Publication: Costa Rica Case Study : Primary Health Care Achievements and Challenges within the Framework of the Social Health Insurance
Loading...
Files in English
7,426 downloads
191 downloads
539 downloads
61 downloads
Published
2013-01
ISSN
Date
2013-05-01
Author(s)
Editor(s)
Abstract
The objective of this paper is to assess the key interventions Costa Rica has developed to expand health coverage for the poor and other vulnerable groups, with an emphasis on its approach to primary health care. Universal health coverage in Costa Rica is provided through a single national health insurance program. This program, which protects the poor without the pitfalls of a fragmented system, and the sustained policies that have enabled the building of a solid primary health care system, is broadly recognized as a success story. At the same, time new challenges are emerging to sustaining the success of Costa Rica's universal health coverage. Social Security of Costa Rica (Caja Costarricense de Seguridad Social, CCSS) faces increased production costs and demographic and epidemiological changes in a rapidly aging population. This report is divided into three broad sections: (1) objective of the case study and health system overview; (2) primary health care and the organization of health services within CCSS; and (3) agenda of key policy decisions for a renewed primary health care approach as part of a more responsive and sustainable health insurance system.
Link to Data Set
Citation
“Montenegro Torres, Fernando. 2013. Costa Rica Case Study : Primary Health Care Achievements and Challenges within the Framework of the Social Health Insurance. UNICO Studies Series;No. 14. © World Bank. http://hdl.handle.net/10986/13279 License: CC BY 3.0 IGO.”
Associated URLs
Associated content
Other publications in this report series
Journal
Journal Volume
Journal Issue
Collections
Related items
Showing items related by metadata.
Publication Colombia Case Study : The Subsidized Regime of Colombia’s National Health Insurance System(World Bank, Washington, DC, 2013-01)This case study provides an overview of the contribution of Colombia's compulsory health insurance, particularly its Subsidized Regime (SR), to universal health care coverage in the country, and the current challenges the SR faces. The case study is based on discussions with stakeholders from academia and the public and private sectors. The report is divided into four sections: (1) country context and health outcomes; (2) the SR within the institutional architecture of the national health insurance system; (3) the subsidized regime: considerations on equity in the context of the public debate on the right to health care in Colombia; and (4) policy decisions and key areas of the agenda for the short and medium term.Publication Peru’s Comprehensive Health Insurance and New Challenges for Universal Coverage(World Bank, Washington DC, 2013-01)This case study analyzes the progress of Peru's Comprehensive Health Insurance (SIS) and evaluates the challenges that remain to achieving universal health care coverage. Peru is an upper-middle-income country with a gross domestic product (GDP) per capita of just over US$10,000 (purchasing power parity). The country has grown rapidly in the last decade; the average growth rate was 6.5 percent. However, 28 percent of the population lives in poverty (2011), which is estimated with regionally differentiated poverty lines between US$1 and US$2 per capita per day. In addition, only one in four individuals has employment with social security coverage. The SIS aims to reduce economic barriers through the elimination of user fees for a package of services. Although its budget has been low, the SIS has played an important role in the reduction of maternal and child mortality. However, the improvements expected to the overall health system have not materialized. Meanwhile, when the decentralization process transferred funds and authority to the regions, it did so in a context of weak management capabilities, and it failed to clearly define the relationship between the national and regional governments. A major effort to strengthen the technical capacity of the Ministry of Health (MOH) should accompany the strategies outlined above. This effort should emphasize a review of health priorities, the design of effective interventions within a fiscally sustainable benefits package, and the introduction of incentives and new payment mechanisms at hospitals and other health facilities.Publication Brazil’s