded 
in 2020 and payment terms became longer, 
impacting the companies’ cash flow, as we will 
see below.
In 2020, Abraidi members pointed out that 
the estimated total value of retained or blocked 
revenue reached R$ 793.4 million – an 
increase of 63.8% compared to 2019. The 
significant increase in this percentage occurred 
after two years (2018 and 2019), in which the 
impact of the practice had remained stable, 
around R$ 485 million.
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One hypothesis is that the suspension and 
postponement of elective surgeries in public and 
private hospitals, added to the uncertainty regarding the 
evolution and development of covid-19, have led health 
plans to take precautions and protect their cash flow, 
retaining the revenue of suppliers. In the case of public 
hospitals – a segment in which the index has also risen, 
even though they have received a significant contribution 
of resources from the federal and state governments– it 
is possible that the resources were directed primarily to 
the care of patients with covid-19.
In 2020, suppliers also had to cope with the 
extension of the deadline for issuing the invoice. 
In this regard, the average time identified in the sector 
for issuing the invoice after the surgery was 45 days, 
ranging from 35 to 52 days. In 2019, the indicator was 
36 days.
Average Number of Days1 Until the Invoice Is Issued by ABRAIDI Members by 
Paying Source
Comparison in days – 2017-2020
CHART 24
HEALTH PLANS 
AND INSURANCE 
COMPANIES
PUBLIC HOSPITALS 
(SUS)
PRIVATE HOSPITALS
68
62
5453
29
45
40
52
35
34
35
48
2017 20192018 2020
Source: Abraidi Members Survey.
1 Estimated calculation based onthe Abraidi Members Survey sample.
112 4. HEALTH DISTORTIONS AND THE SUSTAINABILITY OF THE SECTOR
On the other hand, the average time for effecting payment after issuing 
the invoice decreased to 73 days, ranging from 67 to 77 days. In 2019, the 
average was 85 days.
The most significant reduction in payment terms occurred in public 
hospitals. Although they worked with significant revenue retention, they 
were more agile in making payment after the invoice was issued. A possible 
explanation for this may have been the need to make purchases for quick 
and permanent replacement of supplies and materials, due to the explosion 
ofcovid-19 cases and the need to maintain care for other diseases.
Average Number of Days1 Between Invoice Issuance and Payment – Abraidi 
Members by Paying Source
Comparison in days – 2017-2020
CHART 25
HEALTH PLANS 
AND INSURANCE 
COMPANIES
PUBLIC HOSPITALS 
(SUS)
PRIVATE HOSPITALS 
92 91
83
62
67
81
65 67
107
82
77 75
2017 20192018 2020
Source: ABRAIDI Members Survey.
1 Calendar days.
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Figure 12 depicts the average time that elapsed 
in 2020 between the supplier issuing the invoice after 
the surgery and the actual payment, in most cases, 
previously authorized. The average time was 118 
days, or 3 months and 28 days. There was little 
variation compared to 2019 (average of 121 days), but a 
significant growth compared to 2018 (112 days).
The delay of almost four months to receive 
payment leaves the supplier in a situation of great 
vulnerability, as this period compromises his financial 
capacity and cash flow, in addition to raising the financial 
cost of the operation, which burdens the health system.
Source: ABRAIDI Members Survey.
1 Average number of calendar days among paying sources (estimate by the Abraidi Members Survey).
2 Average number of calendar days among paying sources (estimate by the Abraidi Members Survey).
Average time between invoice issuance 
and receipt from ABRAIDI members – 2020
FIGURE 12
DAYS2
DAYS118 DAYS28MONTHS3= +
73
INCOME 
AUTHORIZATIONSURGERY PAYMENT
DAYS1
45
APPROVAL FOR THE 
PROCEDURE
114 4. HEALTH DISTORTIONS AND THE SUSTAINABILITY OF THE SECTOR
Disallowances occur when the health insurance company or 
plan refuses to pay for some products, materials or equipment 
used in surgery previously authorized by them (in some cases, 
the entire hospital bill may be disallowed). This may happen due 
to bureaucratic, third-party or unjustifiable issues.
Unjustified disallowances have been an important and 
frequent distortion, causing great losses to suppliers. In 2020, 
89% of members reported suffering from disallowances, which 
amounted to R$118.6 million. Although the number of members 
claiming to suffer from disallowances has increased by 3%, the 
total amount disallowed was approximately 26% lower than in 
2019 (R$ 160.6 million).
Disallowances
Disallowance Practice by Health Insurance Plans
In % of members – 2020
CHART 26
NOYES
11%89%
Source: Abraidi Members Survey.
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The reduction in disallowances is a factor that is related 
to the covid-19 pandemic and to one of its striking effects: 
cancellation, suspension or postponement of surgeries and 
elective procedures.
The data also reflects the reduction in the number of 
emergency surgeries – such as trauma surgeries, caused by 
traffic accidents, for example –, one of the effects of quarantine 
and people staying at home.
The fear of contracting the virus has also kept patients 
away from hospitals, even in the most acute cases of illness.
Regarding the volume of disallowances to be received 
by suppliers 64% are attributed to health insurance plans, 
while 36% are related to hospitals.
Total Volume of Disallowances from Abraidi Members
In R$ million – Comparison 2017-2020
CHART 27
2017 2018 2019 2020
100.8
127.2
160.6
118.6
Source: ABRAIDI Members Survey.
116 4. HEALTH DISTORTIONS AND THE SUSTAINABILITY OF THE SECTOR
Another distortion that affects suppliers is default. It occurs 
when the supplier is not remunerated after 180 days from 
the surgical procedure. Default should also be considered the 
amounts “lost” due to the bankruptcy of the service provider or 
the paying source and even intentional default.
According to the Abraidi survey, 94% of members recorded 
losses with default or deadbeat by hospitals, health insurance 
companies or public agencies in 2020, totaling an amount of 
R$ 714 million in funds to be received or lost.
Defaults
Losses with Default by Hospitals, Health Insurance Companies 
and Public Agencies
In % of members
CHART 28
NOYES
6%94%
Source: ABRAIDI Members Survey.
