How is the NPS in the health segment?

How is the NPS in the health segment
10 min

We gathered in this material some publications about the Net Promoter Score method (NPS) of some health institutions, divided between: Diagnostic medicine, Hospitals and Health Plans. Good reading!

Written by Alan Reis and Paulo Veloso


My NPS is fine? To answer that question, you must first understand the context of the segment in which your institution operates and, like this, compare the indicator with its main competitors. For example: If you represent a hospital, it makes no sense to equate your results with a drugstore.

The NPS method is applied in several corporations and segments. It was created by Frederick F. Reichheld, presented in a publication in Harvard Business Review no year of 2003, evolving into editing a book in 2006 and updated five years later. Despite its applicability, many health institutions do not use this methodology to understand the degree of satisfaction and loyalty of their patients, categorizing them into promoters, neutral or detractors as the method suggests. In this way, there is some difficulty in finding reliable and updated results on the NPS of this segment.

We decided to write this material in order to unify the results of the last years regarding the main publications of health associations and companies. The second section consists of an approach to diagnostic medicine, section three reveals data from hospitals, in section four, we demonstrate an analysis by health plan operators and, Lastly, we present a conclusion.

The information in this material was extracted from the institutions that incorporate the NPS data in the sustainability report or financial statements. We are unaware of the channels and techniques used when collecting opinions, thus, these procedures can impact on “improvement” or “worsening” of the results when compared.

Diagnostic medicine

The Brazilian Association of Diagnostic Medicine (ABRAMED) discloses since the year 2018 the result of its associates, between them: Dasa, Fleury Group, Ally, Hermes Pardini e Sabin. The publication of the diagnosis DNA presents annually the main data of the sector, including patient satisfaction level. Associated companies up to 2018 accounted for an average result of 75,1% in 2015; in comparison with 2017 there was a growth of 3,2% on the NPS note. The new members incorporated the balance and made the percentage rise to 80,9% no year of 2017, increasing 2% in the result extracted in 2018 (Figure 1).

Figure 1. The average NPS of member companies published in the Abramed Panel of 2019 and 2018. Source: ABRAMED.

The calculation of NPS is very simple: It is based on the balance of promoter patients subtracting detractors, using a definitive and sentimental question, with a scale of 0 to 1 10, questioning “how much would you recommend the COMPANY to a friend or family member?”. Patients who score a grade of 0 to 1 6 are considered detractors, 7 and 8 are neutral and 9 or 10 are the promoters. It is worth mentioning that the result may vary from -100 to 1 +100.

Since it started measuring the NPS of its brands, Alliar achieved a growth of 2,5% in the first quarter of 2019. The best result of the company was obtained in the third period of 2018, reaching 68,6%. Alliar still failed to reach seven dozen in the result compiled from 90 days. Grupo Fleury started disclosing the NPS associated with financial results in the first quarter of 2015, in which, reached more than 70 points from the second interval of that date. Hermes Pardini rounds off its indicator, a non-recommended practice, and preserves a result close to Grupo Fleury. Finally, Sabin presents the best result in this comparison, compared to the four brands. It is worth mentioning that the data refer to the patient's communication channels with the brand extracted in the period of one year (Figure 2).

Figure 2. The NPS of four major brands of diagnostic medicine. Source: ALLIAR; FLEURY; HERMES PARDINI; SABIN.
¹The process of capturing information related to patient satisfaction was completed in the 1st Quarter of 18.
²The results of the 4th Quarter19 and 3rd Quarter19 are from the CMNG brand as they were globally disseminated.
³Monitors this indicator in the service channels, disclosing the result annually.


The Bain company & Company in partnership with the National Association of Private Hospitals (ANAHP) conducted a satisfaction survey with approximately 14 thousand patients in 18 Brazilian private hospitals. The study considered the institutions that had over 200 valid evaluations and, no minimum, 50 responses by type of service. In general, the NPS average was 59%, revealing a discrepancy in 63 percentage points, with maximum 87% and minimum 24% among the hospitals analyzed. The sector with the lowest average score was the emergency room, with 23%, Maximum of 78% and minimum -14% (Figure 3). According to the study, the two private hospitals with the best indicators for inpatient and outpatient care presented, respectively, o NPS the 41% and 50% in the emergency room.

Figure 3. The NPS of eighteen hospitals surveyed. Source: FIORENTINO et al., 2016.

