Brazil’s Health Care Merger Mania Runs Into Reality

Hapvida, the hospital network and insurer, has indigestion after years of swallowing rivals

Luiz Inacio Lula da Silva speaks during a meeting with governors in Brasilia in January. The president has pledged to increase public health care spending.

Photographer: Arthur Menescal/Bloomberg

Hi, it’s Crayton. I’m in New York, but my mind is on Brazil, where economic distress is causing trouble for a major health-care provider. More on that later, but first...

In the northeastern Brazilian city of Fortaleza, in 1979, an oncologist named Candido Pinheiro Koren de Lima opened a clinic. After 44 years, through rapid acquisition and expansion, that clinic is now Hapvida, one of Brazil's biggest health-care companies — and until recently, one of its most successful.