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OECD Reviews of Health Systems: Costa Rica 2017

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This report puts forward policy recommendations for strengthening the performance and sustainability of the health care system in Costa Rica. There is much to praise in Costa Rica’s health care system: institutional stability; a closely integrated but well-differentiated provider arm, with strong primary care; a degree of inter-sectoral co-ordination that serves as a model of good practice; detailed and effective dialogue between users and health service managers; and, innovation around professional roles and the use of ICT that other health systems could learn from. All this leads to health outcomes on a par with several OECD economies. Nevertheless, serious strains are evident: spending is rising steeply, fuelled by salaries, fees and facility payments based on last year’s outlay. These spending increases are not always associated with improvement in services: waiting lists are excessively long and growing. The system is perhaps too stable: institutional rigidity and vested interests have stalled vital reforms, meaning that Costa Rica still lacks systematic application of DRGs and health technology assessment, despite attempts to bring them in.

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Assessment and recommendations

Costa Rica’s health care system is, broadly, strong. Life expectancy exceeds that in many OECD countries and Costa Ricans have near universal access to a full range of health care services (including the most technologically complex), with effective protection from catastrophic health expenditure. There is scope, as in all health care systems, to improve accessibility (particularly waiting times) and the quality and outcomes of care. But a much bigger concern is sustainability. Remarkably, for a middle-income country, Costa Rica’s health care spending (as a share of GDP) is above the OECD average, and rising twice as fast as general inflation.

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