TBY talks to Dr. María del Rocío Sáenz Madrigal, Executive President of Caja Costarricense de Seguro Social (CCSS), on its initiatives to increase life expectancy in Costa Rica, address long patient waiting lists, and its priorities for the year.

Dr. María del Rocío Sáenz Madrigal
Dr. María del Rocío Sáenz Madrigal is a medical doctor and public health specialist. She is a former Minister of Health of Costa Rica and Coordinator of the Social Council (2002-2006) and is also a member of PAHO/WHO Health Emergency Response Team with emphasis on Central America. Between 1998 and 2002, she was the director of Planning of the Ministry of Health. Dr. Sáenz has worked as an academic in undergraduate and graduate programs of the School of Medicine and School of Public Health at the University of Costa Rica. She has published 42 technical papers and 16 scientific papers, most of them related to health promotion, health policy, and health systems.

Since being established in 1941, the CCSS has worked to reduce child mortality and increase life expectancy. How has the organization evolved in the way that it carries out its mission?

CCSS is a unique institution in Costa Rica because it was established not only by law but also by the Constitution. This is important because in the beginning the main focus was on extending social protection such as healthcare access to more people, especially workers in the formal sector. In these 75 years, we have increasingly covered more kinds of workers, including informal workers and independent workers. The primary source of funding comes from the workers, the employers, and the state, which is markedly different from other systems; our social security system is an adaptation of the Bismarck model. The CCSS was originally a healthcare system for people affected by disease; however, we now integrate services such as health promotion and prevention, immunizations, and a holistic approach to healthcare, from primary healthcare through tertiary care. It provides comprehensive care; Costa Ricans can receive immunizations to prevent diseases as well as top of the line cancer treatment, cardiac disease management, and organ transplants. Our package is implicit, meaning that we are charged with serving all those in need of healthcare services. We make no distinction between the individuals of different income groups; everyone living in Costa Rica has the same opportunity to benefit from quality comprehensive healthcare services. This kind of universal healthcare coverage makes Costa Rica stand out as quite different from other countries, and we are proud of this. This approach reduces child and maternal mortality rates, and our life expectancy is around 81 years. As with other countries with a growing elderly population, we are in the midst of an epidemiologic transition, where the population still suffers from acute infectious diseases but is also being afflicted by chronic diseases such as cancers, diabetes, and cardiovascular ailments. The management of these diseases is more expensive, so one of the challenges that we are currently addressing is the strengthening of a system that would follow individuals throughout their life cycle—through health promotion, disease prevention, opportune care and management of disease, rehabilitation, and palliative care in end-of-life conditions.

What strategy is CCSS following to solve the issue of patient waiting lists?

Like other systems that offer universal healthcare, wait lists are a challenge that we are addressing with creative, patient-centered initiatives, designed and driven from the hospitals themselves.
We are working with different kinds of strategies to increase the optimization of our capacity and resources, including alternative schedules, specialized ambulatory surgery campaigns, and optimization of surgical suite utilization among others. Influenza vaccine administration is another example of opportune patient-centered care. Costa Rica's comprehensive immunization schedule includes 15 different vaccines for children and adults. Special at risk populations like children younger than two years of age, the elderly, and those suffering with other pre-existing conditions like asthma or diabetes, were prioritized when the vaccines were administered.

What are your priorities for 2017?

The priorities for 2017 have been established in the institution's strategic plan 2015-2018 which has been developed across three strategic axes: healthcare services, institutional management and financing. Each axis has strategic themes that include health, pensions, infrastructure, information technology and communication, evaluation and accountability, human resource management and financing among others. Priorities for 2017 include implementation and evaluation of the project for the Integral Development of Strategic Functions of Human Resources, Project for the Organizational Restructure of Central Administration, and the Fortification of Health Care Services project. Infrastructure projects include remodeling emergency services and building new hospitals where population changes have exceeded current capacity. Innovative technology will also be a pivotal component of prioritization in 2017, not only for health services but also for education, including telemedicine and apps for patient use. The CCSS is being positioned to evolve significantly over the next several years.