The inefficiency of Brazilian healthcare is measured in lives

When a patient dies from medical error, there is a medical record, a review committee, sometimes a lawsuit. When a patient dies because the hospital postponed for two years the purchase of the equipment that would have saved them, there is no record at all. No one fills out a form for the second death. It happens months later, on another floor, under another name, and no one connects one thing to the other. Yet it is just as real as the first.

I spent my career in technology and data before choosing to work with hospitals. When people ask me why a tech founder ended up in healthcare, I used to answer with a story. Today I answer with a calculation.

There is a yardstick in health economics that almost no one outside the sector knows. It answers an uncomfortable question: how much does a health system need to spend to give someone one more year of healthy life? A study published in 2023 in The Lancet Global Health calculated this value for 174 countries. For Brazil, US$8,462.

The yardstick was created for a noble and dull purpose: deciding whether a new treatment is worth what it costs, since health money is scarce and someone has to choose where it goes. But it also works in reverse. If you can calculate how much life a real buys, you can calculate how much life a wasted real fails to buy.

Do the math with me. One year of healthy life costs US$8,462. Each premature death prevented gives a person back about 30 years. So preventing a premature death in Brazil costs close to R$1.4 million. Keep that number in mind.

Now look at the other side. Brazilian healthcare throws away close to R$160 billion every year, one fifth of everything the country spends on caring for people. This waste lives in the process. Systems that do not talk to each other inside the same building, bills that go out wrong and come back, authorizations that take ten days, supplies used that never make it into the record, an entire team hired to check another team's work. At the private hospitals in Anahp's network, 17% of everything billed came back as payment denials in 2025, the highest level ever recorded. All of this is routine, it happens every day, in every hospital, and precisely because it is routine it never makes the news.

Divide one number by the other. If that money became care, it could prevent more than 100,000 premature deaths a year.

Banks have been through this. For decades they treated technology as a support function, until they found out that the core of the business was technology, or they would disappear. Retail learned the same lesson, at a loss. Healthcare has reached that threshold now, and arrives at a disadvantage: at Brazil's 20 largest hospitals, people dedicated to engineering and technology average 4% of the workforce. A bank that size with 4% engineers would have gone under twenty years ago.

I know how this sounds. Talking about efficiency next to people who care for others feels cold, and the word waste, coming from someone who has never worn a white coat, sounds like blame. The tension is legitimate, and I know the answer it deserves. No one at a hospital wakes up wanting to lose money. The people who work in billing, auditing and medical claims are, on average, competent and exhausted, and they spend the whole day putting out fires in an architecture no one designed on purpose. It is the architecture that has to change.

And architecture can be changed. That is the only good news in this whole calculation: it describes a choice, and choices can be remade. Every real that returns to a hospital's cash flow becomes a bed, equipment, people hired to stay at the bedside.

Efficient hospitals save more lives. Whoever makes a hospital efficient is also saving lives, only in a place no one films, with no name on the medical record and no thanks from any family. It is long past time for this math to be done out loud.

A note on the calculation

The value of one year of healthy life used in this article comes from the study Determining the efficiency path to universal health coverage, by Pichon-Riviere and colleagues, published in The Lancet Global Health in 2023. The authors calculated, for 174 countries, the cost-effectiveness threshold of each health system: how much it needs to spend, at the margin, to produce one more year of healthy life. The value measures how efficiently a country turns money into health, not the price of a life. For Brazil, US$8,462.

From there, the calculation assumes that each premature death prevented gives a person back 30 years of life, the conservative end of the usual range, and applies that cost to the estimated waste in Brazilian healthcare, about R$160 billion a year. The result comes to 118,000 preventable deaths, rounded down in the text. With 25 years of life per death prevented, the number would rise to 142,000; with 35 years, it would be 101,000.

Originally published in Portuguese in Saúde Insider.