Montenegro Torres, Fernando2013-05-012013-05-012013-01https://hdl.handle.net/10986/13279The 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.En Costa Rica, la cobertura universal de salud se ha logrado mediante un programa único de seguro nacional de salud. Este programa, que protege al pobre sin los escollos de un sistema fragmentado, así como las políticas sostenidas que han permitido el restablecimiento de un sistema sólido de atención primaria de salud, han sido ampliamente reconocidos como un logro ejemplar a nivel mundial. Sin embargo están surgiendo nuevos retos para poder mantener la cobertura universal de salud. El envejecimiento de la población, la crisis económica y financiera mundial y un aumento rápido de los costos del personal médico han ocasionado brechas en los ingresos y gastos del seguro de salud de la CCSS que pueden persistir si no se afrontan de manera integral. El objetivo de este documento es evaluar las intervenciones clave que Costa Rica ha llevado a cabo para ampliar la cobertura de servicios de salud destinados a los pobres y otros grupos vulnerables, haciendo hincapié en su enfoque de atención primaria de salud.en-USCC BY 3.0 IGOabuseaccess to health servicesaccess to servicesAdult mortalityAdult mortality rateage groupsagedagingallocation of resourcesambulatory careambulatory servicesbasic health carebreast cancerburden of diseasecauses of deathChild Survivalclinical guidelinesClinicscommunicable diseasescontraceptionContraceptive prevalencecost structurecost-effectivenessdeathsdebtDelivery of Health Caredemographic transitionDemographic TrendsDental caredependency ratiodeveloping countriesdisabilitiesDisabilityEconomic Analysiseconomies of scaleelderlyelderly populationemergenciesemploymentepidemiological changesepidemiologyfamiliesfamily healthFertilityFertility Ratefinancial managementfinancial protectionfinancial risksfinancial situationHealth Care Coveragehealth care facilitieshealth care managementhealth care networkshealth care providershealth care systemHealth CentersHealth CoverageHealth Datahealth expenditurehealth expenditure per capitaHealth Expenditureshealth facilitieshealth financinghealth for allhealth informationhealth institutionsHealth InsuranceHealth Insurance Systemhealth interventionshealth needsHealth OrganizationHealth Outcome Indicatorshealth outcomeshealth promotionhealth sectorHealth ServicesHealth Systemhealth systemshealth technology evaluationhealth workershealth-carehealthcare servicesHIVhospitalhospital bedshospitalizationHospitalshousehold incomehousehold surveysHuman Resourceshuman resources managementhypertensionill healthimmunizationincentives for efficiencyincomeincome countriesincome groupsindigenous peopleindigenous peoplesindigenous populationsindividual healthinfantinfant mortalityinfant mortality rateinfant mortality ratesinformal sectorinformation systemsinpatient careinstitutional capacityintegrationInternational comparisonsinvestments in educationlawslife expectancieslife expectancyLife expectancy at birthlive birthsmandatesmaternal deathsMaternal mortalityMaternal mortality ratemedical servicesmedical staffMedicinesmidwivesMinistry of Healthmorbiditymortalitynational HealthNational Health Expendituresnational Health Insurancenational levelnationalsNeonatal mortalityNumber of birthsnumber of childrenNumber of deathsnursenursesolder adultsolder age groupspatientpatientsphysicianphysiciansPocket PaymentsPolicy Decisionspolicy dialoguepolicy makerspolitical partiesPopulation growthpregnant womenprenatal careprimary carePrimary Health Careprimary health care servicesprimary health care systemprivate sectorprovision of careprovision of health servicesprovision of servicespsychiatric hospitalspsychiatryPublic expenditurePublic expenditure on healthpublic healthPublic health expenditurepublic health insurancepublic health interventionspublic informationPublic opinionpublic policiespublic sectorpurchasing powerpurchasing power parityquality of carequality of servicesregional networksrehabilitationresource allocationrespectrisk factorsrural areasRural populationsafe watersafety netsanitationsanitation facilitiesset of recommendationsShare of Public SpendingSkilled birth attendanceSocial Health Insurancesocial insurancesocial policysocial sectorSocial Securitysocioeconomic statustertiary leveltertiary levelstrade unionsTuberculosisuniversal accessuniversal health insurance coverageurban areasurban developmentuse of resourcesvulnerable groupsvulnerable populationswomanworkersWorld Health OrganizationWorld Bank10.1596/13279