Primary Care Strategy(World Bank, Washington, DC, 2013-01)This case study summarizes the responses to the questionnaire on The Nuts and Bolts of the Program Expanding Health Coverage to the Poor, developed within the framework of the World Bank's UNICO - Universal Challenge Program. By so doing, it assesses the key features and the achievements and challenges of Brazil s Primary Care Strategy (PCS) and analyzes the contribution of this strategy to the establishment and implementation of universal coverage. Section 2 provides context for the discussion by summarizing key reforms and the impact of the PCS and describes Brazil s health care delivery and financing system. The institutional architecture and interaction of the health care program (HCP), in this case the PCS, is discussed in section 3. Sections 4 through 8 outline the main features of the strategy, including the identification and targeting of beneficiaries, management of public funds, services covered, and the information environment. The case study concludes with a discussion of lessons learned (section 9) and the pending agenda (section 10).Publication Consolidation and Transparency : Transforming Tunisia’s Health Care for the Poor(World Bank, Washington DC, 2013-01)Since the 2011 popular revolution in Tunisia, calls for a new social contract have been made to improve social inclusion, including addressing gaps in health care coverage for the vulnerable households. This paper evaluates Tunisia's Free Medical Assistance for the Poor (FMAP) and seeks to identify opportunities to improve universal coverage in Tunisia. The study focuses on the structural and institutional framework of health care coverage for the poor in Tunisia in terms of strengths, weaknesses, and recommendations for achieving universal coverage. The paper reviews Tunisia's health financing and delivery system with a special emphasis on FMAP, and analyzes the main structural and targeting challenges the program faces. The distinctive characteristic of this paper is the focus on institutional design and organizational practice of FMAP. The legal and regulatory framework is assessed in terms of management, beneficiary targeting methods, benefits package, and the information environment. Section 2 provides an overview of health financing and service delivery in Tunisia, including the relationship between the FMAP and the main financing schemes. Section 3 describes key supply-side issues in terms of primary health care provision for the poor. Section 4 assesses the institutional framework of the FMAP in greater detail and its linkages to the health care delivery system. Section 5 focuses on beneficiary selection and targeting methods under the FMAP. Section 6 examines public financial management under the FMAP, which is followed by a discussion in Section 7 of the benefits package. Sections 8 and 9 describe the information environment of the FMAP and how this links to the special focus of future financing reforms. The concluding section discusses the pending agenda and priorities for the FMAP moving forward.Publication Improving Access to Health Care Services through the Expansion of Coverage Program : The Case of Guatemala(World Bank, Washington DC, 2013-01)Since the signing of the 1996 Peace Accords, Guatemala has made efforts to establish economic and political stability, and to improve its social indicators. The country's Constitution states that access to health care is a basic right of all Guatemalans. In practice, however, it has been challenging for the Government of Guatemala to guarantee this right using public facilities. As a result, it has been trying to improve access to health services using both Ministry of Public Health and Social Assistance (MOH) facilities and staff, and alternative health service providers, particularly nongovernmental organizations (NGOs). This case study reviews the experience implementing the Expansion of Coverage Program (Programa de Extension de Cobertura, PEC) that was established by the Government of Guatemala in 1997 to improve coverage of health and nutrition services to poor, rural, and largely indigenous areas by contracting NGOs. It describes its origins; its package of services; contracting, financing, monitoring, and supervision mechanisms; and its contributions to improving access and strengthening primary health care services in Guatemala. It also discusses opportunities and challenges that need to be addressed to continue to improve health services coverage in the country.
