2023-11-01-世界银行-增加主要门诊外科医生的数量以减少哥斯达黎加的候诊名单（英）_7页_347kb

Summary

Background:
Major Outpatient Surgeries (MAS) are surgeries performed with admission and discharge within 24 hours, allowing patients to recover at home. This approach reduces hospital costs, focuses resources on severe cases, and significantly decreases waiting times. In Costa Rica, the Caja Costarricense de Seguro Social (CCSS) increased the proportion of MAS from 18% to over 43% of all major surgeries between 2013 and 2018, reducing the waiting time for surgeries by 60%.

Key Facilitators:

1. Program for Results (PforR):
   • A World Bank-funded project aligned MAS expansion with strategic objectives and provided financial incentives.
2. Regulatory Changes:
   • Policies allowed hospitals and healthcare units to implement and standardize MAS procedures.
3. Collaborative Networks:
   • Integration of Comprehensive Health Care Centers (CAIS) with hospitals enabled the transfer of outpatient procedures, improving resource utilization.
4. Decentralized Governance:
   • The CCSS’s decentralized management through Integrated Health Services Delivery Networks (RIPSS) facilitated communication and operational implementation across care levels.

Challenges Encountered:

• Bureaucratic and administrative inefficiencies delayed the approval of governing documents.
• Updates to clinical guidelines and surgical regulations lagged due to institutional inefficiencies.
• Uneven distribution of specialized medical equipment and human resources limited implementation in rural areas.
• Resistance to the ambulatory model by healthcare professionals influenced by fear and lack of knowledge.
• Sustainability during disruptions like the COVID-19 pandemic hindered progress in scaling MAS.

Outcomes and Lessons Learned:

• MAS exceeded initial targets, leading to substantial wait-time reductions (e.g., 60% reduction for hip/knee replacements).
• Institutional commitment and clear strategic planning are crucial for successful program implementation.
• Collaborations across care levels are key to equitable expansion.
• Flexibility and context-specific approaches are necessary to sustain the model.

Future Directions

Approval of the operational manual, periodic updates of accepted procedures, and standardized clinical guidelines will support further expansion to other healthcare units. The CCSS plans to evaluate the impact of MAS on hospital efficiency and patient satisfaction, extending the model to second-level centers.