Publication:
Lessons Learned through the Health Program for Results in Costa Rica

Loading...
Thumbnail Image
Files in English
English PDF (404.31 KB)
156 downloads
English Text (26.23 KB)
47 downloads
Other Files
Spanish PDF (422.9 KB)
45 downloads
Spanish Text (28.11 KB)
32 downloads
Published
2023-10-24
ISSN
Date
2023-10-24
Editor(s)
Abstract
Costa Rica was one of the first countries in the Latin America and Caribbean region to choose the World Bank Program for Results (PforR) financing instrument to support the implementation of the Strategic Agenda for Strengthening Health Insurance by the Costa Rican Social Security Fund (CCSS), for its name in Spanish, Caja Costarricense de Seguro Social). The PforR’s unique features include using a country’s own institutions and processes and linking disbursement of funds directly to the achievement of specific program results, which helps building capacity within the country, enhances effectiveness and efficiency and leads to achievement of tangible, sustainable program results. The CCSS is the primary provider of health care in the country. The PforR “Strengthening Universal Health Insurance in Costa Rica" was approved by the World Bank's Board of Executive Directors in 2016, with the aim of improving the availability and quality of the universal health insurance system while boosting the institutional efficiency of the CCSS. Through the PforR, the CCSS successfully undertook strategic and complex health sector reforms that have had significant impact on quality of care, equity, and efficiency in Costa Rica’s health sector. 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 faced, and crucial lessons learned during the design and implementation of the PforR and its associated transformative reforms. The overarching objective is to provide a practical guide for other countries interested in implementing similar programs.
Link to Data Set
Citation
Mussini, Micaela; Lara, Ana Maria; Rosado Valenzuela, Ana Lucia; Sheffel, Ashley; Di Giorgio, Laura. 2023. Lessons Learned through the Health Program for Results in Costa Rica. © World Bank. http://hdl.handle.net/10986/40523 License: CC BY-NC 3.0 IGO.
Digital Object Identifier
Associated URLs
Associated content
Report Series
Other publications in this report series
Journal
Journal Volume
Journal Issue

Related items

Showing items related by metadata.

