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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 efficiency and sustainability in Costa Rica

This chapter assesses the efficiency and financial sustainability of health care in Costa Rica. Health spending now surpasses the OECD average, as a share of GDP. Upward trajectories of spending mean that the health system’s, at best, fragile efficiency is likely to deteriorate.. Spending increases have been almost entirely consumed by increases in the number and salary of CCSS employees, without convincing evidence of benefit to patients. In the shorter term, Costa Rica will need to apply more effective expenditure ceilings and spending reviews to the health sector. In the longer term, better use of performance data as well as innovative payments systems will be needed. A shift away from employment-linked contributions as a basis for health system revenue will also contribute to longer-term sustainability.

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