At Hospital Israelita Albert Einstein, the Diagnostic Medicine sector leads the NPS score with 86,10%, approaching the result obtained by Sabin in Figure 2. The lowest score achieved was related to the emergency service, 66,10%. A relevant fact is in the disclosure of the sectoral NPS, a more detailed view of your results, leaving only the disclosure of the global NPS. The Sírio-Libanês Hospital decreased 1,89% in comparison with 2017, fact that led him to be in the second position, behind the A. C. Camargo Cancer Center, with a difference of 0,98%. The São Francisco Xavier Foundation, Hospital Moinhos de Vento and Beneficência Portuguesa Hospital of São Paulo round off their indicator and have the percentage of 82, 80 and 76%, respectively. The German Hospital Oswaldo Cruz has 73,50% and, in the last position, between these institutions (Figure 4).

Figure 4. The NPS of some health institutions in the year 2018. Source: ALBERT EINSTEIN; SYRIA-LIBANESE; GERMAN OSWALDO CRUZ; WINDMILLS, BP; A.C. CAMARGO CANCER CENTER; FSFX.
¹In 2018 Albert Einstein started to carry out the NPS research, disclosing results by sector.
²The Sírio-Libanês had an index of 90,31% in 2017.
³ BP started measuring NPS in 2017 and hit 73%.

Health plan operators

Few operators publicize their results and most still do not use NPS as a system to understand the degree of satisfaction and loyalty of their beneficiaries. Health plans carry out, a maximum of two searches per year, mainly to meet the requirements of the National Supplementary Health Agency (YEARS) regarding the Supplementary Health Performance Index survey (IDSS). Unlike this principle, Amil publishes its results by product line, in which “Premium” has the highest score with 52 points against 19 points of the “Community” line. Unimed Porto Alegre and Belo Horizonte exhibit the overall result, with 71,48% and 59%, respectively (Figure 5).

Figure 5. The NPS of three healthcare operators in the year 2018. Source: AMIL; UNIMED BELO HORIZONTE; UNIMED PORTO ALEGRE.

The lessons we can learn from this content

Comparing your NPS with the market is essential. Without this, it will not be possible to understand whether your indicators are satisfactory or, even, establish an action plan focused on improving. Avoiding confronting your NPS with companies or institutions from different segments is essential. Each industry has its particularities, Law Suit, activities, experiences and behaviors of consumers or patients of completely different profiles. In this way, it is necessary to always look for references from companies that have the same business model, operate in the same market and apply the same measurement standard.

The health segment, although evolved in the subject of satisfaction survey, still lacks institutions and companies that use NPS as a system (S – System) to improve its internal processes based on the cycle of feedbacks of patients or beneficiaries. One of the challenges in producing this material was to find NPS data from the most referenced institutions in the country. Some do not apply this methodology and others do not publicly disclose their results. In this sense, we believe that the evolution of the market still involves an awareness and dissemination of the importance of using methods that help institutions to make daily decisions to improve their operational and management processes, using a simpler questionnaire and abandoning long and outdated surveys.

About SoluCX

SoluCX is a startup from São José dos Campos / SP, specialized in satisfaction survey omnichannel, than, among the main market methodologies, uses NPS, CSAT and CES. Wow startup introduces companies to the importance of using these methodologies on a daily basis, as well as, their relationship with increased revenue and customer loyalty. Know more!



ABRAMED – Brazilian Association of Diagnostic Medicine. The DNA of diagnosis 2018.

ABRAMED – Brazilian Association of Diagnostic Medicine. The DNA of diagnosis 2019.

A.C. Camargo Cancer Center. Sustainability report.

ALLIAR. Investor Relations.

AMIL. Sustainability report.

FIORENTINO, G; SEBASTIAN, B; GRASS, K; LEMOS E. Patient satisfaction in Brazilian private hospitals. Sao Paulo: Bain & Company and Anahp, 2016.

FLEURY. Investor Relations.


HERMES PARDINI. Investor Relations.

GERMAN HOSPITAL OSWALDO CRUZ. Sustainability reports.


HOSPITAL MOINHOS DE VENTO. Annual report 2018.

SYRIA-LIBANESE HOSPITAL. Sustainability reports.

REICHHELD, F. F. The one number you need to grow. Harvard Business Review, 2003.

SABIN. Sustainability report.

UNIMED BELO HORIZONTE. Management reports.

UNIMED PORTO ALEGRE. Management reports.

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