  • Publication
    The Integrated Family Record System (SIFF), a Key Tool for Monitoring the Social Determinants of Health in Costa Rica
    (World Bank, Washington, DC, 2023-10-24) Rosado Valenzuela, Ana Lucia; Sheffel, Ashley; Mussini, Micaela; Lara Salinas, Ana Maria; Di Giorgio, Laura
    Costa Rica was one of the first countries in the Latin America and Caribbean region to choose the World Bank Program for Results (PforR) financing instrument to support the implementation of the Strategic Agenda for Strengthening Health Insurance by the Costa Rican Social Security Fund (CCSS), for its name in Spanish, Caja Costarricense de Seguro Social). The PforR’s unique features include using a country’s own institutions and processes and linking disbursement of funds directly to the achievement of specific program results, which helps building capacity within the country, enhances effectiveness and efficiency and leads to achievement of tangible, sustainable program results. The CCSS is the primary provider of health care in the country. The PforR “Strengthening Universal Health Insurance in Costa Rica" was approved by the World Bank's Board of Executive Directors in 2016, with the aim of improving the availability and quality of the universal health insurance system while boosting the institutional efficiency of the CCSS. Through the PforR, the CCSS successfully undertook strategic and complex health sector reforms that have had significant impact on quality of care, equity, and efficiency in Costa Rica’s health sector. 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 faced, and crucial lessons learned during the design and implementation of the PforR and its associated transformative reforms. The overarching objective is to provide a practical guide for other countries interested in implementing similar programs.
  • Publication
    The Use of Satisfaction Surveys to Improve the Delivery of Health Services to the Population in Costa Rica
    (World Bank, Washington DC, 2023-10-23) Rosado Valenzuela, Ana Lucia; Sheffel, Ashley; Mussini, Micaela; Lara Salinas, Ana Maria; Di Giorgio, Laura
    Costa Rica was one of the first countries in the Latin America and Caribbean region to choose the World Bank Program for Results (PforR) financing instrument to support the implementation of the Strategic Agenda for Strengthening Health Insurance by the Costa Rican Social Security Fund (CCSS), for its name in Spanish, Caja Costarricense de Seguro Social). The PforR’s unique features include using a country’s own institutions and processes and linking disbursement of funds directly to the achievement of specific program results, which helps building capacity within the country, enhances effectiveness and efficiency and leads to achievement of tangible, sustainable program results. The CCSS is the primary provider of health care in the country. The PforR “Strengthening Universal Health Insurance in Costa Rica" was approved by the World Bank's Board of Executive Directors in 2016, with the aim of improving the availability and quality of the universal health insurance system while boosting the institutional efficiency of the CCSS. Through the PforR, the CCSS successfully undertook strategic and complex health sector reforms that have had significant impact on quality of care, equity, and efficiency in Costa Rica’s health sector. 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 faced, and crucial lessons learned during the design and implementation of the PforR and its associated transformative reforms. The overarching objective is to provide a practical guide for other countries interested in implementing similar programs.
  • Publication
    Expansion of the Coverage of the Single Digital Health Record (EDUS) in the PHC System in Costa Rica
    (World Bank, Washington, DC, 2023-10-24) Rosado Valenzuela, Ana Lucia; Sheffel, Ashley; Lara, Ana Maria; Mussini, Micaela; Di Giorgio, Laura
    Costa Rica was one of the first countries in the Latin America and Caribbean region to choose the World Bank Program for Results (PforR) financing instrument to support the implementation of the Strategic Agenda for Strengthening Health Insurance by the Costa Rican Social Security Fund (CCSS), for its name in Spanish, Caja Costarricense de Seguro Social). The PforR’s unique features include using a country’s own institutions and processes and linking disbursement of funds directly to the achievement of specific program results, which helps building capacity within the country, enhances effectiveness and efficiency and leads to achievement of tangible, sustainable program results. The CCSS is the primary provider of health care in the country. The PforR “Strengthening Universal Health Insurance in Costa Rica" was approved by the World Bank's Board of Executive Directors in 2016, with the aim of improving the availability and quality of the universal health insurance system while boosting the institutional efficiency of the CCSS. Through the PforR, the CCSS successfully undertook strategic and complex health sector reforms that have had significant impact on quality of care, equity, and efficiency in Costa Rica’s health sector. 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 faced, and crucial lessons learned during the design and implementation of the PforR and its associated transformative reforms. The overarching objective is to provide a practical guide for other countries interested in implementing similar programs.
  • Publication
    Increasing the Number of Major Outpatient Surgeries to Reduce the Waiting List in Costa Rica
    (World Bank, Washington, DC, 2023-10-23) Rosado Valenzuela, Ana Lucia; Sheffel, Ashley; Mussini, Micaela; Lara Salinas, Ana Maria; Di Giorgio, Laura
    Costa Rica was one of the first countries in the Latin America and Caribbean region to choose the World Bank Program for Results (PforR) financing instrument to support the implementation of the Strategic Agenda for Strengthening Health Insurance by the Costa Rican Social Security Fund (CCSS), for its name in Spanish, Caja Costarricense de Seguro Social). The PforR’s unique features include using a country’s own institutions and processes and linking disbursement of funds directly to the achievement of specific program results, which helps building capacity within the country, enhances effectiveness and efficiency and leads to achievement of tangible, sustainable program results. The CCSS is the primary provider of health care in the country. The PforR “Strengthening Universal Health Insurance in Costa Rica" was approved by the World Bank's Board of Executive Directors in 2016, with the aim of improving the availability and quality of the universal health insurance system while boosting the institutional efficiency of the CCSS. Through the PforR, the CCSS successfully undertook strategic and complex health sector reforms that have had significant impact on quality of care, equity, and efficiency in Costa Rica’s health sector. 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 faced, and crucial lessons learned during the design and implementation of the PforR and its associated transformative reforms. The overarching objective is to provide a practical guide for other countries interested in implementing similar programs.
  • Publication
    Introducing Strategic Purchasing in Costa Rica
    (Washington, DC: World Bank, 2024-07-25) Di Giorgio, Laura; Rosado Valenzuela, Ana Lucia; Sheffel, Ashley; Mussini, Micaela
    The Costa Rican Social Security Fund (CCSS) has taken its first steps towards the introduction of strategic purchasing of healthcare services with a pilot that was introduced for the first time as part of the institution’s 2024 budget, which is currently being implemented. With this highly relevant reform, the CCSS begins its transition from a resource allocation model based solely on the historical budget to (i) a capitation model at the first level of care and (ii) the introduction of prospective elements at the hospital level. The purpose of the review in the resource allocation methodology is to align resources with the health needs of the population and the supply of services, while encouraging the achievement of specific strategic objectives, such as increasing productivity, accessibility, and quality of services.

