FIRST RATE ACROSS THE BOARD

Costa Rica 2018 | HEALTH & EDUCATION | INTERVIEW

TBY talks to Dr. Fernando Llorca Castro, Executive President of Caja Costarricense del Seguro Social, on the importance of institutional longevity, joining the OECD, and bringing standardized services to every part of the country.

Dr. Fernando Llorca Castro
BIOGRAPHY
Dr. Fernando Llorca Castro has worked as a registered medical disability analyst in the UK, a medical manager for the public healthcare system in Costa Rica, and for international private insurance companies in Spain. He has an MSc in health policy, planning, and finance from the London School of Economics and Political Science (LSE) and the London School of Hygiene and Tropical Medicine (LSHTM), and an MA in health economics and pharmacoeconomics from the Universitat Pompeu Fabra (UPF) in Barcelona. He trained as a medical doctor in Costa Rica and has an Advanced Studies Diploma (ASD) in political economy from the Universidad Complutense de Madrid. He is a PhD candidate in economics.

What is behind the success of healthcare system penetration in Costa Rica?

Costa Rica has been building its healthcare system for a long time. For example, we have had a Ministry of Health for 90 years now, not to mention a labor insurance program for the same amount. The Caja Costarricense del Seguro Social (CCSS) celebrated its 75th anniversary in 2016. We have also had strong nutritional programs for children for 66 years now. For example, the budget of CCSS is USD5.7 million, a large sum of money for merely one institution in a country like this. The third is that we have been able to train enough health professionals to provide high-quality services to the population. We have developed strong legislation that regulates the way we build houses, produce food, and industrialize consumption products that have contributed to the healthcare system, allowing it to be recognized internationally. We are also in the process of becoming an OCED member and have its approval in health policy affairs. It was the second sector that was approved. We have had universal coverage for at least four or five decades, with a strong institutional effort and investment in healthcare.

Are there still challenges to overcome?

We still need to make sure most of the inhabitants have access to the healthcare system. There are still people we should cover with official insurance, though this only applies to about 4-5% of the population, including foreigners. We have about 69 hospitals, more than 100 clinics and what we call “health areas," which are local administrations, and nearly 1,000 public local healthcare centers. These basic organization units require at least a physician, nurse, and technician as a part of their team and require a huge financial and political effort to build up in a country like Costa Rica.

What is your strategy to ensure that you have an adequate supply of medicine and devices?

We have a large offering of services to the population. Of course, we still have a huge problem guaranteeing people have access because there is a long waiting list for specialized services such as diagnosis services, specialized treatments for cancer, and surgeries. We still offer public and official institutionalized services and would love to develop an institutional policy to provide high-quality services to everyone as well as standardized services in every part of the country, which we have yet to reach. In order to ensure that we can provide all the medication or resources required, we need a large sum of investment in those affairs, even though CCSS already makes large investments. It is one of the largest parts of the budget that is in fact growing currently because new treatments are specialized and expensive, and remain one of the main concerns of the people who run healthcare systems in most countries, even in Europe.

How does CCSS benefit from all the investment coming into the country?

We seek to introduce a high-quality standard into the buying process in a technical manner. We are, for example, trying to develop and improve the technical requirements of each specific product. We have had many problems in the past in terms of the quality of the product and services we have received and do not want that to happen again. In Costa Rica, we have many options in terms of providers, which is great, though we have to ensure we provide the population with top-quality products.

What are your goals for the next year?

CCSS is recognized as a macroeconomically efficient organization. When we go to the micro level, there are many challenges, such as long waiting lists and other small access problems. Thus we hope to develop new infrastructure, go forward with certain projects, and launch new clinics, hospitals, and services.