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117
The default recorded in 2020 was about 10% 
lower than in 2019 (R$ 789 million). Nevertheless, 
the high amount contributed to leave the supplier 
in a vulnerable situation and without a cash 
flow. It is another factor that adds to the fact 
that elective surgeries have been suspended 
in both the public and private sectors, forcing 
the supplier to collect amounts not yet received 
to maintain liquidity and, consequently, the 
company’s operation.
Default Volume – Resources Receivable 
for More than 180 Days or Lost – ABRAIDI Members
In R$ million – Comparison 2017-2020
CHART 29
2017 2018 2019 2020
692,2
554,8
789
714
Source: ABRAIDI Member Survey.
118 4. HEALTH DISTORTIONS AND THE SUSTAINABILITY OF THE SECTOR
The financial discount is characterized as the 
unilateral practice of hospitals to demand or 
impose on suppliers the granting of discounts 
as an essential condition for the supply of 
products, materials and equipment.
Although the financial discount is a legal and 
valid practice, it becomes abusive when there is 
a requirement that the discount is applied by 
the supplier only in the bank payment slip, 
and not in the invoice, which formalizes and 
monitors the sales transaction, characterizing 
an illegal operation. When this happens, 
hospitals tend to charge health insurance 
Financial Discount
Hospital Discounting Practice/Financial
In % of members – 2020
CHART 30
NOYES
36%64%
Source: ABRAIDI Members Survey.
companies for the full amount of the invoice, 
profiting “on both ends”, that is, in relation to the 
supplier and the health insurance company.
Abraidi has reinforced the guidance given 
to members regarding the financial discount, 
recommending them to observe the guidelines 
contained in the Abraidi Code of Ethics and 
Conduct, as well as the Normative Instructions of 
Instituto Ética Saúde.
THE SUPPLY 
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IN BRAZIL
119
In 2020, 64% of members who respond the survey 
pointed out the occurrence of the practice of hospital 
discounts in their region of operation. There was a 
significant drop in the rate compared to 2019, when 
83% of participants reported the problem.
The result can be attributed to a greater awareness of 
suppliers about the illegality of this practice by hospitals, 
the risks for companies, as well as the importance of 
formalizing business relationships through contracts, 
for example. At these points, Abraidi has been actively 
working to bring information and awareness to its 
members.
The fact that 75% of suppliers report retaliation 
for denying the financial discount is a clear record that 
this abusive practice remains at extremely high levels in 
the device market. In 2019, the percentage was 73%, 
revealing that little has changed on this topic.
Retaliation by Denying the Granting of a Hospital Discount
In % of members - 2020
CHART 31
NOYES
25%75%
Source: ABRAIDI Members Survey.
120 4. HEALTH DISTORTIONS AND THE SUSTAINABILITY OF THE SECTOR
ADDITIONAL SERVICES 
INCLUDE EVERYTHING FROM 
THE SUPPLY OF INSTRUMENTAL 
KITS, EQUIPMENT AND EVEN 
PROFESSIONAL PROVISION.
THE SUPPLY 
CYCLE OF 
HEALTHCARE 
PRODUCTS
IN BRAZIL
121
One of thebiggest distortions in the medical 
devices market is the provision of a series of 
added services by suppliers that are not related 
to the logistics of importing and distributing 
healthcare products and for which they are not 
remunerated.
Additional services include everything from 
the supply of essential items for performing 
surgeries – such as instrument kits – to providing 
professionals who work as assistants in these 
procedures, such as surgical technician and 
perfusionists.
It is an atypical situation that has no parallel 
with the performance of suppliers in any other 
country, in which these items, services and 
professionals are, in general, part of the hospitals’ 
assets. See below some examples of additional 
materials and services under the responsibility of 
the suppliers:
• Supply of surgical tables and patient 
monitoring equipment, on a loan basis.
 Supply of equipment such as 
orthopedic saws and drills, cardiopulmonary 
bypass, electric scalpels, towers for video 
surgeries, on a loan or non-release basis.
Provision of Added 
Services
 Programming of valves and other 
equipment, as well as technical support and 
maintenance in certain cases.
Making this equipment and materials 
available implies high investments by suppliers, 
with long amortization periods and without the 
counterpart of incorporating these costs into the 
prices of products and procedures.
In addition to configuring a major distortion 
of the Brazilian health system, this situation is 
another problem that adds to those already 
mentioned above, such as the revenue retention 
and long payment periods, directly affecting the 
performance of companies.
122 4. HEALTH DISTORTIONS AND THE SUSTAINABILITY OF THE SECTOR
The distortions that occur in the medical 
devices sector and the proportions with which 
they occur, as measured by the survey, impose 
a series of additional costs on the suppliers’ 
operation that end up reverberating throughout 
the entire health chain.
Cost of Distortions
Percentage of Suppliers’ Operating Costs Arising from Distortions in the Healthcare 
Products Industry
In % of average annual operating cost - 2020
CHART 32
DEFAULT
VALIDITY LOSSES
REVENUE RETENTION
LOSSES DUE TO PRODUCT WASTE 
OR DAMAGE TO EQUIPMENT AND 
INSTRUMENTS
UNPAID SERVICES – SURGICAL 
TECHNICIANS, EQUIPMENT, 
INSTRUMENTS AND OTHERS
FINANCIAL DISCOUNT OR 
OTHER UNDUE FEES
DISALLOWANCES
These are abusive practices that drain 
resources from the health system and directly 
harm patients. In addition, they create an 
unethical, unfair and unequal remuneration 
mechanism among the parties in business 
relations.
12
12
8
8
9
7
8
Source: ABRAIDI Members Survey.
THE SUPPLY 
CYCLE OF 
HEALTHCARE 
PRODUCTS
IN BRAZIL
123
The survey reveals that distortions are responsible 
for 64% of healthcare products suppliers’ 
operating costs. In the period between 2019 and 
2020, the percentage increased by 14%.
The services provided by suppliers to hospitals, but 
not paid – such as hiring surgical technician and other 
health professionals, or even the lending of equipment 
and instruments, which should also be under the 
responsibility of these establishments– weighed in 
calculation. This irregularity accounted for 12% of 
operating costs.