Users also downloaded

Showing related downloaded files

  • Publication
    Kyrgyz Republic Country Climate and Development Report
    (Washington, DC: World Bank, 2025-11-03) World Bank Group
    This Country Climate and Development Report (CCDR) on the Kyrgyz Republic aims to support the country’s development goals amid a changing climate. The CCDR considers two policy scenarios up to 2050: the business-as-usual (BAU) and high-growth scenarios. As it quantifies the likely impacts of climate change on the Kyrgyz economy between now and 2050, the report highlights key government actions to best prepare for and adapt to climate impacts (referred to as “with adaptation” measures), with a particular focus on the time horizon up to 2030. The CCDR also outlines a path to net zero emissions by 2050 (referred to as “with mitigation” measures, “decarbonization,” or, simply, “net zero 2050”), highlighting associated development co-benefits.
  • Publication
    Comoros Country Climate and Development Report
    (Washington, DC: World Bank, 2025-06-18) World Bank Group
    The Union of the Comoros (The Comoros) has significant vulnerability to climate change-related risks but has considerable opportunities to strengthen preparedness and resilience against these challenges. According to the Notre Dame Global Adaptation Index, the Comoros is the 29th-most vulnerable country to climate change and the 163rd most ready to adapt (out of 191). The Comoros archipelago is exposed to many natural hazards that adversely affect the country’s natural capital, people, and physical infrastructure. In 2014, the economic cost of climate-related disasters was estimated at 5.7 million dollars annually, equivalent to 9.2 percent of Gross Domestic Product (GDP). Between 2018 and 2023, as many as 11 tropical depressions or cyclones impacted the country, with Cyclone Kenneth causing the greatest damage, equivalent to 14 percent of GDP, resulting in total economic growth falling from 3.6 percent in 2018 to 1.9 percent in 2019. More than 345,000 people (40 percent of the population) were affected by the cyclone, with 185,000 people experiencing severe impacts and 12,000 people displaced. However, there is an opportunity for the country to grow more robust and shock-responsive, and to establish pre-positioned funding mechanisms to enhance future crisis response efforts. For the Comoros, adaptation and climate-resilient development are the key climate change focus areas, with the country projected to face 836 million dollars 2050 in additional costs due to climate-related impacts. Current plans to adapt to the impacts of climate change in the Comoros include efforts to improve water management, strengthen coastal protection, and develop climate-smart agriculture practices. Given the country’s reliance on its natural resource base for economic growth and mobility, protection of these resources from climate change will be essential for promoting resilient growth and development. In addition to growing the adaptive capacity of the country’s natural resource sectors, strategic economic diversification will be important to help minimize future climate impacts, and development activities will need to be undertaken in such a way as to attract low-carbon co-benefits. The Union of the Comoros is committed to addressing climate change through its Nationally Determined Contribution (NDC) and national priorities. The country’s NDC (which was revised in 2021 for a ten-year horizon) sets ambitious targets, with a goal of reducing greenhouse gas emissions by 23 percent by 2030. The country also plans to significantly increase the share of renewable energy in its energy portfolio, reaching 33 MW by 2030. This will not only promote low-carbon development but also reduce the country’s dependency on imported oil and coal, which currently make up 95 percent of the energy mix. Additionally, the Comoros has declared its intention to increase CO2 removals by 47 percent by 2030, compared to BAU.
  • Publication
    Jobs in a Changing Climate: Insights from World Bank Group Country Climate and Development Reports Covering 93 Economies
    (Washington, DC: World Bank, 2025-11-05) World Bank
    The World Bank Group’s Country Climate and Development Reports (CCDRs) provide a crosscutting look at how countries’ development prospects, and the job opportunities they offer to their people, can be threatened by climate impacts and supported by climate policies. Climate change and policies affect jobs through impacts on productivity, energy and material efficiency, and physical, human, and natural capital. They can also transform employment opportunities, especially through complementary measures that help workers and firms adapt to and benefit from new technologies and production practices. Prepared by the World Bank, the International Finance Corporation (IFC), and the Multilateral Investment Guarantee Agency (MIGA), CCDRs integrate country perspectives, climate science and economic modeling, private sector information, and policy analysis to assess how countries can successfully grow and develop their economies and create jobs despite increasing climate risks and while achieving their climate objectives and commitments. Each CCDR starts from the country’s development priorities, opportunities, and challenges, and is developed in close consultation with governments, businesses, and civil society, ensuring the recommendations reflect national priorities. By combining evidence on adaptation, resilience, and emissions pathways, CCDRs highlight where climate action can reinforce development and job creation, and where targeted policies are needed to manage risks and smooth labor market transitions. Taken together, these elements can help create local jobs, ensure economic transitions are just and inclusive, and equip workers and firms to navigate the disruptions and opportunities of a changing climate and changing technologies.
