世界银行-哥斯达黎加卫生成果方案的经验教训（英）-2023.10-6页_376kb

报告摘要

Summary of Lessons Learned through the Health Program for Results in Costa Rica

Introduction and Overview

The World Bank's Program for Results (PforR) is a financing instrument focused on achieving specific development results rather than inputs. Costa Rica was one of the first countries in Latin America to adopt it for strengthening its universal health insurance system through the Costa Rican Social Security Fund (CCSS). The "Results-Based Program for Strengthening Universal Health Insurance in Costa Rica" was approved in 2016 and has since driven significant reforms in the health sector.

Background and Objectives

The CCSS administers Costa Rica's public health insurance system, providing universal coverage to approximately 95% of the population. By 2016, challenges emerged, including aging population needs, non-communicable diseases, institutional capacity, and outdated financial management. The Strategic Agenda for Strengthening Health Insurance (SASHI) aimed to address these through three priority areas: strengthening primary health care integration, improving institutional management, and enhancing financial efficiency. The PforR supported this agenda, with disbursements linked to verified results.

Key Achievements

Health System Modernization: Implementation of the Single Digital Health Record (EDUS), digitizing health services across all levels, even remote areas.
Integrated Networks and Care: Creation of Integrated Health Networks for better coordination and resource use, improving quality and equity.
Operational Improvements: Reduction in waiting lists for surgeries, increased outpatient procedures, and enhanced preventive activities leading to better control of chronic diseases like diabetes and hypertension.
User Satisfaction: Regular satisfaction surveys improved service perceptions and institutional accountability.

Lessons Learned

Success Factors:
- Existence of a comprehensive strategic program (SASHI) with institutional ownership.
- Emphasis on results-focused disbursements incentivized performance and cultural change.
- Robust national systems and technical assistance aligned with reforms.
Challenges:
- Issues with budget allocation and verifying process indicators.
- Political hurdles in data sharing with the World Bank, requiring proactive governance improvements.
Future Recommendations:
- Continue reforms to sustain efficiency gains, such as expanding integrated health networks.
- Foster ongoing collaboration with government actors to ensure continuity post-PforR.