The same impact, also at the 12% level, can 
be credited to the revenue retention suffered by the 
companies. These are parameters that increased 
compared to 2019 and that are added to the increase in 
costs generated by default, disallowances and financial 
discounts, producing a perverse and harmful account 
for the health system and patients.
DISTORTIONS ARE 
RESPONSIBLE FOR 
64% OF SUPPLIERS’ 
OPERATING COSTS.
THE SUPPLY CYCLE OF HEALTHCARE PRODUCTS IN BRAZIL0124
It was a year of difficulties, of factors that 
impacted companies’ cash flow and that 
penalized especially small and medium- 
-sized companies. The cancellation, 
suspension or postponement of elective 
surgeries was, without a doubt, a key factor in 
this scenario. More than 1 million surgeries 
were no longer performed in SUS alone – a 
reduction of more than 25%.
Other factors are the rising dollar and the 
decision of the government of the state of 
São Paulo to raise from 0% to 18%, in the 
middle of the pandemic, the ICMS tax on 
sales to private hospitals and health insurance 
companies of about 200 healthcare products, 
many of them essentials.
The blockades and lockdowns decreed by 
the governments of several countries made 
imports more difficult and expensive and 
reduced exports. In the national market, the 
increase in freight costs was another factor to 
pressure companies’ operations.
The need for all players to guarantee revenue 
and preserve cash amidst uncertainties has 
reinforced historical distortions and abusive 
business practices in the sector. The revenue 
retention rate grew 64% in the year and the 
average payment term for services rendered 
remained at the high level of four months.
All these factors were added to an 
outdated SUS payment schedule, which has 
not been readjusted for more than 20 years. 
In a moment like the present and with the market 
conjuncture factors mentioned above, SUS runs 
a serious risk of collapsing in healthcare and lack 
of supply of healthcare products in the medium 
term.
Unfortunately, as in all sectors of the economy, 
these factors have also forced medical devices 
suppliers to reduce labor contracts and 
dismiss.
CONCLUSION
THE PANDEMIC AND THE SET OF CHALLENGES AND 
UNCERTAINTIES THAT CAME IN ITS MATTER AND 
DOMINATED ALMOST THE ENTIRE YEAR OF 2020 BROUGHT 
OUT THE BEST AND WORST IN HEALTHCARE, ESPECIALLY 
IN THE MEDICAL DEVICES, THE FOCUS OF THIS 
YEARBOOK.
THE SUPPLY 
CYCLE OF 
HEALTHCARE 
PRODUCTS
IN BRAZIL
125
On the other hand, given the need to 
reduce costs, members also looked for other 
solutions, as the covid-19 survey pointed out. 
The participants reported that the pandemic 
forced them to look for innovative and more 
effective ways of management. It was also 
necessary to adopt other business models, 
review contracts, look for new customers and 
diversify the portfolio of products sold – changes 
that are here to stay.
Abraidi, in turn, continued defending 
the sustainability of the sector and taking 
its claims to all levels of government 
and powers. The webinars and the regional 
meetings, that were necessarily virtual, have 
increased the capillarity of information and the 
permanent service also to members from distant 
regions. Materials and training courses were 
also made available on the network, benefiting a 
MOST PEOPLE BET 
THAT BY 2022 MORE 
POSITIVE WINDS WILL 
BLOW.
greater number of companies.
About compliance, in addition to important 
participation in the meetings of the Inter-American 
Coalition for Ethics in the Medical Devices 
Sector, Abraidi promoted a virtual International 
Seminar and held the launch of the 4th edition 
of the entity’s Code of Ethics and Conduct with 
several advances.
The future is still uncertain, as well as 
the course of the economy, even after the 
immunization of a large portion of the population, 
which should occur more rapidly in the second 
half of 2021. However, the entrepreneurs who 
participated in the survey are optimistic. Many 
of them believe that changes will occur later this 
year and most of them bet that by 2022 more 
positive winds will blow.
ABRAIDI MEMBER COMPANIES126
ACRE
PSC DE HOLANDA
ALAGOAS
ALL MEDIC COMÉRCIO DE MATERIAIS MÉDICOS EIRELI
FIX BRASIL LTDA.
IMPLAMEDICAL ALAGOAS COM. DE PRODUTOS MÉDICOS LTDA.
AMAPÁ
MEDICON IMPORTAÇÃO
AMAZONAS
HW COMÉRCIO DE PRODUTOS HOSPITALARES LTDA.
LIDERA COMÉRCIO DE ARTIGOS MÉDICOS LTDA. – EPP
SAGA MEDICAL
BAHIA
CORAMED COMÉRCIO DE ARTIGOS MÉDICOS LTDA.
IMPLANTES MÉDICOS BAHIA COM. DE PRODS. MÉD. HOSP. LTDA.
JDR COMÉRCIO PRODUTOS CIRÚRGICOS LTDA.
JOINTMED COM. DE MAT. CIR. HOSP. E ORT. LTDA.
MARIN MEDICAL
MEDICICOR COMERCIAL EIRELI
ORTHEK COMÉRCIO E IMPORTAÇÃO DE PRODUTOS HOSPITALARESLTDA.
SAFEMEDIC PRODUTOS MÉDICOS HOSPITALARES LTDA.
SYNTECH COMÉRCIO IMPORTAÇÃO EXPORTAÇÃO LTDA.
CEARÁ
AGF MEDICAL LTDA.
MEDTRAUMA COMÉRCIO E IMPORTAÇÃO DE ORTOPEDIA LTDA. – ME
NEW CARDIO MEDICAL COMÉRCIO PRODUTOS MÉDICOS LTDA. – ME
ORTOGÊNESE COM. IMP. MAT. MÉD. CIRÚRGICOS LTDA.
DISTRITO FEDERAL
BRASMÉDICA HOSPITALAR E ORTOPÉDICA LTDA.
CARDIOMED IMPORTAÇÃO E DIST. DE PROD. PARA SAÚDE EIRELI – ME
FOUR MED IMPORTAÇÃO DE PROD. MÉDICOS HOSPITALARES EIRELI
FUSÃO SOLUÇÕES PARA MEDICINA LTDA.
