Costa Rica was one of the first countries in the Latin American and Caribbean region to choose the financial instrument of the World Bank’s Program for Results (PforR) to support the implementation of the Strategic Program to Strengthen Health Insurance by the Social Security Fund of Costa Rica ( CCSS, for its name in Spanish, Caja Costarricense de Seguro Social).
The unique features of PforR include the use of a country’s own institutions and processes and linking the disbursement of funds directly to the achievement of specific program resultswhich helps build capacity in the country, increases effectiveness and efficiency, and leads to tangible, sustainable program results.
CCSS is the primary health care provider in the country. PforR “Strengthening Universal Health Insurance in Costa Rica” was endorsed by the World Bank Board of Executive Directors in 2016 to improve the availability and quality of the universal health insurance system while increasing the institutional effectiveness of the CCSS.
Through PforR, CCSS has successfully undertaken strategic and complex health sector reforms that have had a significant impact on quality of care, equity and efficiency in Costa Rica’s health sector. These reforms included:
Piloting integrated health networks.
- Reforming the resource allocation formula for both primary health care and hospitals.
- Digitization of the health system through the Unified Digital Health Record (EDUS).
- Improved management of non-communicable diseases.
- Reducing waiting lists for priority procedures by transferring major operations from inpatient to outpatient care.
This series of knowledge reports, developed by the World Bank in collaboration with the CCSS, aims to document the drivers of success, how challenges were met, and important lessons learned during the design and implementation of PforR and related transformational reforms . The main aim is to provide practical guidance for other countries interested in implementing similar programmes.
The series consists of five informational references:
The first brief information delves into PforR as a funding tool, offering insights into the key drivers of its success, how challenges were addressed and key lessons learned from its design and implementation. The brief provides a roadmap for countries interested in using the same World Bank financial instrument.
The second brief information provides insight into the performance of ambulatory operations by the CCSS. The institution increased its rate of major outpatient surgery to more than 43 percent of major surgeries. This transformation resulted in a significant reduction of 60 percent in the waiting period (measured in days) for other major operations. Major ambulatory surgeries have the potential for significant gains in the health system by helping to reduce costs, allowing limited resources to be directed to more severe cases, helping to reduce waiting lists and allowing patients to recover at home, reducing the risk of nosocomial infections.
Costa Rica’s Electronic Health Record, known as EDUS, is a cornerstone and innovator in guaranteeing the right to universal health coverage and improving the quality, efficiency and effectiveness of health services in Costa Rica. Notably, the implementation of EDUS at all levels of care was achieved only three years after the start of PforR. The third brief summarizes Costa Rica’s experience in successfully implementing one of the most comprehensive electronic health records in Latin America.
The fourth brief provides an overview of the implementation of the Integrated Family Record System, which captures socioeconomic and health information from users of the health system. These data, which are digitized and gradually include geo-referencing information, serve as a key input in the country’s public multi-sectoral strategy aimed at addressing the risk factors and health determinants affecting the population. This information can also be used to generate insight into the concentration of epidemiological profiles and community-level risk maps to better target preventive measures and facilitate the management of future epidemics and natural disasters, among other benefits.
The fifth brief summarizes the CCSS experience of using satisfaction surveys as a tool to improve the delivery of health services to populations. Customer satisfaction surveys have been successfully implemented in the country for more than five consecutive years, even during the COVID-19 pandemic. Among other things, institutions use survey results to develop specific facility improvement plans focused on patient priorities and to capture specific insights into the local population’s experience of interacting with the health care system.
More information about the World Bank’s work in Costa Rica.
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