Title: Costa Rica restructures health system to curb financial crisis
Abstract: Costa Rica's once-famed health service has been forced to implement emergency cost-cutting measures to avoid bankruptcy. David Boddiger reports from the capital, San José. Since its creation in the late 1940s, Costa Rica's Social Security System, known as the Caja, has become the country's most-respected public institution, providing universal health-care coverage and some of the best health-care services in Latin America. But excessive spending, mismanagement, and the global economic crisis have strained the institution's finances and forced officials to implement emergency cost-cutting measures in an effort to prevent the Caja from going bankrupt. Caja officials say those measures, which include a restructuring of medical staff at the Caja's network of local hospitals and clinics, will not affect quality of care. But some health-care workers are not convinced. “The transfer of specialists to the night shift from the day shift has caused a serious upheaval in patient care at San Francisco de Asís Hospital in Grecia”, a statement from the National Doctors Union said. The 40-year-old hospital in Grecia, an agricultural city 45 km northwest of capital San José, provides care for some 160 000 residents in Grecia and outlying communities. Yet the hospital was built for a population of only 60 000. “The hospital in Grecia has been around for many years without any type of upgrade”, said the city's mayor, Adrián Barquero. “We've witnessed a serious deterioration in the service our hospital provides. Now, in addition we're facing a budget shortage on a national scale.” According to the doctors' union, placing more doctors on call and shifting doctors from daytime to night-time shifts without hiring more staff could delay some 850 patient visits per month at the hospital. As more patients with non-life-threating illnesses seek emergency care, waiting time for non-emergencies could increase from 2 hours to up to 7 hours, a statement from the mayor's office said. “Currently we perform 30 surgeries per week with four surgeons”, said Iván Guerrero, a spokesman for the doctors' union and a general practitioner at Liberia Hospital, in the capital of the northwestern province Guanacaste, near the Nicaraguan border. “Now they're asking us to perform 60 surgeries per week with the same four doctors.” But Caja officials say the measures are necessary to reign in a burgeoning institutional debt that has placed the entire system in jeopardy. “In the past 5 years, we've accumulated US$138 million in debt”, said Ileana Balmaceda, the Caja's executive president, who took over the post in May, 2010. “We were determined to make the institution solvent at any cost.” In 2011, Caja officials asked the Pan American Health Organization to study the institution's financial health, and the results were alarming. Without a change of course, the Caja would be bankrupt by 2015, the report found. The first sign of trouble came in July, 2009, following the financial downturn in the USA. In a single month, Caja's income from premiums paid by employers, workers, and the central government decreased by $18 million. At the same time, to confront the threat of rising unemployment in the medical profession, the Caja added 10 000 new jobs to its payroll, the equivalent of more than 20% of its current staff of 54 000. Despite the economic crisis, salary increases for Caja employees increased by 27% in 2010 and 18% in 2011, according to Caja financial director Carlos Montoya. This year, officials have sharply cut salary growth to a total of 6·4%. Another factor that has contributed to the building crisis is that while care improves, so does the cost of providing better treatments with more expensive technology. “Part of the problem is success. We are confronting first world problems, and that requires more resources and funding”, Montoya said. “There is no doubt that epidemiology has changed”, said Fernando Morales, general director of the National Geriatric Hospital in San José. “The incidence and prevalence of disease has changed, as well as demographics.” As the Costa Rican population gets older, more strain is put on the public health-care system, along with the prevalence of chronic disease among the country's ageing residents. Morales predicted the nation of 4·5 million people would confront a demographic crisis in 2025, the year in which 1 million Costa Ricans would be over the age of 60 years, and nearly 700 000 of them older than 65 years. According to Balmaceda, the Caja's plan to reverse the financial crisis relies on improving efficiency and curbing spending. Last year, officials cut the Caja's budget by $39·5 million. They cut workers' sick-time pay by 40%. “All of these measures have upset organised labour”, Balmaceda acknowledged, referring to members of the Caja's 70 unions. “But I assure you, in 2015, we are going to be stable.”
Publication Year: 2012
Publication Date: 2012-03-01
Language: en
Type: article
Indexed In: ['crossref', 'pubmed']
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Cited By Count: 3
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