INOMEDI COMÉRCIO DE MATERIAL HOSPITALAR LTDA.
LEADS MEDICAL COMÉRCIO DE MATERIAIS HOSPITALARES LTDA.
MEDICATO PRODUTOS PARA SAÚDE LTDA.
TRAUMA SURGICAL PRODUTOS MÉDICOS HOSP. LTDA.
UNIÃO MÉDICA COM. PRODS. HOSPITALARES LTDA.
UNIMEK COM. DE MAT. MÉD. HOSP. LTDA.
VIVA COMÉRCIO E IMPORTAÇÃO LTDA.
Rio Branco
Maceió
Maceió
Maceió
Macapá
Manaus
Manaus
Manaus
Salvador
Salvador
Salvador
Salvador
Salvador
Salvador
Salvador
Salvador
Salvador
Fortaleza
Fortaleza
Fortaleza
Fortaleza
Brasília
Brasília
Brasília
Brasília
Brasília
Brasília
Brasília
Brasília
Brasília
Brasília
Brasília
ABRAIDI MEMBER 
COMPANIES
THE SUPPLY 
CYCLE OF 
HEALTHCARE 
PRODUCTS
IN BRAZIL
127
ESPÍRITO SANTO
BONE SURGERY COM. DIST. LTDA.
COMERCIAL COSTA GOMES LTDA.
EMILCARDIO PRODUTOS HOSPITALARES EIRELI
MEDICAL SUTURE COM. LTDA.
MULTIVISION COMÉRCIO DE MATERIAL HOSP. EIRELI
ORTHOHEAD INSTR. E IMPL. CIRÚRGICOS LTDA.
PH COMÉRCIO DE PRODUTOS HOSPITALARES LTDA.
UL QUÍMICA E CIENTÍFICA LTDA.
VITÓRIA HOSPITALAR LTDA.
GOIÁS
CMS PRODUTOS MÉDICOS LTDA.
GYNMED DIST. IMP. E EXP. DE PRODUTOS HOSPITALARES LTDA
CENTRAL HOSPITALAR
SCITECH PRODUTOS MÉDICOS S.A.
SÍNTESE COMERCIAL HOSPITALAR LTDA.
MARANHÃO
LIMINE PRODUTOS MÉDICOS LTDA
MEDFIX ORTOPÉDICA LTDA.
TG COMÉRCIO E IMPORTAÇÕES DE MATERIAL MÉDICO LTDA. – ME
MATO GROSSO
FAST MEDICAL COMÉRCIO HOSPITALAR LTDA. – EPP
QUALITY COMERCIAL DE PROD. MÉD. HOSP. LTDA.
TITANIUN COMÉRCIO DE MAT. MÉD. HOSPITALARES LTDA.
MATO GROSSO DO SUL
NOREM PRODUTOS MÉDICOS E HOSPITALARES LTDA. – ME
MINAS GERAIS
AMGS – COMÉRCIO E REPRESENTAÇÕES LTDA.
BIOMEDICAL PROD. CIENT. MÉD. E HOSPITALARES LTDA.
COMÉRCIO E DISTRIBUIÇÃO ALLBORG MED. LTDA.
ENDOLATINA COMÉRCIO E REPRESENTAÇÕES LTDA.
EVOLUTION BRASIL LTDA.
GJO COMÉRCIO E REPRESENTAÇÕES LTDA.
H MEDICAL IMPORTAÇÃO E COMÉRCIO LTDA.
IMPLANTEC – COMÉRCIO E ASSISTÊNCIA TÉCNICA LTDA. – ME
JYAS COMÉRCIO MATERIAIS CIRÚRG. HOSPITALARES LTDA.
MARJA COM. REP. IMP. DE PROD. P/ SAÚDE LTDA.
MEDIODONTOMINAS COMÉRCIO LTDA.
MKS COMÉRCIO E REPRESENTAÇÃO DE PRODUTOS MÉDICOS, HOSPITALAR
ORTONEURO PRODUTOS CIRÚRGICOS E HOSPITALARES LTDA. – EPP
ORTONEURO PRODUTOS CIRURGICOS E HOSPITALARES LTDA. – EPP
TRAUMINAS DIST. MAT. CIRÚRGICOS HOSPITALARES S.A.
Vitória
Cariacica
Vitória
Vitória
Vitória
Serra
Serra
Vitória
Vitória
Aparecida de Goiânia
Aparecida de Goiânia
Rialma
Aparecida de Goiânia
Goiânia
São Luís
São Luís
São Luís
Cuiabá
Cuiabá
Cuiabá
Campo Grande
Belo Horizonte
Belo Horizonte
Barbacena
Belo Horizonte
Belo Horizonte
Belo Horizonte
Belo Horizonte
Belo Horizonte
Belo Horizonte
Ubá
Montes Claros
Belo Horizonte
Governador Valadares
Governador Valadares
Belo Horizonte
ABRAIDI MEMBER COMPANIES128
PARÁ
ART MED COMÉRCIO LTDA. – ME
BIOSAÚDE PRODUTOS HOSPITALARES LTDA.
CTA CLÍNICA TRAUMA ARLES EIRELI – EPP
IMPLANTUS COMÉRCIO E REPRES. DE PRODUTOS HOSPITALARES LTDA.
LIDERA SURGICAL COMÉRCIO DE ARTIGOS MÉDICOS LTDA.
NORDICA DISTRIBUIDORA HOSPITALAR LTDA.
PARAÍBA
POTENGY COMÉRCIO E REPRESENTAÇÃO DE PRODUTOS HOSPITALARES LTDA.
PROMED MATERIAIS CIRÚRGICOS LTDA.
TOP IMPLANTES MATERIAIS CIRÚRGICOS LTDA.
PARANÁ
ANGIOMEDIC COM. DE MATERIAL MÉDICO HOSPITALAR EIRELI
ARTROFIX COMÉRCIO DE MATERIAIS CIRÚRGICOS LTDA.
