Brazil has the largest healthcare market in South America, with the highest per-capita spending on health in the region. The per-capita spending on health has been increasing in the country, despite the growing population. The Brazilian pharmaceutical market is the sixth largest in the world and is ranked only second after China among emerging economies, in terms of sales value. The pharmaceuticals market in Brazil grew by 16.8% in 2013 to $ 25.9 billion. The sales volume of the market is expected to grow by 12% to $ 46 billion in 2018. A growing middle class and rising household incomes, a strong labor market, and an aging population of 200 million, as well as the increasing public spending in the area of health, are among the main drivers of pharmaceuticals market growth in the country. About 70 percent of Brazilian hospitals are owned by private companies, reflecting the shortcomings of the Brazilian National Health System.