Users also downloaded
Showing related downloaded files
Publication World Bank Annual Report 2024(Washington, DC: World Bank, 2024-10-25)This annual report, which covers the period from July 1, 2023, to June 30, 2024, has been prepared by the Executive Directors of both the International Bank for Reconstruction and Development (IBRD) and the International Development Association (IDA)—collectively known as the World Bank—in accordance with the respective bylaws of the two institutions. Ajay Banga, President of the World Bank Group and Chairman of the Board of Executive Directors, has submitted this report, together with the accompanying administrative budgets and audited financial statements, to the Board of Governors.Publication Digital Africa(Washington, DC: World Bank, 2023-03-13)All African countries need better and more jobs for their growing populations. "Digital Africa: Technological Transformation for Jobs" shows that broader use of productivity-enhancing, digital technologies by enterprises and households is imperative to generate such jobs, including for lower-skilled people. At the same time, it can support not only countries’ short-term objective of postpandemic economic recovery but also their vision of economic transformation with more inclusive growth. These outcomes are not automatic, however. Mobile internet availability has increased throughout the continent in recent years, but Africa’s uptake gap is the highest in the world. Areas with at least 3G mobile internet service now cover 84 percent of Africa’s population, but only 22 percent uses such services. And the average African business lags in the use of smartphones and computers as well as more sophisticated digital technologies that catalyze further productivity gains. Two issues explain the usage gap: affordability of these new technologies and willingness to use them. For the 40 percent of Africans below the extreme poverty line, mobile data plans alone would cost one-third of their incomes—in addition to the price of access devices, apps, and electricity. Data plans for small- and medium-size businesses are also more expensive than in other regions. Moreover, shortcomings in the quality of internet services—and in the supply of attractive, skills-appropriate apps that promote entrepreneurship and raise earnings—dampen people’s willingness to use them. For those countries already using these technologies, the development payoffs are significant. New empirical studies for this report add to the rapidly growing evidence that mobile internet availability directly raises enterprise productivity, increases jobs, and reduces poverty throughout Africa. To realize these and other benefits more widely, Africa’s countries must implement complementary and mutually reinforcing policies to strengthen both consumers’ ability to pay and willingness to use digital technologies. These interventions must prioritize productive use to generate large numbers of inclusive jobs in a region poised to benefit from a massive, youthful workforce—one projected to become the world’s largest by the end of this century.Publication Morocco Economic Update, Winter 2025(Washington, DC: World Bank, 2025-04-03)Despite the drought causing a modest deceleration of overall GDP growth to 3.2 percent, the Moroccan economy has exhibited some encouraging trends in 2024. Non-agricultural growth has accelerated to an estimated 3.8 percent, driven by a revitalized industrial sector and a rebound in gross capital formation. Inflation has dropped below 1 percent, allowing Bank al-Maghrib to begin easing its monetary policy. While rural labor markets remain depressed, the economy has added close to 162,000 jobs in urban areas. Morocco’s external position remains strong overall, with a moderate current account deficit largely financed by growing foreign direct investment inflows, underpinned by solid investor confidence indicators. Despite significant spending pressures, the debt-to-GDP ratio is slowly declining.Publication Classroom Assessment to Support Foundational Literacy(Washington, DC: World Bank, 2025-03-21)This document focuses primarily on how classroom assessment activities can measure students’ literacy skills as they progress along a learning trajectory towards reading fluently and with comprehension by the end of primary school grades. The document addresses considerations regarding the design and implementation of early grade reading classroom assessment, provides examples of assessment activities from a variety of countries and contexts, and discusses the importance of incorporating classroom assessment practices into teacher training and professional development opportunities for teachers. The structure of the document is as follows. The first section presents definitions and addresses basic questions on classroom assessment. Section 2 covers the intersection between assessment and early grade reading by discussing how learning assessment can measure early grade reading skills following the reading learning trajectory. Section 3 compares some of the most common early grade literacy assessment tools with respect to the early grade reading skills and developmental phases. Section 4 of the document addresses teacher training considerations in developing, scoring, and using early grade reading assessment. Additional issues in assessing reading skills in the classroom and using assessment results to improve teaching and learning are reviewed in section 5. Throughout the document, country cases are presented to demonstrate how assessment activities can be implemented in the classroom in different contexts.Publication Digital-in-Health(Washington, DC: World Bank, 2023-08-18)Technology and data are integral to daily life. As health systems face increasing demands to deliver new, more, better, and seamless services affordable to all people, data and technology are essential. With the potential and perils of innovations like artificial intelligence the future of health care is expected to be technology-embedded and data-linked. This shift involves expanding the focus from digitization of health data to integrating digital and health as one: Digital-in-Health. The World Bank’s report, Digital-in-Health: Unlocking the Value for Everyone, calls for a new digital-in-health approach where digital technology and data are infused into every aspect of health systems management and health service delivery for better health outcomes. The report proposes ten recommendations across three priority areas for governments to invest in: prioritize, connect and scale.