FORMATHOS FORNECEDORA DE MATERIAL HOSPITALAR LTDA.
HYPERDINÂMICA REPRESENTAÇÕES COMERCIAIS LTDA.
INTERMEDICAL COMÉRCIO DE PRODUTOS MÉDICOS LTDA
INVASIVE IMP. E COM. DE PROD. MÉDICOS LTDA.
L&G MATERIAIS CIRÚRGICOS LTDA.
LUMINAL PRODUTOS MÉDICOS EIRELI
ORTHOFACE IMPLANTES ESPECIAIS LTDA.
ORTOESTE COM. PROD. MÉD. HOSPITALARES LTDA.
POLYMEDICAL IMP. E COM. DE PRODUTOS MÉDICOS LTDA.
PRÓ VASCULAR REPRESENTAÇÕES COMERCIAIS LTDA.
PROSPINE COMÉRCIO DE MATERIAIS CIRÚRGICOS LTDA.
PROSURG PRODUTOS MÉDICOS LTDA.
PROTECNO COMÉRCIO DE MATERIAIS HOSPITALARES LTDA.
TC TÉCNICA CIRÚRGICA COM. MAT. HOSP. ODONT. LTDA.
TECMEDIC COMÉRCIO DE PRODUTOS MÉDICOS LTDA.
TECNOMEDICAL PRODUTOS MÉDICOS LTDA.
VITTA MEDI PRODUTOS MÉDICOS LTDA
PERNAMBUCO
ADN SAÚDE COMÉRCIO DE PRODUTOS HOSPITALARES LTDA.
BRASIL ORTOPEDIA COM. IMP. PROD. CIRÚRG. HOSP. LTDA.
CROMUS MATERIAIS MEDICOS HOSPITALARES EIRELI – ME
GOLDMEDIC PRODUTOS MÉDICOS HOSPITALARES LTDA.
JL MATERIAL CIRÚRGICO LTDA.
NEUROFIX COM. DE MATERIAIS HOSPITALARES LTDA. – EPP
ORTHOMAX MEDICAL COM. IMPL. ORTOP. LTDA. – EPP
ORTHOSERV COMÉRCIO E SERVIÇOS LTDA. – ME
ORTOPLAN COMÉRCIO DE IMPLANTES ORTOPÉDICOS LTDA.
PE IMPLANTES COM. IMPL. ORTOPÉDICOS LTDA.
PROMEPE COMÉRCIO DE PRODUTOS MÉDICOS DE PERNAMBUCO LTDA.
CARDIO PRODUTOS MÉDICOS
REPRESENTA MATERIAIS CIRÚRGICOS MÉDICOS E HOSPITALARES LTDA.
SAFEMEDIC PRODUTOS MÉDICOS HOSPITALARES LTDA.
Ananindeua
Belém
Parauapebas
Belém
Belém
Belém
João Pessoa
João Pessoa
Campina Grande
Londrina
Londrina
Curitiba
Curitiba
Curitiba
Curitiba
Curitiba
Curitiba
Curitiba
Curitiba
Curitiba
Curitiba
Curitiba
Curitiba
Cascavel
Curitiba
Curitiba
Curitiba
Londrina
Recife
Recife
Camaragibe
Recife
Recife
Recife
Recife
Recife
Recife
Recife
Recife
Recife
Recife
Recife
THE SUPPLY 
CYCLE OF 
HEALTHCARE 
PRODUCTS
IN BRAZIL
129
PIAUÍ
BIOSÍNTESE COM. IMP. MAT. MÉD. HOSP. IMPL. LTDA.
RIO DE JANEIRO
AXISTE COMÉRCIO DE PRODUTOS MÉDICOS HOSPITALARES LTDA.
BIOCARDIO COMÉRCIO E REPRESENTAÇÕES LTDA.
CLASSY MED COMÉRCIO DE MATERIAL HOSPITALAR LTDA. – ME
CORTEX MED COM. DE PRODUTOS HOSP. LTDA
CROMO LIFE DIST. DE MATERIAIS HOSPITALARES LTDA.
DMO DISTRIBUIDORA MATERIAIS ORTOPÉDICOS LTDA
E. TAMUSSINO & CIA LTDA.
ECMAX COMÉRCIO DE MATERIAL HOSPITALAR LTDA. – ME
ENDO SUTURE COMÉRCIO E REPRESENTAÇÕES LTDA
FLEX LAB COMÉRCIO DE MATERIAIS CIRÚRGICOS E HOSP. EIRELI – EPP
GLOBUS MEDICAL BRASIL LTDA.
LABORATÓRIOS B. BRAUN S.A.
MAXCARE INSTRUMENTAL HOSPITALAR EIRELI
MEDICAL HEALTH COMÉRCIO, SERVIÇOS E IMPORTAÇÃO EIRELI
NUVASIVE BRASIL COMERCIAL LTDA
OPERANDI COMÉRCIO DE MATERIAL HOSPITALAR LTDA. 
ORTONENSE EQUIPAMENTOS HOSPITALARES LTDA. – RJ
ORTONEURO COMÉRCIO E IMPORT. MATERIAIS HOSPITALAR
PER PRIMA COMÉRCIO E REPRESENTAÇÕES LTDA.
PORTO SURGICAL COMÉRCIO DE MATERIAL HOSPITALAR LTDA.
REALCARE COM. E REPR. DE MAT. MÉDICO HOSP. LTDA.
RIO SURGICAL COMÉRCIO DE MATERIAL HOSPITALAR LTDA. 
RPM COMÉRCIO DE MATERIAL HOSPITALAR LTDA.
SINTEX MEDICAL IMPLANTES BIOMÉDICA COMERCIAL LTDA.
SÓLIDA HOSPITALAR
TECHNICARE INSTRUMENTAL CIRÚRGICO LTDA.
TECNEURO PRODUTOS CIENTÍFICOS E HOSPITALARES LTDA.
TELLUS RIO COMÉRCIO IMP. EXP. LTDA.
VERTICAL RIO
WM WORLD MEDICAL IMPORTAÇÃO E EXPORTAÇÃO LTDA.