  • Publication
    Gabon Country Climate and Development Report
    (Washington, DC: World Bank, 2025-11-01) World Bank
    Gabon has a unique opportunity to drive inclusive growth, reduce poverty, and build a resilient post-oil economy, with climate action accelerating progress toward these goals. The country’s main development challenge is achieving higher growth and poverty reduction, as stronger growth is needed regardless of projected climate shocks to create jobs, raise living standards, and enable a viable post-oil economy. While pursuing growth-promoting economic reforms, climate action that prioritizes people must remain central to its development pathway. However, climate change risks exacerbating poverty and regional inequalities in a country already facing long-term challenges in expanding economic opportunities and basic public services, especially in rural areas. Climate shifts compound these challenges, making stronger private sector-led growth driven by reforms essential for resilience, diversification, job creation, and poverty reduction, though targeted investments in adaptation will still be required to mitigate climate shocks. Using a whole-of-economy approach, the Gabon Country Climate Development Report (CCDR) estimates that climate change impacts could result in GDP losses of 3.5 to 5.3 percent per year through 2050 compared to a business-as-usual baseline trajectory.
  • Publication
    Guinea-Bissau Country Climate and Development Report
    (Washington, DC: World Bank, 2024-10-23) World Bank Group
    Guinea-Bissau is endowed with a wealth of natural resources, with the highest natural capital per capita in West Africa (US3,874 dollars per capita), which could be leveraged for sustainable and resilient growth. However, Guinea-Bissau faces significant development hurdles, such as high poverty rates, political instability, and economic challenges, including an over-reliance on cashew nuts. Rural poverty has increased, and the nation's infrastructure, education, and health care systems are underdeveloped. Climate change poses a severe threat, potentially impacting agriculture, fisheries, and infrastructure. Without adaptation, it could lead to a significant cut in real GDP per capita (minus 7.3 percent by 2050) and increase in poverty (with up to over 200,000 additional poor by 2050, that is, 5 percent of the expected population, in the worst scenario). The country's low greenhouse gas emissions are expected to rise, mainly due to agriculture and land-use changes, with deforestation being a major contributing factor. Although Guinea-Bissau is a low emitter, it has high mitigation ambitions, targeting a 30 percent reduction in greenhouse gas emissions by 2030. The Nationally Determined Contribution outlines significant climate actions, with initiatives focused on forest conservation, sustainable agriculture, and community development. However, the country's political instability, institutional weaknesses, and limited financial resources pose challenges to implementing these climate commitments, which depend heavily on external funding. The financial sector's underdevelopment and vulnerability to external shocks limit its ability to support green investments, though reforms could enhance resilience. Guinea-Bissau must consider its climate financing as development financing and vice-versa, engage the private sector, and integrate climate goals with national development plans to ensure a sustainable future. Concessional climate financing is vital due to the underdeveloped financial sector and the government’s limited borrowing capacity. Addressing Guinea-Bissau's vulnerability to climate change and its structural issues requires a cohesive approach that integrates development and climate strategies. This could involve improving governance, diversifying the economy, protecting natural capital, developing human capital, and investing in sustainable agriculture and infrastructure. The transition to a more sustainable and inclusive development pathway that supports economic growth is possible, but requires focusing on key strategic sectors, enhancing institutional capacity, and creating the conditions to mobilize finance. As a highly vulnerable country, there are myriad needs in the different sectors; however, to be more efficient and effective, Guinea-Bissau should prioritize actions in a few sectors, especially actions on biodiversity, agriculture, and social protection. Low carbon development, especially in energy and forestry sectors, could provide cost-efficient solutions and attract climate finance, including from the private sector, which will support the overall development agenda.