| Resumen: |
Universal health coverage in Costa Rica is provided through a single national health insurance program. This program, which protects the poor without the pitfalls of a fragmented system, and the sustained policies that have enabled the building of a solid primary health care system, is broadly recognized as a success story. One reason for its success is that, early in the process, a decision was made to prioritize coverage of a basic package of primary health care services and key public health interventions, with an emphasis on health promotion and prevention for all people, including those outside the formal sector.
Consolidation of universal health insurance coverage took place in the 1990s, when the Ministry of Health stopped providing health services and transferred some inpatient care units and the provision of primary health care services to the social security system. It is primary health care that has contributed in important ways to putting Costa Rica on the list of the top health outcome performers in Latin America and the Caribbean, with life expectancies and infant mortality rates at levels similar of those of European OECD (Organisation for Economic Co-operation and Development) countries.
At the same time new challenges are emerging to sustaining the success of Costa Rica s universal health coverage. Social Security of Costa Rica (Caja Costarricense de Seguridad Social, CCSS) faces increased production costs and demographic and epidemiological changes in a rapidly aging population. A financial accounting review of CCSS Health Insurance conducted by the Pan-American Health Organization and an independent commission confirmed the existence of a rapidly growing gap between revenues and expenditures. Clinical and financial management and information tools are outdated, and there are no tools or data to monitor costs by production units or responsiveness of health care providers. Performance agreements and diagnosis-related groups introduced in the past are yet to be fully exploited as modern management tools. Concern about responsiveness and financial sustainability is growing along with increasing levels of dissatisfaction with long waiting lists, particularly for inpatient and specialized care. |