ZEIKI MEDICAL PRODUTOS MÉDICOS LTDA.
RIO GRANDE DO NORTE
KOMPAZO SAÚDE DIST. DE PROD. E SERV. HOSPITALARES LTDA.
RIO GRANDE DO SUL
BOYNTON IMPORTAÇÃO E EXPORTAÇÃO LTDA.
CANADÁ CENTRAL DE NEGÓCIOS DO BRASIL LTDA.
DISCOMED COMÉRCIO PRODUTOS HOSPITALARES LTDA.
ENDOSUL COM. E REP. DE MAT. CIRÚRGICO LTDA.
GF MEDICAL IMPLANTES CIRÚRGICOS LTDA.
GF MEDIKA IMPORTAÇÃO E EXPORTAÇÃO LTDA.
IMPROTEC COMÉRCIO DE MATERIAL CIRÚRGICO LTDA.
INMED COMÉRCIO DE MATERIAIS HOSPITALARES LTDA.
INTELIMED COMÉRCIO E REPRESENTAÇÕES LTDA.
Teresina
Rio de Janeiro
Rio de Janeiro
Rio de Janeiro
Rio de Janeiro
Rio de Janeiro
Rio de Janeiro
Rio de Janeiro
Rio de Janeiro
Itaperuna
Rio de Janeiro
Niterói
São Gonçalo
Rio de Janeiro
Rio de Janeiro
Rio de Janeiro
Niterói 
Volta Redonda
Rio de Janeiro
Rio de Janeiro
Rio de Janeiro
Rio de Janeiro
Rio das Ostras 
Rio de Janeiro
Rio de Janeiro
Rio de Janeiro
Rio de Janeiro
Três Rios
Rio de Janeiro
Rio de Janeiro
Rio de Janeiro
Rio de Janeiro
Natal
Porto Alegre
Porto Alegre
Porto Alegre
Porto Alegre
Porto Alegre
Porto Alegre
Porto Alegre
Porto Alegre
Porto Alegre
ABRAIDI MEMBER COMPANIES130
Porto Alegre
Caxias do Sul
Porto Alegre
Porto Alegre
Porto Alegre
Porto Alegre
Caxias do SulPorto Alegre
Florianópolis
São José
Florianópolis
Garuva
São Paulo
Mogi Guaçu
São Paulo
Ribeirão Preto
São Paulo
São Paulo
Campinas
São Paulo
Rio Claro
São Paulo
São Paulo
São Bernardo do Campo
São Paulo
São Caetano do Sul
São Paulo
São Paulo
Itu
São José do Rio Preto
São José do Rio Preto
São Paulo
São Paulo
São Paulo
São Paulo
São Paulo
Ribeirão Preto
Fernandópolis
São Paulo
São Paulo
Santo André
São Paulo
São José dos Campos
OSTHEON COMÉRCIO IMP. E EXP. DE PRODS. HOSPITALARES LTDA.
PORTOMED CAXIAS COMÉRCIO DE PRODUTOS ORTOPÉDICOS LTDA.
PORTOMED COMÉRCIO E REP. DE MATERIAIS ORTOPÉDICOS LTDA.
PROGER COMÉRCIO, IMPORTAÇÃO E EXPORTAÇÃO LTDA.
PROSUL COM. E IMP. DE MATERIAIS MÉDICO CIRÚRGICOS LTDA.
PROTIL – PRÓTESE E INSTRUMENTAL LTDA.
SERRA NORTE IMPLANTES ORTOPÉDICOS LTDA.
ZAREK DISTRIBUIDORA DE MAT. CIRÚRG. E MEDICAMENTOS
SANTA CATARINA
BR MEDICAL LTDA.
CMO COMÉRCIO DE MATERIAIS ORTOPÉDICOS LTDA.
FENERGY COM. PROD. MÉD. HOSP. LTDA.
SELECTA MED DISTRIBUIDORA PRODUTOS MÉDICOS HOSPITALARES LTDA.
SÃO PAULO
3D MEDICAL IMPORTAÇÃO E COMÉRCIO DE PRODUTOS MÉDICOS E HOSPI.
A2 MEDICAL SUPLLY COMÉRCIO E REPRESENTAÇÃO LTDA. – ME
ACERTTA DISTRIBUIDORA HOSPITALAR LTDA.
ALFA COMÉRCIO DE PRODUTOS CIRÚRGICOS LTDA. – EPP
ALLENT COM. IMP. DIST. MAT. MÉD. LTDA
ALLERGAN PRODUTOS FARMACÊUTICOS LTDA. – EPP
ANGIOMEDICAL COMÉRCIO DE PRODUTOS MÉDICOS LTDA.
ARTHREX DO BRASIL IMP. COM. EQUIP. LTDA.
ARTROMED DISTRIBUIDORA DE PRODUTOS HOSPITALARES EIRELI – ME
BALT BRASIL PRODUTOS MÉDICOS LTDA.
BIOCATH COMÉRCIO DE PRODUTOS HOSPITALARES LTDA.
BIOIMPORTS COMÉRCIO IMPORTAÇÃO EXPORTAÇÃO DE PRODUTOS MÉDICOS
BIOMAX MEDICAL COMÉRCIO E REPRESENTAÇÕES LTDA.
BM9 COMÉRCIO DE MATERIAIS CIRÚRGICOS EIRELI
BONE SURGICAL EQUIPAMENTOS MEDICOS EIRELI
BOSTON SCIENTIFIC DO BRASIL LTDA.
BR HOMMED COM MAT. MÉDICOS LTDA.
BRAILE BIOMÉDICA INDÚSTRIA COMÉRCIO E REPRESENTAÇÕES LTDA.
BRUNO GARISTO JUNIOR – BRUMED IMPLANTES
CARL ZEISS DO BRASIL LTDA.
CICLO MED DO BRASIL LTDA.
CIENLABOR INDÚSTRIA E COMÉRCIO LTDA.
COMÉRCIO E IMPORTAÇÃO ERECTA LTDA.
CORTEXMEDICAL COMERCIAL DE PRODUTOS MÉDICOS LTDA.
