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）-2023-7页_346kb

Summary of Knowledge Brief: Increasing Major Outpatient Surgeries to Reduce Waiting Lists in Costa Rica

Background
The Costa Rican Social Security Fund (CCSS) implemented a major ambulatory (outpatient) surgeries (MAS) program to reduce surgical waiting lists. Between 2013 and 2018, the proportion of MAS increased from 18% to 43% of all major surgeries, leading to a 60% reduction in waiting times for certain procedures.

Key mechanisms included the World Bank's Program for Results (PforR) funding, which incentivized strategic objectives. A dedicated commission was established to develop guidelines, and collaboration between hospital levels, utilizing community health centers, helped expand capacity. MASs offer cost savings by avoiding hospitalization and reducing nosocomial infections, improving timely care.

Challenges were governance issues, bureaucratic delays in approving documents, and regional disparities in resources. Lessons include the importance of institutional commitment, standardized processes, and context-sensitive implementation. Mas should be updated regularly due to rapid technological advancements. Future steps involve approving operational manuals and evaluating broader impacts on efficiency and patient satisfaction.