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OECD Reviews of Health Systems: Costa Rica 2017

image of OECD Reviews of Health Systems: Costa Rica 2017

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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Health care access and quality in Costa Rica

This chapter assesses the accessibility of health care in Costa Rica, as well as its quality. A key issue concerns long waiting times, which have been a persistent and challenging problem. While these are now improving, financial accessibility may be worsening, with evidence of an upward trend in out-of-pocket spending. A preoccupation with waiting times also means that other dimensions of quality, particularly patient outcomes, have not received sufficient attention in recent years. Some key quality indicators, such as those relating to patient experience and patient safety, are not regularly collected, which means that continuous quality monitoring and improvement will struggle to become an embedded feature of the Costa Rican health care system.

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