CORTICAL COMÉRCIO DE PRODUTOS CIRÚRGICOS LTDA.
CRUZ ALTA PRÓ HOSPITALAR EIRELI
DABASONS IMPORTAÇÃO EXPORTAÇÃO E COMÉRCIO LTDA.
DENUO MEDIC IMPORT. E EXP. LTDA.
DMF MEDICAL MAT. MÉDICOS EIRELI – ME
DPA DISTR PAULISTA ARTIGOS MÉDICOS
DPM VALE COM. DE PRODS. CIRÚRGICOS LTDA. – EPP
THE SUPPLY 
CYCLE OF 
HEALTHCARE 
PRODUCTS
IN BRAZIL
131
EDWARDS LIFESCIENCES COM. PROD. MÉD. CIRÚRGICOS LTDA.
ENDOLOG LOGÍSTICA E ARMAZÉNS LTDA.
ENDOTEC PRODUTOS MÉDICOS LTDA.
FIXEN MED COMERCIAL E DISTRIBUIDORA DE PRODUTOS MÉDICOS LTDA.
FOCCUS MEDICAL EQUIPAMENTOS MÉDICOS EIRELI
GADALI MEDICAL COM. DE PRODUTOS MÉDICOS HOSPITALAR LTDA.
GADE IMP. E EXP. MAT. EQUIPS. HOSPS. LTDA.
GC DISTR. PROD. ORTOPÉDICOS LTDA.
GETMED – DISTRIBUIDORA MÉDICO HOSPITALAR LTDA.
GM DOS REIS INDÚSTRIA E COMÉRCIO LTDA.
GUSSON – EQUIPAMENTOS MÉDICOS HOSPITALARES LTDA.
HANDLE COMÉRCIO DE EQUIPAMENTOS MÉDICOS S.A.
HELCA IMP. EXP. COM. DE MAT. CIR. LTDA.
HEXAGON IND. COM. DE IMPLANTES ORTOPÉDICOS LTDA.
HMA PRODUTOS MÉDICOS LTDA. – ME
HMS IMP. E COM. DE PROD. MÉDICOS EIRELI
IMPLAMED IMPLANTES ESP. COM. IMP. EXP. LTDA.
INOMEDICAL COM. PROD. HOSPITALARES LTDA.
INOVASC DISTRIBUIDORA DE MATERIAL MÉDICO HOSPITALAR LTDA. – ME
INTEGRIT COM. DIST. IMP. E EXP. DE PROD. MÉD. HOSP. LTDA.
INTERMEDIC TECHNOLOGY IMPORTAÇÃO EXPORTAÇÃO LTDA.
INVASIVE SP MEDICAL DEVICES COM. DE PRODS. MÉDICOS LTDA.
IOL IMPLANTES LTDA.
IOMED ORTOPEDIA ESPECIALIZADA LTDA. – EPP
JOHNSON & JOHNSON DO BRASIL IND. E COM. PROD. SAÚDE LTDA.
JOTEC DO BRASIL IMP. E COM. EQUIPS. HOSP.
KAGIMED COMÉRCIO IMPORTAÇÃO E EXPORTAÇÃO LTDA.
LAS – LATIM AMERICAN SOLUTIONS IMP. E EXP. LTDA.
LDR BRASIL COM. IMP. EXP. PROD. MÉD. LTDA.
LG COMERCIAL LTDA.
LIFE SPINE IMPLANTES LTDA.
LIMA DO BRASIL LTDA.
LINK DISTRIBUIÇÃO DE PRODUTOS ORTOPÉDICOS DO BRASIL LTDA.
LIVANOVA BRASIL COM. E DIST. DE EQUIP. MÉD. HOSP. LTDA.
LIVE COM. DE PROD. CIRÚRGICOS MÉD. HOSP.LTDA.
M&LIMA COM. MAT. MÉD. LTDA. – ME
M.A.S IMPORTAÇÃO E DISTRIBUIÇÃO DE PRODUTOS MÉDICOS LTDA.
MAX CARE IMPORT. E DIST. DE PRODS. MÉDICOS HOSP. LTDA. – EPP
MAX SURGICAL COMÉRCIO DE IMPLANTES ORTOPÉDICOS LTDA.
MAXI MÉDICA ARTIGOS CIRÚRGICOS E HOSPITALARES LTDA.
MB OSTEOS – COM. IMP. MATERIAL MÉDICO LTDA.
MEDARTIS IMPORTAÇÃO E EXPORTAÇÃO LTDA.
MEDCORP HOSPITALAR LTDA.
MEDIC CALL COM. DE PROD. MÉDICOS E HOSPITALARES EIRELI
MEDIC SOLUTION PROD. MÉD. HOSPITALARES LTDA.
MEDICAL ORTOPEDIA COM. IMP. EXP. MAT. CIRÚR. LTDA.
MEDICAL PROVIDER COM. ATACADISTA DE MATS. MÉD. E HOSP. LTDA.
 São Paulo
Diadema
São Paulo
Barueri
São Paulo
Campinas
São Bernardo do Campo
Santo André
Bauru
Campinas
Fernandópolis
Ribeirão Preto
São Paulo
Itapira
São Caetano do Sul
São Bernardo do Campo
São Paulo
São Paulo
São José dos Campos
São Paulo
São Paulo
São Paulo
Diadema
São Paulo
Guarulhos
Valinhos
Valinhos
São Paulo
Santo André
Bonfim Paulista
São Paulo
São Paulo
São Paulo
São Paulo
São Paulo
São Paulo
São Bernardo do Campo
São Paulo
Rio Claro
São Paulo
São Paulo
São Paulo
São Paulo
São Bernardo do Campo
São Paulo
Valinhos
Campinas
ABRAIDI MEMBER COMPANIES132
MEDICAL SUPPORT MATERIAIS MÉDICOS E HOSPITALARES LTDA.
MEDTRONIC COMERCIAL LTDA.
MF MEDICAL COM. DE PRODTS. MÉDICOS E HOSPITALARES LTDA. – EPP
MICROMEDICAL IMPLANTES DO BRASIL LTDA.
MM MEDICAL PRODUTOS MÉDICOS E HOSPITALARES LTDA.
MP COMÉRCIO DE PRODUTOS MÉDICOS LTDA.
MR BIOMEDICA RIO PRETO LTDA.
MR ORTHOS COM. E IMP. DE PROD. HOSP. LTDA. – EPP
NACIONAL COML HOSPITALAR S.A.
NIVAA PRODUTOS MÉDICOS E HOSPITALARES LTDA.
NOVELTY COM. IMP. PROD. CIRÚRG. ORTOP. LTDA – EPP
OP ASSIS – ME
ORTHO STEEL DISTRIBUIDORA DE MATERIAL HOSP. LTDA.
ORTHO SYSTEM – COM. IMPORT. E EXPORT. DE IMPLANT. ORTOP. LTDA.
ORTHOFIX DO BRASIL LTDA.
ORTHOMAXX HOSPITALAR EIRELI
ORTHONEURO COM. IMP. EXP. PRODS. MÉDICOS LTDA.
ORTO’S COM. PROD. MED. HOSP. LTDA.
ORTOCIR ORTOPEDIA CIRURGIA LTDA.
ORTOMEDIC DISTRIBUIDORA DE PRODUTOS MÉDICOS LTDA.
ORTOSPINE COM. IMP. E EXP. DE MAT. HOSP. LTDA.
ORTOSYS COMÉRCIO DE MATERIAIS CIRÚRGICOS LTDA.
OSTEO COMPANY COMÉRCIO E DISTRIBUIÇÃO DE PRODUTOS CIRÚRGICOS
OSTEOLINK PRODUTOS MÉDICOS LTDA.
OSTEUM PRODUTOS MÉDICOS E HOSPITALARES LTDA. – ME
PAOLA PORTALEONI EIRELI – EPP
PRIME CIR IMP. EXP. COM. DE PROD. ORT. LTDA. – EPP
PRISMA MEDICAL LTDA.
PRONEC EQUIPAMENTOS CIRÚRGICOS LTDA. – ME
QUALIMEDIC MATERIAIS CIRÚRGICOS LTDA.
RCL IMP. COM. LOC. MAT. MÉD. HOSPITALARES LTDA.
RIAADE SUPRIMENTOS MÉDICOS LTDA.
ROVER DISTRIBUIDORA DE PRODUTOS PARA SAÚDE EIRELI
SAO PAULO SURGICAL COMÉRCIO DE MATERIAL HOSPITALAR LTDA.
SINNERGY IMPORTAÇÃO E EXPORTAÇÃO LTDA.
SLIM PRODUTOS MÉDICOS LTDA. – ME
SMITH & NEPHEW COM. DE PRODS. MÉDICOS LTDA.
SOMMA PRODUTOS HOSPITALARES LTDA.
SP INTERVENTION LTDA.
SP OSTEO DISTRIB. PROD. SAÚDE LTDA.
SPINE LEVEL – COM. IMPORT. E LOCAÇÃO DE PRODS. MÉDICOS LTDA.
SPM COMERCIO DE PRODUTOS MÉDICOS EIRELI
STRYKER DO BRASIL LTDA.
SUPPORT SURGICAL COM. DE PROD. HOSP. E ODONT. EIRELI – EPP
SURGICARE COM. PROD. CIRÚRGICOS LTDA.
SYNCROFILM DISTRIBUIDORA LTDA.
TECNIMED COM. IMP. DE PROD. MÉD. HOSP. LTDA.
Ribeirão Preto
São Paulo
São Paulo
São Paulo
São Paulo
São Paulo
São José do Rio Preto
Campinas
Ribeirão Preto
São Bernardo do Campo
São Caetano do Sul
Santa Cruz do Rio Pardo
Valinhos
Rio Claro
São Paulo
São José do Rio Preto
São Paulo
São Paulo
São Paulo
São Bernardo do Campo
Barueri
Campinas
Ribeirão Preto
São Bernardo do Campo
São Caetano do Sul
Praia Grande
Campinas
Ribeirão Preto
Ribeirão Preto
São Bernardo do Campo
São Caetano do Sul
Ribeirão Preto
São Bernardo do Campo
São Paulo
São Paulo
São Vicente
São Paulo
Ribeirão Preto
São Paulo
São Caetano do Sul
São Bernardo do Campo
São Bernardo do Campo
São Paulo
Campinas
Paulínia
São Paulo
São Caetano do Sul
THE SUPPLY 
CYCLE OF 
HEALTHCARE 
PRODUCTS
IN BRAZIL
133
TOTAL MEDIC COMÉRCIO DE PRODUTOS MÉDICOS E ODONTOLÓGICOS LTDA.
TRÍADE IMPLANTES COM. IMP. EXP. IMPL. ORT. LTDA.
ULTTRA MEDICAL BRASIL COMÉRCIO, IMPORTAÇÃO E EXPORTAÇÃO LTDA.
VENTURA BIOMÉDICA LTDA.
WL GORE & ASSOCIATES DO BRASIL LTDA.
WORLD MEDICA COMERCIO DE PRODUTOS MÉDICOSLTDA.
WRIGHT MEDICAL LTDA.
X-SAFE COM. PROD. MÉD. HOSP. LTDA.
SERGIPE
IMPLAMEDICAL SERGIPE COMÉRCIO DE PRODUTOS MÉDICOS LTDA.
MEDPLACE DISTR. MÉDICO HOSPITALAR LTDA. – ME
ORTOPLAN SERGIPE LTDA.
São Paulo
São José dos Campos
São Caetano do Sul
São José do Rio Preto
São Paulo
São Paulo
São Paulo
São Caetano do Sul
Aracaju
Aracaju
Aracaju
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ABRAIDI
Associação Brasileira de Importadores
e Distribuidores de Produtos para Saúde
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O CICLO DE FORNECIMENTO
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ABRAIDI
Associação Brasileira de Importadores
e Distribuidores de Produtos para Saúde
4ª edição
2 0 2 1
O CICLO DE FORNECIMENTO
DE PRODUTOS PARA SAÚDE
NO BRASIL
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